Kaiser Permanente Senior Advantage Value Lane (HMO-POS)

4 out of 5 stars* for plan year 2023
$0.00 Monthly Premium

Kaiser Permanente Senior Advantage Value Lane (HMO-POS) is a HMO-POS Medicare Advantage (Medicare Part C) plan offered by Kaiser Foundation Health Plan, Inc.

Plan ID: H9003-008-000

$0.00 Monthly Premium

Oregon Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Oregon Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage Details
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$175.00
Out-of-pocket maximum$3,800.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$7,400.00
Primary care doctor visit
POS (Out-of-Network):

Doctor Office Visit:
Copayment for Medicare Covered Primary Care Office Visit $0.00 to $55.00
Specialty doctor visitIn-Network:

Doctor Specialty Visit:
Copayment for Physician Specialist Office Visit $35.00
Prior Authorization Required for Doctor Specialty Visit
Referral Required for Doctor Specialty Visit

POS (Out-of-Network):
Doctor Specialty Visit:
Copayment for Medicare Covered Physician Specialist Office Visit $55.00
Inpatient hospital careIn-Network:

Acute Hospital Services:
$440.00 per day for days 1 to 4
$0.00 per day for days 5 to the end of your stay
Prior Authorization Required for Acute Hospital Services
Referral Required for Acute Hospital Services
Urgent care
Urgent Care:
Copayment for Urgent Care $40.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $40.00
Emergency room visit
Emergency Care:
Copayment for Emergency Care $90.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $90.00
Copayment for Worldwide Emergency Transportation $250.00
Ambulance transportationIn-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $250.00

Air Ambulance:
Copayment for Air Ambulance Services $250.00

Please see Evidence of Coverage for Prior Authorization rules

Health Care Services and Medical Supplies

Kaiser Permanente Senior Advantage Value Lane (HMO-POS) covers a range of additional benefits. Learn more about Kaiser Permanente Senior Advantage Value Lane (HMO-POS) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $20.00
Copayment for Routine Care $20.00
  • Maximum 18 Routine Care every year
Prior Authorization Required for Chiropractic Services
Referral Required for Chiropractic Services

POS (Out-of-Network):
Chiropractic Services:
Copayment for Medicare Covered Chiropractic Services $55.00
Diabetes supplies, training, nutrition therapy and monitoringIn-Network:

Diabetic Supplies and Services:
Copayment for Medicare-covered Diabetic Supplies $0.00
Coinsurance for Medicare-covered Diabetic Therapeutic Shoes or Inserts 20%
Prior Authorization Required for Diabetic Supplies and Services
Durable medical equipment (DME)In-Network:

Durable Medical Equipment:
Coinsurance for Medicare-covered Durable Medical Equipment 0% to 20%
Prior Authorization Required for Durable Medical Equipment
Diagnostic tests, lab and radiology services, and X-raysIn-Network:

Outpatient Diag Procs/Tests/Lab Services:
Copayment for Medicare-covered Diagnostic Procedures/Tests $15.00 to $40.00
Copayment for Medicare-covered Lab Services $0.00
Prior Authorization Required for Outpatient Diag Procs/Tests/Lab Services
Referral Required for Outpatient Diag Procs/Tests/Lab Services

Outpatient Diag/Therapeutic Rad Services:
Copayment for Medicare-covered Diagnostic Radiological Services $15.00 to $200.00
Copayment for Medicare-covered Therapeutic Radiological Services $35.00
Copayment for Medicare-covered X-Ray Services $15.00
Prior Authorization Required for Outpatient Diag/Therapeutic Rad Services
Referral Required for Outpatient Diag/Therapeutic Rad Services
Home health careIn-Network:

Home Health Services:
Copayment for Medicare-covered Home Health Services $0.00
Prior Authorization Required for Home Health Services
Referral Required for Home Health Services
Mental health inpatient careIn-Network:

Psychiatric Hospital Services:
$440.00 per day for days 1 to 4
$0.00 per day for days 5 to 90
Prior Authorization Required for Psychiatric Hospital Services
Referral Required for Psychiatric Hospital Services
Mental health outpatient careIn-Network:

Outpatient Mental Health Services:
Copayment for Medicare-covered Individual Sessions $5.00
Copayment for Medicare-covered Group Sessions $2.00
Prior Authorization Required for Outpatient Mental Health Services

POS (Out-of-Network):
Outpatient Mental Health Services:
Copayment for Medicare Covered Individual Sessions $25.00 and $15.00 Group Sessions
Outpatient services/surgeryIn-Network:

Outpatient Hospital Services:
Copayment for Medicare Covered Outpatient Hospital Services $0.00 to $375.00
Prior Authorization Required for Outpatient Hospital Services
Referral Required for Outpatient Hospital Services

Outpatient Observation Services:
Copayment for Medicare Covered Observation Services - Per stay $0.00 to $90.00
Prior Authorization Required for Outpatient Observation Services
Referral Required for Outpatient Observation Services

Ambulatory Surgical Center Services:
Copayment for Ambulatory Surgical Center Services $375.00
Prior Authorization Required for Ambulatory Surgical Center Services
Referral Required for Ambulatory Surgical Center Services
Outpatient substance abuse careIn-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $5.00
Copayment for Medicare-covered Group Sessions $2.00
Prior Authorization Required for Outpatient Substance Abuse Services
Referral Required for Outpatient Substance Abuse Services

POS (Out-of-Network):
Outpatient Substance Abuse Services:
Copayment for Medicare Covered Individual Sessions $25.00 and $15.00 Group Sessions
Podiatry servicesIn-Network:

Podiatry Services:
Copayment for Medicare-Covered Podiatry Services $35.00
Prior Authorization Required for Podiatry Services
Referral Required for Podiatry Services

POS (Out-of-Network):
Podiatry Services:
Copayment for Medicare Covered Podiatry Services $55.00
Skilled Nursing Facility (SNF) careIn-Network:

Skilled Nursing Facility Services:
$0.00 per day for days 1 to 20
$150.00 per day for days 21 to 100
Prior Authorization Required for Skilled Nursing Facility Services
Referral Required for Skilled Nursing Facility Services

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Dental careIn-Network:

Comprehensive Dental:
Copayment for Medicare-covered Benefits $35.00
Prior Authorization Required for Comprehensive Dental
Referral Required for Comprehensive Dental

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Vision benefitsIn-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0.00 to $35.00
Copayment for Routine Eye Exams $35.00

Eyewear:
Copayment for Medicare-Covered Benefits $0.00

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Hearing benefitsIn-Network:

Hearing Exams:
Copayment for Medicare Covered Benefits $35.00
Copayment for Routine Hearing Exams $35.00

POS (Out-of-Network):

Medicare Covered Hearing Services:
Copayment for Medicare Covered Hearing Exams $55.00

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Preventive services and health/wellness education programsIn-Network:
$0.00 copay for Medicare Covered Preventive Services:

Abdominal aortic aneurysm screening
Alcohol misuse screenings & counseling
Bone mass measurements (bone density)
Cardiovascular disease screenings
Cardiovascular disease (behavioral therapy)
Cervical & vaginal cancer screening
Colorectal cancer screenings
Depression screenings
Diabetes screenings
Diabetes self-management training
Hepatitis B (HBV) infection screening
Hepatitis C screening test
HIV screening
Lung cancer screening
Mammograms (screening)
Nutrition therapy services
Obesity screenings & counseling
One-time Welcome to Medicare preventive visit
Prostate cancer screenings (PSA)
Sexually transmitted infections screening & counseling
Shots:
  • COVID-19 shots
Flu shots Hepatitis B shots Pneumococcal shots
Tobacco use cessation
Yearly "Wellness" visit

POS (Out-of-Network):
Medicare-covered Zero Dollar Preventive Services:
Copayment for Medicare-covered Preventive Services $0.00

Prescription Drug Costs and Coverage

The Kaiser Permanente Senior Advantage Value Lane (HMO-POS) offers prescription drug coverage, with an annual drug deductible of $175.00 (excludes Tiers 1, 2 and 6)

Coverage
Cost
Coverage & Cost
Annual drug deductible$175.00 (excludes Tiers 1, 2 and 6)
Tier 1
  • Preferred retail $0.00
  • Standard retail $19.00
  • Standard mail order $0.00
  • Tier 2
  • Preferred retail $10.00
  • Standard retail $20.00
  • Standard mail order $10.00
  • Tier 6
  • Preferred retail $0.00
  • Standard retail $0.00
  • Annual drug deductible$175.00 (excludes Tiers 1, 2 and 6)
    Tier 1
  • Preferred retail $0.00
  • Standard retail $38.00
  • Standard mail order $0.00
  • Tier 2
  • Preferred retail $20.00
  • Standard retail $40.00
  • Standard mail order $20.00
  • Tier 6
  • Preferred retail N/A
  • Standard retail N/A
  • Annual drug deductible$175.00 (excludes Tiers 1, 2 and 6)
    Tier 1
  • Preferred retail $0.00
  • Standard retail $57.00
  • Standard mail order $0.00
  • Tier 2
  • Preferred retail $30.00
  • Standard retail $60.00
  • Standard mail order $20.00
  • Tier 6
  • Preferred retail N/A
  • Standard retail N/A
  • When reviewing Oregon Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

    You may be able to find plans in your part of Oregon that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

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