Kaiser Permanente Senior Advantage Choice North (PPO)
Medicare Advantage Plan H3138-003 • 2026
Kaiser Permanente Senior Advantage Choice North (PPO) Medicare Advantage Plan H3138-003 • 2026
Kaiser Permanente Senior Advantage Choice North is a Medicare Advantage PPO plan offered by Kaiser Permanente for the 2026 plan year. It uses a Preferred Provider Organization (PPO) provider network and comes with prescription drug coverage. CMS Plan ID H3138-003 identifies this plan.
Kaiser Permanente Senior Advantage Choice North Overview
Plan Overview for H3138-003-0 |
|
|---|---|
| CMS Plan ID: | H3138-003-0 |
| Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $6500.00 (In-Network) |
| Part B Give Back: | −$7.00 reduction |
| Prescription Drug Coverage: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | See List |
| Enrollment (Nationwide) | 79 beneficiaries |
| Provided By: | Kaiser Permanente |
Plan Availability
Kaiser Permanente Senior Advantage Choice North (H3138-003-0) is available in the following locations (click to open):
Plan Details for Kaiser Permanente Senior Advantage Choice North
This Medicare Advantage MAPD PPO plan includes Medicare Part A and Part B services along with integrated prescription drug coverage. The monthly premium is $0.00, and the plan allows access to Medicare-approved providers, with lower costs when using in-network providers. The annual Part D deductible is $0.00.
Primary care visits have a $0 copay | Out-of-network: $40 copay, and specialist visits come with a $35 copay | Out-of-network: $75 copay. Urgent care services carry a $45 copay, and ground ambulance transportation is $375 copay | Out-of-network: $375 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6500.00. Once 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 {title_plan_id}. Cost-sharing details are provided below.
Cost Sharing Expenses
Kaiser Permanente Senior Advantage Choice North has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H3138-003.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $40 copay |
| Specialist: | In-network: $35 copay | Out-of-network: $75 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: $0 copay |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $70-$400 copay | Out-of-network: 40% coinsurance |
| Lab services: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Outpatient x-rays: | In-network: $15 copay | Out-of-network: 40% coinsurance |
| Diagnostic tests and procedures: | In-network: $0 copay | Out-of-network: 40% coinsurance |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $130 copay |
| Worldwide emergency care: | $130 copay |
| Urgent care: | $45 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $350 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | $500 per day for days 1-18 | $0 per day for days 19-90 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $203 per day for days 21-53 | $0 per day for days 54-100 | Out-of-network: | $225 per day for days 1-45 | $0 per day for days 46-100 | $0 per stay |
| Ground ambulance: | In-network: $375 copay | Out-of-network: $375 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $25 copay | Out-of-network: $50 copay |
| Outpatient group therapy: | In-network: $15 copay | Out-of-network: $40 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $350 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | $500 per day for days 1-18 | $0 per day for days 19-90 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $30 copay | Out-of-network: 40% coinsurance |
| Occupational therapy: | In-network: $30 copay | Out-of-network: 40% coinsurance |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: $0 copay |
| Durable medical equipment: | In-network: 0%-20% coinsurance | Out-of-network: 40% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 40% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $0 copay |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay |
| Periodontics: | In-network: $0 copay | Out-of-network: $0 copay |
| Endodontics: | Not covered |
| Restorative services: | Not covered |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | Not covered |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: 40% coinsurance |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Kaiser Permanente Senior Advantage Choice North as a Part B benefit.
Prescription Drug Coverage
Kaiser Permanente Senior Advantage Choice North 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 Advantage coverage.
| Basic Part D Premium: | $-23.40 |
|---|---|
| Supplemental Part D Premium: | $23.40 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $35.24 |
| 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 Choice North 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 | $100.00 copay | Coming soon |
| Specialty Tier | 33% coinsurance | Coming soon |
| Vaccines | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
Medicare Plan 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 | Plan too new to be measured |
| Managing Chronic (Long Term) Conditions | Plan too new to be measured |
| Member Experience with Health Plan | Plan too new to be measured |
| Complaints and Changes in Plans Performance | Plan too new to be measured |
| Health Plan Customer Service | Plan too new to be measured |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | Plan too new to be measured |
| Member Experience with the Drug Plan | Plan too new to be measured |
| Drug Safety and Accuracy of Drug Pricing |
How much does plan H3138-003 cost per month?
The plan’s monthly premium is $0.00 for 2026. The Part B premium is not included.
What is the annual out-of-pocket maximum (MOOP) for this plan?
The annual in-network MOOP is $6500.00 for 2026. After this limit is reached, covered in-network services are fully paid.
What is the CMS star rating for Kaiser Permanente Senior Advantage Choice North?
The 2026 CMS star rating for Kaiser Permanente Senior Advantage Choice North is ★0.0 out of 5.
How many beneficiaries are enrolled in this plan?
CMS reports 79 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2026?
For 2026, the prescription drug deductible is $0.00.
Contact Information for Kaiser Permanente
| Contact Type | Details |
|---|---|
| Website: | Kaiser Permanente Plan Page |
| New Members: | 1-877-408-3492 |
| Existing Members: | 1-800-476-2167 |
| Plan Address: | Kaiser Permanente Insurance Company (KPIC) | 1800 Harrison St., 20th Fl | 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.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- Kaiser Permanente (official source), http://kp.org/medicare — Last accessed October 13, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options" — Last accessed 25 May, 2025
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