Kaiser Permanente Senior Advantage Alam., SF, Napa (HMO)
Kaiser Permanente · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $99
- Highest of 29 plans here
- Most you pay in a year for covered care in network
- $3,900
- Drug deductible
- $0
- Tied for lowest here
- Medicare star rating
- 4.5 of 5
In plain English
Compared with the 28 other plans in San Francisco County that the same person could join.
What stands out
- No drug deductible, tied for lowest here
Watch out for
- $99 monthly premium, highest of 29 plans here
- $15 for specialist visits, higher than most plans here
- $150 for the emergency room, tied for highest here
- No hearing extra, though most plans here have one
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$1,188$1,188 in premiums + $0 for careHighest of 29 plans here2 checkups and 2 lab tests.
- A busier year$1,258$1,188 in premiums + $70 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$3,768$1,188 in premiums + $2,580 for careHigher than most 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$150Tied for highest hereNot charged if you stay in the hospital within 24 hours
- Hospital stay$270 a day for days 1 to 5, then $0 for days 6 to 90Referral neededPlan approval may be needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$240Higher than most plans here
- Outpatient hospital care$0 to $240Depends on the service
- X-rays$10Higher than most plans hereReferral needed
- MRI, CT and other scans$10 to $275Depends on the serviceReferral needed
- Ground ambulance$350Tied for highest 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 28 other plans in San Francisco 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 | $7 |
| 3Preferred Brand | $47 |
| 4Non-Preferred Drug | $100 |
| 5Specialty Tier | 32% 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 Senior Advantage Alam., SF, Napa (HMO), plan number H0524-032, for 2026?”