Kaiser Permanente Sr Advantage LA, Orange Value (HMO)
Kaiser Permanente · HMO · 2026 coverage
The big numbers
The plan premium is on top of your Part B premium.
- Monthly premium
- $0
- Most you pay in a year for covered care in network
- $1,999
- Drug deductible
- $0
- Tied for lowest here
- Medicare star rating
- 4.5 of 5
In plain English
Compared with the 63 other plans in Orange County that the same person could join.
What stands out
- No monthly premium
- No drug deductible, tied for lowest here
- Dental, vision and hearing extras included
Watch out for
- $750 for a 5-day hospital stay, higher than most plans here
- $150 for the emergency room, tied for highest here
- You need a referral to see a specialist
- Covers only the plan’s own doctors and hospitals, except in an emergency or for urgent care
What a year could cost
Premiums plus the plan’s copays for three example years. Medicines are not included.
- A light year$0$0 in premiums + $0 for care2 checkups and 2 lab tests.
- A busier year$0$0 in premiums + $0 for careTied for lowest here4 checkups, 4 specialist visits, 4 lab tests, 1 X-ray and 1 urgent care visit.
- A hard year$1,650$0 in premiums + $1,650 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$0Referral needed
- Urgent care$0
- Emergency room$150Tied for highest hereNot charged if you stay in the hospital within 24 hours
- Hospital stay$150 a day for days 1 to 5, then $0 for days 6 to 90Higher than most plans hereReferral needed
- Lab tests$0Referral needed
More care: surgery, X-rays, scans, ambulance, nursing home
- Outpatient surgery center$150Higher than most plans here
- Outpatient hospital care$0 to $150Depends on the service
- X-rays$0Referral needed
- MRI, CT and other scans$0 to $250Depends on the serviceReferral needed
- Ground ambulance$250
- 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 63 other plans in Orange 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 | $0 |
| 3Preferred Brand | $40 |
| 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. Glasses or contacts covered.Eyewear: plan pays up to $250 every two years.
- Hearing IncludedHearing aids covered.Hearing aids: plan pays up to $1,000 every three years per ear.
- Over-the-counter items IncludedUp to $75 every three months for things like vitamins, pain relief and bandages.Unused money does not carry over.
- Fitness IncludedIncludes gym or fitness classes and memory fitness.
- 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 Advantage LA, Orange Value (HMO), plan number H0524-078, for 2026?”