Kaiser Permanente Senior Advantage Inland Empire (HMO)
Available to residents of Riverside County, CA for 2026. Contract H0524, plan 015, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
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- Plan website
- Browse the Kaiser Permanente Senior Advantage Inland Empire (HMO) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $0.00 |
|---|---|
| — medical (Part C) part | $0.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $0.00? |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $1,300.00? |
| Drug deductible | $0.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO? |
| Contract / plan | H0524-015-0 |
| Offered by | Kaiser Permanente |
| Parent organization | Kaiser Foundation Health Plan, Inc. |
| Formulary drugs | 3,355 |
| Formulary exception tier | 5? |
| Pharmacy search | kp.org/directory |
| Member services | (800)777-1238TTY 711 |
CMS star ratings
- Overall
- 4.5 out of 5 stars for Overall
- Health plan (Part C)
- 4 out of 5 stars for Health plan (Part C)
- Drug plan (Part D)
- 5 out of 5 stars for Drug plan (Part D)
Published per contract — every plan under contract H0524 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $0 copay(referral required) |
| Other health care professional | $0 copay(authorization required) |
| Additional telehealth services | $0 copay |
| Preventive care | |
| Medicare-covered preventive services | $0 copay(referral required) |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay |
| Glaucoma screening | $0 copay(referral required) |
| Diabetes self-management training | $0 copay(referral required) |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0 copay(referral required) |
| Lab services | $0 copay(referral required) |
| Diagnostic radiology (e.g. MRI, CT) | $0–$200 copay(referral required) |
| Therapeutic radiology | $0 copay(referral required) |
| Outpatient x-rays | $0 copay(referral required) |
| Emergency and urgent care | |
| Emergency room | $150 copay |
| Urgent care | $0 copay |
| Worldwide emergency coverage | $150 copay |
| Worldwide urgent care | $0 copay |
| Worldwide emergency transportation | $325 copay |
| Hospital care | |
| Inpatient hospital stay | $100 per day for days 1–5; $0 per day for days 6–90; $0 per day for days 91–999 (additional days)(referral required) |
| Outpatient hospital services | $0–$100 copay |
| Outpatient observation | $0–$150 copay |
| Ambulatory surgical center | $100 copay |
| Outpatient blood services | $0 copay(referral required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $150 per day for days 21–100(referral required) |
| Home health care | $0 copay(referral required) |
| Kidney dialysis | 20% coinsurance(referral required) |
| Rehabilitation | |
| Occupational therapy | $5–$10 copay(referral required) |
| Physical therapy and speech-language therapy | $0–$10 copay(referral required) |
| Cardiac rehabilitation | $0 copay(referral required) |
| Pulmonary rehabilitation | $0 copay(referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $100 per day for days 1–5; $0 per day for days 6–90; $0 per day for days 91–999 (additional days)(referral required) |
| Outpatient mental health, individual session | $0 copay |
| Outpatient mental health, group session | $0 copay |
| Psychiatrist, individual session | $0 copay |
| Psychiatrist, group session | $0 copay |
| Partial hospitalization | $0 copay(referral required) |
| Intensive outpatient program | $0 copay(referral required) |
| Outpatient substance use, individual session | $0 copay |
| Outpatient substance use, group session | $0 copay |
| Opioid treatment program | $0 copay |
| Ambulance and transportation | |
| Ground ambulance | $325 copay |
| Air ambulance | $325 copay |
| Transportation to plan-approved locations | Not covered |
| Medical equipment and supplies | |
| Durable medical equipment (e.g. wheelchairs, oxygen) | 0%–20% coinsurance(authorization required) |
| Prosthetics (e.g. braces, artificial limbs) | 20% coinsurance(authorization required) |
| Medical supplies | 0%–20% coinsurance(authorization required) |
| Diabetes supplies | $0 copay(authorization required) |
| Diabetic therapeutic shoes or inserts | 20% coinsurance(authorization required) |
| Chiropractic, acupuncture and foot care | |
| Chiropractic (Medicare-covered) | $0 copay |
| Routine chiropractic care | Not covered |
| Acupuncture | $0 copay(authorization required) |
| Foot exams and treatment (Medicare-covered) | $0 copay(referral required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $0 copay(authorization and referral required) |
| Other diagnostic dental services | Optional supplemental benefit (extra premium) |
| Other preventive dental services | Optional supplemental benefit (extra premium) |
| Restorative services (fillings, crowns) | Optional supplemental benefit (extra premium) |
| Endodontics (root canals) | Optional supplemental benefit (extra premium) |
| Periodontics (gum disease) | $0 copay(authorization and referral required, limits apply) |
| Dentures and other removable prosthodontics | Optional supplemental benefit (extra premium) |
| Maxillofacial prosthetics | Not covered |
| Implants | Optional supplemental benefit (extra premium) |
| Bridges and other fixed prosthodontics | Optional supplemental benefit (extra premium) |
| Oral and maxillofacial surgery | Optional supplemental benefit (extra premium) |
| Orthodontics | Not covered |
| Adjunctive general services | $0 copay(authorization and referral required) |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay(referral required) |
| Routine eye exam | $0 copay(referral required) |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay(referral required) |
| Contact lenses | Not covered |
| Eyeglasses (frames and lenses) | Not covered |
| Eyeglass lenses | Not covered |
| Eyeglass frames | Not covered |
| Eyewear upgrades | Not covered |
| Hearing? | |
| Hearing exam (Medicare-covered) | $0 copay |
| Routine hearing exam | Not covered |
| Hearing aid fitting and evaluation | Not covered |
| Hearing aids (all types) | Not covered |
| Hearing aids, inner ear | Not covered |
| Hearing aids, outer ear | Not covered |
| Hearing aids, over the ear | Not covered |
| Medicare Part B drugs | |
| Part B insulin | $12–$35 copay |
| Chemotherapy and radiation drugs | $0–$47 copay; 0%–20% coinsurance |
| Other Part B drugs | $0–$47 copay; 0%–20% coinsurance |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | $40 allowance every three months |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay(referral required) |
| Health education | $0 copay(referral required) |
| Nutritional / dietary benefit | $0 copay(referral required) |
| Extra smoking and tobacco cessation counseling | Not covered |
| Enhanced disease management | Not covered |
| Telemonitoring | Not covered |
| Remote access technologies (web/phone, nurse line) | $0 copay(referral required) |
| Home and bathroom safety devices | Not covered |
| Counseling services | Not covered |
| In-home safety assessment | Not covered |
| Personal emergency response system (PERS) | Not covered |
| Medical nutrition therapy | Not covered |
| Post-discharge in-home medication reconciliation | Not covered |
| Re-admission prevention | Not covered |
| Wigs for hair loss from chemotherapy | Not covered |
| Weight management programs | Not covered |
| Alternative therapies | Not covered |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | Not covered |
| In-home support services | Not covered |
| Support for caregivers | Not covered |
In-network cost-sharing as the plan filed it with CMS (CMS plan benefit package (PBP) files, CY2026). A range means the cost depends on the service or setting. Rows the filing does not state are left out rather than guessed. Contact the plan for the full Evidence of Coverage.
Drug tiers — preferred pharmacy, initial coverage
| Tier | Cost-sharing |
|---|---|
| Tier 1 | $0.00 |
| Tier 2 | $0.00 |
| Tier 3 | $40.00 |
| Tier 4 | $95.00 |
| Tier 5 | 32% |
| Tier 6 | $0.00 |
Rx cost-sharing by coverage phase
| Tier | 30-day supply | 90-day supply | ||||
|---|---|---|---|---|---|---|
| Preferred | Standard | Mail Order | Preferred | Standard | Mail Order | |
| Initial coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $40.00 | $40.00 | $40.00 | $120.00 | $120.00 | $80.00 |
| Tier 4: Non-Preferred Drug | $95.00 | $95.00 | $95.00 | $285.00 | $285.00 | $190.00 |
| Tier 5: Specialty Tier | 32% | 32% | 32% | 32% | 32% | 32% |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | n/a | n/a | n/a | n/a |
| Catastrophic coverage phase | ||||||
| Tier 1: Preferred Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 2: Generic | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 3: Preferred Brand | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 4: Non-Preferred Drug | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 5: Specialty Tier | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
| Tier 6: Select Care Drugs | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 | $0.00 |
Also available in 1 other CA county
Benefits in plain text
Kaiser Permanente Senior Advantage Inland Empire (HMO) (H0524-015-0) is a 2026 HMO Medicare Advantage plan offered by Kaiser Permanente, available to residents of Riverside County, CA.
The monthly premium is $0.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $0.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $1,300.00.
The drug deductible is $0.00.
The plan's formulary lists 3,355 drugs.
At a preferred pharmacy in the initial coverage phase, a 30-day supply costs tier 1: $0.00; tier 2: $0.00; tier 3: $40.00; tier 4: $95.00; tier 5: 32%; tier 6: $0.00.
CMS gives the plan's contract (H0524) an overall rating of 4.5 out of 5 stars.
Email a copy of the plan benefit details
Plan facts come from the CMS quarterly prescription drug plan public use files; the premium split, Extra Help premium, MOOP and plan type from the CMS Landscape file; the Part B giveback and health benefits from the CMS plan benefit package (PBP) files.