Plan Documents for Kaiser Permanente Senior Advantage HMO
Kaiser Permanente maintains an integrated health system consisting of participating physicians, hospitals and other healthcare providers. Generally, you only have access to Kaiser Permanente providers and facilities in your home region. You can either select a Primary Care Physician (PCP) or one will be assigned to you; you can change your doctor at any time. The Evidence of Coverage (EOC) for this Kaiser Permanente Senior Advantage HMO plan contains a complete list of benefits, limitations and exclusions. You must receive all of your care through an integrated system of participating physicians, hospitals and healthcare providers. Most services are covered at 100% after you pay your required copayment. Please refer to Evidence of Coverage documents for more information. To participate, you must live in one of the zip code service areas served by Kaiser Permanente Senior Advantage HMO. See below for a list of plan documents for Retirees with Medicare.
To learn more about the Kaiser Permanente Senior Advantage HMO plan and compare your Medicare plan options, please click the buttons below.
The Kaiser Permanente HMO plan in Hawaii, Oregon, or Washington will end on December 31, 2026, and be replaced by the Blue Shield of California PPO plan with access to the national Blue Cross Blue Shield Association’s network. Beginning January 1, 2027, all Kaiser Permanente members outside of California will automatically be transitioned to the Blue Shield of California PPO plan, which will be the only available national medical plan option for SFHSS members who reside outside of California.
Watch the video for a summary of your Kaiser Permanente Senior Advantage benefits.
Find the Value in Your Benefits
Discover more about the other options available to you by reviewing the Summary of Benefits in the plan documents. Below are some examples:
$1,000 Individual Out-of-Pocket Maximum
Limits your annual out-of-pocket costs for covered services.
Inpatient Hospital Care
One copay upon admission (Day 1), then $0 per day thereafter.
Skilled Nursing Facility
$0 for Days 1–100.
Telehealth
$0 copay for covered telehealth services.
Routine Eye Exams
Routine eye exams with a Plan Optometrist.
Routine Physical Exams
Coverage for routine physical exams.
Home Meal Delivery
Three meals per day for a consecutive four-week period, once per calendar year, following a hospitalization or skilled nursing facility stay.
Routine Transportation
Up to 24 one-way trips per calendar year, up to 50 miles per trip.
One Pass Fitness Benefit
Access to fitness and wellness resources through One Pass.
Prescription Drug Benefits
Up to a 100-day supply for eligible prescriptions.
Tier 1: $5 for a 30-day supply / $10 for a 100-day supply
Tier 2: $15 for a 30-day supply / $30 for a 100-day supply
Tier 4: 20% coinsurance, up to $100 for a 100-day supply.