Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO)
Kaiser Permanente · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $95
- Highest of 4 plans here
- Most you pay in a year for covered care in network
- $3,900
- Higher than most plans here
- Drug deductible
- $0
- Medicare star rating
- 4.5 of 5
In plain English
Compared with the 3 other plans in Yuba County that the same person could join.
What stands out
- No drug deductible
Watch out for
- $95 monthly premium, highest of 4 plans here
- Up to $3,900 a year for covered care, higher than most plans here
- $1,450 for a 5-day hospital stay, higher than most plans here
- $15 for specialist visits, higher than most plans here
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$1,140$1,140 in premiums + $0 for careHighest of 4 plans here2 checkups and 2 lab tests.
- A busier year$1,215$1,140 in premiums + $75 for careHighest of 4 plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$3,770$1,140 in premiums + $2,630 for careHighest of 4 plans here6 checkups, 12 specialist visits, 6 lab tests, 2 scans, an ambulance ride, an ER visit and a 5-day hospital stay.Uses the highest listed cost for: MRI, CT and other scans.
The visit counts are examples we chose to show how costs add up, not a prediction. Your costs depend on the care you get.
What you pay for care
Your cost each time, at doctors and hospitals in the plan’s network.
- Primary care visit$0
- Specialist visit$15Higher than most plans hereReferral needed
- Urgent care$0
- Emergency room$150Highest of 4 plans hereNot charged if you stay in the hospital within 24 hours
- Hospital stay$290 a day for days 1 to 5, then $0 for days 6 to 90Higher than most plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$290Higher than most plans here
- Outpatient hospital care$0 to $290Depends on the service
- X-rays$15Higher than most plans hereReferral needed
- MRI, CT and other scans$15 to $275Depends on the serviceReferral needed
- Ground ambulance$300Higher than most plans here
- Skilled nursing facility$0 for days 1 to 20, then $100 a day for days 21 to 100Referral needed
From the costs the plan filed with Medicare for 2026. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 3 other plans in Yuba County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $10 |
| 3Preferred Brand | $47 |
| 4Non-Preferred Drug | $100 |
| 5Specialty Tier | 33% of the price |
| 6Vaccines | $0 |
For a 1-month supply. Covered insulin costs at most $35 for a month’s supply. Your medicine’s tier is on the plan’s drug list; check it below.
Check my medicines
See if this plan covers each medicine you take in 2026, and what a month costs.
Type the name on the bottle. Add the strength to narrow it down.
Add each medicine once. We’ll show if this plan covers it, what a month costs, and any rules.
Extras
Help Original Medicare doesn’t give you.
- Dental IncludedCleanings and exams covered. Some bigger dental work included, more with an optional add-on you can buy.
- Vision IncludedYearly eye exam: $0.
- Hearing Not included
- Over-the-counter items IncludedCovered for things like vitamins, pain relief and bandages.
- Fitness IncludedFitness benefit included.
- Rides to care Not included
Is my doctor in this plan?
Look up your doctors, then confirm with their office.
Call each doctor’s office and ask:
“Do you take Kaiser Permanente Sr Adv Enhanced Sac., Sonoma (HMO), plan number H0524-013, for 2026?”