Kaiser Permanente Sr Adv Enhanced Santa Clara (HMO) Medicare Advantage Plan H0524-039 • 2026 • Santa Clara County, CA
This Medicare Advantage HMO plan, identified by CMS Plan ID H0524-039, is offered by Kaiser Permanente for the 2026 plan year. The plan uses a Health Maintenance Organization (HMO) provider network and comes with prescription coverage (Part D ).
Kaiser Permanente Sr Adv Enhanced Santa Clara Overview
Plan Overview for
H0524-039-0
|
|
|---|---|
| CMS Plan ID: |
H0524-039-0
|
| Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: |
$95.00
Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $3900.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Santa Clara County, CA |
| Enrollment (Nationwide): | 41,717 beneficiaries |
| Enrollment (CMS – Local) | 41,470 beneficiaries in Santa Clara County |
| Provided By: | Kaiser Permanente |
Plan Overview for Kaiser Permanente Sr Adv Enhanced Santa Clara
Kaiser Permanente Sr Adv Enhanced Santa Clara is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $95.00, and services are generally covered when received from in-network providers, except in emergency situations. The annual Part D deductible is $0.00.
Primary care visits have a $0 copay, specialist visits come with a $15 copay, urgent care services carry a $0 copay, and ambulance transportation is $300 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $3900.00. After this limit is reached, in-network services are fully covered for the remainder of the year.
This plan is listed by CMS under Plan ID H0524-039. Cost-sharing details for key services are provided below.
Cost Sharing Expenses
Cost-sharing for Kaiser Permanente Sr Adv Enhanced Santa Clara includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H0524-039.
Certain preventive services are covered 100% by Kaiser Permanente Sr Adv Enhanced Santa Clara as a Part B benefit.
Prescription Drug Coverage
Kaiser Permanente Sr Adv Enhanced Santa Clara includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Special Needs Plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Basic Part D Premium: | $0.00 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $12.00 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Kaiser Permanente starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, Kaiser Permanente Sr Adv Enhanced Santa Clara may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $7.00 copay | Coming soon |
| Preferred Brand | $47.00 copay | Coming soon |
| Non-Preferred Drug | $100.00 copay | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| Vaccines | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS Star Ratings
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
How much does plan H0524-039 cost per month?
The 2026 monthly premium is $95.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H0524-039?
For 2026, the in-network maximum out-of-pocket is $3900.00. The plan pays 100% of covered in-network services beyond this amount.
What is the star rating for plan H0524-039 in 2026?
For 2026, plan H0524-039 has a CMS star rating of ★4.5 out of 5 stars.
How many beneficiaries are enrolled in this plan?
The plan has 41,717 enrolled beneficiaries according to CMS.
What is the Part D deductible for plan H0524-039?
The Part D deductible is $0.00.
Contact Information for Kaiser Permanente
| Contact Type | Details |
|---|---|
| Website: | Kaiser Permanente Plan Page |
| New Members: | 1-800-777-1238 |
| Existing Members: | 1-800-443-0815 |
| Plan Address: | One Kaiser Plaza | Oakland, CA 94612 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | September 8, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | September 8, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Kaiser Permanente (official source) | http://kp.org/medicare | October 13, 2025 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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