Kaiser Permanente Senior Advantage Enhanced (HMO-POS) Medicare Advantage Plan H0630-023 • 2027
- Monthly Premium
- $59.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4400.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $0.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 999 beneficiaries
Kaiser Permanente Senior Advantage Enhanced (HMO-POS) Introduction
CMS Plan ID H0630-023 identifies Kaiser Permanente Senior Advantage Enhanced, a Medicare Advantage HMO-POS plan offered by Kaiser Permanente. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $59.00 monthly premium, $0.00 medical deductible, and $4400.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $0.00.
Plan Benefits
Kaiser Permanente Senior Advantage Enhanced includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The tables below outline the most common in-network out-of-pocket costs associated with plan H0630-023.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Specialist | In-network: $0-$35 copay Out-of-network: $0-$35 copay |
In-network: $25 copay Out-of-network: $25 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay |
| Telehealth benefit | In-network: $0 copay | In-network: $0 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | In-network: $0 copay | In-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $40-$325 copay Out-of-network: $40 copay |
In-network: $40-$325 copay Out-of-network: $40 copay |
| Lab services | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
| Outpatient x-rays | In-network: $5 copay Out-of-network: $5 copay |
In-network: $5 copay Out-of-network: $5 copay |
| Diagnostic tests and procedures | In-network: $0 copay Out-of-network: $0 copay |
In-network: $0 copay Out-of-network: $0 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $150 copay | $130 copay |
| Worldwide emergency care | Coming soon | $130 copay |
| Urgent care | $50 copay | $25 copay |
| Inpatient hospital care | In-network: Tier 1 $330 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $270 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
| Skilled Nursing Facility | In-network: Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 |
In-network: Tier 1 $0 per day for days 1-20 $203 per day for days 21-45 $0 per day for days 46-100 |
| Ground ambulance | In-network: $275 copay | In-network: $275 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $5 copay Out-of-network: $0-$5 copay |
In-network: $5 copay Out-of-network: $0-$5 copay |
| Outpatient group therapy | In-network: $0 copay Out-of-network: $0-$5 copay |
In-network: $0 copay Out-of-network: $0-$5 copay |
| Inpatient psychiatric hospital care | In-network: Tier 1 $330 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
In-network: Tier 1 $270 per day for days 1-6 $0 per day for days 7-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $20 copay Out-of-network: $20 copay |
In-network: $20 copay Out-of-network: $20 copay |
| Occupational therapy | In-network: $20 copay Out-of-network: $20 copay |
In-network: $20 copay Out-of-network: $20 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay |
| Durable medical equipment | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Prosthetics | In-network: 20% coinsurance | In-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: $5-$47 copay, 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: $5-$47 copay, 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: $5-$47 copay, 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
In-network: $5-$47 copay, 0%-20% coinsurance Out-of-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay Out-of-network: 0%-50% coinsurance |
In-network: $0 copay |
| Dental x-rays | In-network: $0 copay Out-of-network: 0%-50% coinsurance |
In-network: $0 copay |
| Cleaning | In-network: $0 copay Out-of-network: 0%-50% coinsurance |
In-network: $0 copay |
| Periodontics | In-network: 0%-50% coinsurance Out-of-network: 0%-50% coinsurance |
In-network: $0 copay, 50% coinsurance |
| Endodontics | In-network: 50% coinsurance Out-of-network: 0%-50% coinsurance |
In-network: 50% coinsurance |
| Restorative services | In-network: 50% coinsurance Out-of-network: 0%-50% coinsurance |
In-network: 50% coinsurance |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: 50% coinsurance Out-of-network: 0%-50% coinsurance |
In-network: 50% coinsurance |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | In-network: $0 copay | In-network: $0 copay |
| Eyeglass lenses only | In-network: $0 copay | In-network: $0 copay |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $0 copay | In-network: $0 copay |
| Prescription hearing aids | In-network: $0 copay | In-network: $0 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by Kaiser Permanente Senior Advantage Enhanced as a Part B benefit.
Prescription Drug Coverage
Kaiser Permanente Senior Advantage Enhanced 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 Advantage 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.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($13.70) |
| Supplemental Part D Premium: | $$13.70 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $18.36 |
| 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 Senior Advantage Enhanced 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 | $5.00 copay | Coming soon |
| Preferred Brand | $45.00 copay | Coming soon |
| Non-Preferred Drug | $90.00 copay | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| Vaccines | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H0630)
CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 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 |
Contact Information for Kaiser Permanente
- Website
- Kaiser Permanente Plan Page
- Providers
- Kaiser Permanente Providers Page
- Formulary
- Kaiser Permanente Formulary Page
- Pharmacy
- Kaiser Permanente Pharmacy Page
- New Member Health Plan Help
- (877)408-3492
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (877)408-3492
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
Kaiser Permanente Senior Advantage Enhanced (H0630-023-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About Kaiser Permanente Senior Advantage Enhanced (HMO-POS)
What is the monthly premium for Kaiser Permanente Senior Advantage Enhanced (HMO-POS)?
The 2027 monthly premium is $59.00. The Medicare Part B premium is paid separately.
What is the in-network MOOP for plan H0630-023?
The annual in-network MOOP is $4400.00 for 2027. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for this plan?
For 2027, plan H0630-023 has a CMS star rating of ★4.0 out of 5 stars.
How many beneficiaries are enrolled in this plan?
Total enrollment is 999 beneficiaries based on the latest CMS data.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Kaiser Permanente (official source) | http://kp.org/medicare | October 4, 2026 |
| 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 | Explore your Medicare coverage options | 25 May, 2025 |
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