Kaiser Permanente Senior Advantage Santa Cruz (HMO)
Kaiser Permanente · HMO · 2027 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $92
- Higher than most plans here
- Most you pay in a year for covered care in network
- $4,900
- Tied for highest here
- Drug deductible
- $0
- Medicare star rating
- No rating yet
In plain English
Compared with the 4 other plans in Santa Cruz County that the same person could join.
What stands out
- No drug deductible
Watch out for
- $92 monthly premium, higher than most plans here
- Up to $4,900 a year for covered care, tied for highest here
- $2,000 for a 5-day hospital stay, highest of 5 plans here
- $130 for the emergency room, 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$1,104$1,104 in premiums + $0 for careHigher than most plans here2 checkups and 2 lab tests.
- A busier year$1,204$1,104 in premiums + $100 for careHigher than most plans here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$4,484$1,104 in premiums + $3,380 for careHighest of 5 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$25Referral needed
- Urgent care$0
- Emergency room$130Higher than most plans hereNot charged if you stay in the hospital within 24 hours
- Hospital stay$400 a day for days 1 to 5, then $0 for days 6 to 90Highest of 5 plans hereReferral neededPlan approval may be needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$400Highest of 5 plans here
- Outpatient hospital care$0 to $400Depends on the service
- X-rays$0Referral needed
- MRI, CT and other scans$0 to $300Depends on the serviceReferral needed
- Ground ambulance$350Highest of 5 plans here
- Skilled nursing facility$0 for days 1 to 20, then $221 a day for days 21 to 100Referral needed
From the costs the plan filed with Medicare for 2027. A range like “$0 to $100” means the cost depends on the service or the place. “Lower than most” compares this plan with the 4 other plans in Santa Cruz County that the same person could join. Ask the plan for its 2027 Evidence of Coverage booklet for the full rules.
What medicines cost
| Drug tier | Network pharmacy |
|---|---|
| 1Preferred Generic | $0 |
| 2Generic | $5 |
| 3Preferred Brand | $47 |
| 4Non-Preferred Drug | $100 |
| 5Specialty Tier | 29% 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 2027, 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 IncludedIncludes gym or fitness classes, a home fitness kit and memory fitness.
- Rides to care IncludedRides to medical visits, no set number.
What changed from 2026
- Monthly premium2026$88 a month2027$92 a month
- Specialist visit2026$152027$25
- Hospital stay2026$230 a day for days 1 to 5, then $0 for days 6 to 902027$400 a day for days 1 to 5, then $0 for days 6 to 90
- Outpatient surgery center2026$2002027$400
- Outpatient hospital care2026$0 to $2002027$0 to $400
- MRI, CT and other scans2026$0 to $2002027$0 to $300
- Ground ambulance2026$2502027$350
- Skilled nursing facility2026$0 for days 1 to 20, then $100 a day for days 21 to 1002027$0 for days 1 to 20, then $221 a day for days 21 to 100
- Fitness2026Fitness benefit included2027Includes gym or fitness classes, a home fitness kit and memory fitness
- Rides to care2026Not covered2027Rides to medical visits, no set number
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 Santa Cruz (HMO), plan number H0524-054, for 2027?”