Plans that make Medicare complete
With Kaiser Permanente Senior Advantage (HMO), you get one plan that takes care of the whole you. We offer more coverage and more benefits than Original Medicare—and that’s just the beginning.
View the details below to see why Kaiser Permanente Senior Advantage (HMO) stands apart. Then when you’re ready, enroll online now.
For additional information about Kaiser Permanente Medicare plans or plans’ ratings, visit the Medicare Web site.
Kaiser Permanente Senior Advantage (HMO) Individual Plan
2010 benefit highlights
Effective January 1 to December 31, 2010
|Basic Plan||Enhanced Plan|
|Monthly Premium||$0 in addition to your monthly Medicare Part B premium||$116 in addition to your monthly Medicare Part B premium|
|Annual medical deductible||None||None|
|Plan benefit||Basic Plan||Enhanced Plan|
|Office visit||$25 per visit||$10 per visit|
|Medicare prescription drug coverage (Part D)|
Initial coverage: Until the total cost of your Part D—covered drugs1 paid by you and us (or any other Part D plan) reaches $2,830 in 2010, you will pay
|Coverage gap: Once the total cost of your Part D—covered drugs paid by you and us (or any other Part D plan) reaches $2,830 in 2010, you will pay |
|Catastrophic coverage: If your out-of-pocket expenses (copayments, coinsurance, and payments for full-price drugs) reach $4,550 in 2010, you will pay |
$4 per Rx
$4 per Rx
|Routine eye exams||$30 per visit||$10 per visit|
|Hearing tests||$30 per visit||$10 per visit|
|Diagnostic tests, X-Rays, and laboratory services||$25 for Medicare-covered diagnostic procedures and tests; $25 for most X-Rays; $100 for MRI, CT, and PET; $0 for Medicare-covered lab services.||$10 for Medicare-covered diagnostic procedures and tests; $10 for most X-Rays; $50 for MRI, CT, and PET; $0 for Medicare-covered lab services.|
|Inpatient hospital care|
Days 1-12: $175 per day
|Outpatient surgery||$25 to $175 for each Medicare-covered ambulatory surgical center visit||$10 for each Medicare-covered ambulatory surgical center visit|
|Annual out-of-pocket maximum for certain services2—The maximum amount you will pay for services covered by Medicare parts A and B in a calendar year. Thereafter, the services are provided at no charge for the rest of that year.||$3,400||$3,000|
1Calculated using prices set by the pharmacy.
2Only certain covered services apply to this annual out-of-pocket maximum as described in the Evidence of Coverage. For example, Medicare Part D drugs do not count toward this maximum.
Please note: You must reside on Oahu, Maui, or the Big Island (except in ZIP codes 96718, 96772, and 96777) to join Kaiser Permanente Senior Advantage (HMO).
For full information on Kaiser Permanente benefits, please see the Evidence of Coverage below or call 1-877-269-9821 (toll free) or 1-888-758-6054 (toll-free TTY for the hearing/speech impaired), 8 a.m. to 8 p.m., seven days a week.
Rx drug formulary
Are your prescriptions covered by Kaiser Permanente? See the latest formulary of covered drugs for your region.
Save money on Rx refill by mail
When you refill a prescription by mail, you can get up to a 90-day supply from a plan pharmacy for only two copayments, instead of three copayments (restrictions and limitations may apply). A small number of drugs cannot be mailed; plan pharmacies can give you details.
2010 Summary of Benefits
This document provides an overview of the plan’s benefits and includes:
- a comparison of our benefits to the Original Medicare plan benefits
- information about the plan’s monthly premium, annual deductible, and other yearly out-of-pocket costs
- service areas, listed by ZIP code
- information on eligibility, choice of doctor, and prescription drugs
2010 Evidence of Coverage
Provides comprehensive benefit information and explains:
- what is covered by our plan and what isn’t covered
- how to get the care you need or prescriptions refilled
- what to do if you’re unhappy with our services
- how to leave our plan and other Medicare options that are available
2010 Provider Directory
Find contact information for clinics, primary care physicians, specialists, pharmacies, and other health providers in your area.
Advantage Plus—dental, hearing, and vision benefits
Add more coverage to your Kaiser Permanente Senior Advantage (HMO) plan. Kaiser Permanente Senior Advantage (HMO) Individual Plan members can enroll in our Advantage Plus option for an additional $20 each month*
2010 Advantage Plus benefits† include:
- dental—cleanings at 75 percent coverage and examinations at 90 percent coverage; most X-rays are at 80 percent coverage
- hearing—$500 credit to purchase up to two hearing aids every three years
- vision—$100 credit to purchase one pair of prescription eyeglasses or one order of contact lenses every two years
If you are already a Kaiser Permanente Senior Advantage (HMO) member, you may be eligible to enroll in Advantage Plus today. For more information, see the Advantage Plus enrollment brochure♦.
Silver and FitTM fitness and healthy aging program
Exercise is good for you—at any age. The Silver and Fit program is designed specifically to help you achieve better health through regular exercise and includes the following benefits:
- free membership at a local, participating fitness facility
- group exercise classes designed for Silver and Fit members
- a healthy aging educational kit
- social events with other Silver and Fit members
- access to the Silver and Fit Web site which has a wide range of tools and resources
- optional Silver and Fit home fitness programs for members who prefer to exercise at home
- The Silver Slate® quarterly newsletter
Read more about the Silver and Fit program♦.
Silver and Fit is provided by American Specialty Health Networks, Inc. and Healthyroads, Inc., subsidiaries of American Specialty Health Incorporated (ASH). Silver and Fit, the Silver and Fit logo, and The Silver Slate are federally registered trademarks of ASH.
*You must be a Kaiser Permanente Senior Advantage (HMO) Individual Plan member to apply and continue to pay applicable Kaiser Permanente Senior Advantage (HMO) and Medicare Part B premiums.
†For details about hearing and vision services for Kaiser Permanente Senior Advantage (HMO) Individual Plan members, see our benefits chart above.
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