Kaiser Permanente Senior Advantage Basic SnJoaq (HMO)
Kaiser Permanente · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $24
- Higher than most plans here
- Most you pay in a year for covered care in network
- $4,400
- Higher than most plans here
- Drug deductible
- $0
- Tied for lowest here
- Medicare star rating
- 4.5 of 5
In plain English
Compared with the 24 other plans in San Joaquin County that the same person could join.
What stands out
- No drug deductible, tied for lowest here
Watch out for
- $24 monthly premium, higher than most plans here
- Up to $4,400 a year for covered care, higher than most plans here
- $1,050 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$288$288 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$348$288 in premiums + $60 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$2,498$288 in premiums + $2,210 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$130Not charged if you stay in the hospital within 24 hours
- Hospital stay$210 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$160Higher than most plans here
- Outpatient hospital care$0 to $160Depends on the service
- X-rays$0Referral needed
- MRI, CT and other scans$0 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 24 other plans in San Joaquin County that the same person could join. Read the plan’s 2026 booklet (PDF)
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $3 |
| 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 Senior Advantage Basic SnJoaq (HMO), plan number H0524-043, for 2026?”