Kaiser Permanente Senior Advantage Standard (HMO-POS)
Available to residents of Cowlitz County, WA for 2026. Contract H9003, plan 006, segment 0.
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- Plan health benefits
- Benefits in plain text
- Rx cost-sharing for all pharmacies and tiers
- Other plans in Cowlitz County
- Plan website
- Browse the Kaiser Permanente Senior Advantage Standard (HMO-POS) formulary
Renewed for 2026. CMS carries this plan forward from 2025.
Plan details
| Monthly premium (Part C + D) | $37.00 |
|---|---|
| — medical (Part C) part | $37.00 |
| — drug (Part D) part | $0.00? |
| Monthly premium with full Extra Help (LIS) | $37.00?drug (Part D) part $0.00; Extra Help does not cover the medical (Part C) premium |
| Part B premium reduction (giveback) | None |
| Health plan deductible (in-network) | None |
| In-network out-of-pocket maximum | $4,500.00? |
| Drug deductible | $0.00 |
| Drug out-of-pocket threshold | $2,100.00 |
| Plan type | HMO-POS? |
| Contract / plan | H9003-006-0 |
| 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 | (877)408-3496TTY 711 |
CMS star ratings
- Overall
- 4 out of 5 stars for Overall
- Health plan (Part C)
- 3.5 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 H9003 shares this rating.
Plan health benefits
| Service | In-network |
|---|---|
| Doctor visits | |
| Primary care doctor | $0 copay |
| Specialist | $30 copay(authorization and referral required) |
| Other health care professional | $0–$30 copay(authorization and referral required) |
| Additional telehealth services | $0 copay(referral required) |
| Preventive care | |
| Medicare-covered preventive services | $0 copay |
| Annual physical exam | $0 copay |
| Kidney disease education | $0 copay(referral required) |
| Glaucoma screening | $30 copay |
| Diabetes self-management training | $0 copay |
| Diagnostic tests, labs and imaging | |
| Diagnostic tests and procedures | $0–$30 copay(authorization and referral required) |
| Lab services | $0 copay(authorization and referral required) |
| Diagnostic radiology (e.g. MRI, CT) | $0–$175 copay(authorization and referral required) |
| Therapeutic radiology | $30 copay(authorization and referral required) |
| Outpatient x-rays | $0 copay(authorization and referral required) |
| Emergency and urgent care | |
| Emergency room | $125 copay |
| Urgent care | $50 copay |
| Worldwide emergency coverage | $125 copay |
| Worldwide urgent care | $50 copay |
| Worldwide emergency transportation | $225 copay |
| Hospital care | |
| Inpatient hospital stay | $250 per day for days 1–6; $0 per day for days 7–90; $0 per day for days 91–999 (additional days)(authorization and referral required) |
| Outpatient hospital services | $0–$160 copay(authorization and referral required) |
| Outpatient observation | $0–$125 copay(authorization and referral required) |
| Ambulatory surgical center | $160 copay(authorization and referral required) |
| Outpatient blood services | $0 copay(referral required) |
| Skilled nursing and home health | |
| Skilled nursing facility | $0 per day for days 1–20; $196 per day for days 21–100(authorization and referral required) |
| Home health care | $0 copay(authorization and referral required) |
| Kidney dialysis | 20% coinsurance(authorization and referral required) |
| Rehabilitation | |
| Occupational therapy | $30 copay(authorization and referral required) |
| Physical therapy and speech-language therapy | $30 copay(authorization and referral required) |
| Cardiac rehabilitation | $35 copay(authorization and referral required) |
| Pulmonary rehabilitation | $15 copay(authorization and referral required) |
| Mental health and substance use | |
| Inpatient psychiatric hospital stay | $250 per day for days 1–6; $0 per day for days 7–90(authorization and referral required) |
| Outpatient mental health, individual session | $0 copay(authorization required) |
| Outpatient mental health, group session | $0 copay(authorization required) |
| Psychiatrist, individual session | $0 copay(authorization required) |
| Psychiatrist, group session | $0 copay(authorization required) |
| Partial hospitalization | $0 copay(authorization and referral required) |
| Intensive outpatient program | $0 copay(authorization and referral required) |
| Outpatient substance use, individual session | $0 copay(authorization and referral required) |
| Outpatient substance use, group session | $0 copay(authorization and referral required) |
| Opioid treatment program | $30 copay(authorization and referral required) |
| Ambulance and transportation | |
| Ground ambulance | $225 copay(authorization required) |
| Air ambulance | $225 copay(authorization required) |
| 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) | $15 copay(authorization and referral required) |
| Routine chiropractic care | $15 copay(authorization and referral required, limits apply) |
| Acupuncture | $15 copay(limits apply) |
| Foot exams and treatment (Medicare-covered) | $30 copay(authorization and referral required) |
| Routine foot care | Not covered |
| Dental? | |
| Medicare-covered dental services | $30 copay(authorization and referral required) |
| Oral exams | Not covered |
| Cleanings | Not covered |
| Fluoride treatment | Not covered |
| Dental x-rays | Not covered |
| Other diagnostic dental services | Not covered |
| Other preventive dental services | Not covered |
| Restorative services (fillings, crowns) | Not covered |
| Endodontics (root canals) | Not covered |
| Periodontics (gum disease) | Not covered |
| Dentures and other removable prosthodontics | Not covered |
| Maxillofacial prosthetics | Not covered |
| Implants | Not covered |
| Bridges and other fixed prosthodontics | Not covered |
| Oral and maxillofacial surgery | Not covered |
| Orthodontics | Not covered |
| Adjunctive general services | Not covered |
| Vision? | |
| Eye exam (Medicare-covered) | $0 copay |
| Routine eye exam | $0 copay |
| Eyewear after cataract surgery (Medicare-covered) | $0 copay |
| 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 | $0 copay |
| 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 | $10–$35 copay(authorization required) |
| Chemotherapy and radiation drugs | $10–$45 copay; 0%–20% coinsurance(authorization required) |
| Other Part B drugs | $0–$45 copay; 0%–20% coinsurance(authorization required) |
| Other extra benefits? | |
| Over-the-counter (OTC) allowance | Not covered |
| Meals after a hospital stay or for a chronic condition | Not covered |
| Fitness benefit | $0 copay(authorization and referral required) |
| Health education | $0 copay(authorization and referral required) |
| Nutritional / dietary benefit | $0 copay(authorization and 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(authorization and 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 | $15 copay(authorization and referral required) |
| Therapeutic massage | Not covered |
| Adult day health services | Not covered |
| Home-based palliative care | $0 copay(authorization and referral required) |
| 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 | $10.00 |
| Tier 3 | $45.00 |
| Tier 4 | $90.00 |
| Tier 5 | 33% |
| 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 | $10.00 | $10.00 | $10.00 | $30.00 | $30.00 | $20.00 |
| Tier 3: Preferred Brand | $45.00 | $45.00 | $45.00 | $135.00 | $135.00 | $90.00 |
| Tier 4: Non-Preferred Drug | $90.00 | $90.00 | $90.00 | $270.00 | $270.00 | $180.00 |
| Tier 5: Specialty Tier | 33% | 33% | 33% | 33% | 33% | 33% |
| 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 2 other WA counties
Benefits in plain text
Kaiser Permanente Senior Advantage Standard (HMO-POS) (H9003-006-0) is a 2026 HMO-POS Medicare Advantage plan offered by Kaiser Permanente, available to residents of Cowlitz County, WA.
The monthly premium is $37.00 (Part C and Part D together).
With full Extra Help (the Low-Income Subsidy), the total monthly premium is $37.00.
There is no in-network deductible for health services.
Its in-network out-of-pocket maximum is $4,500.00.
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: $10.00; tier 3: $45.00; tier 4: $90.00; tier 5: 33%; tier 6: $0.00.
CMS gives the plan's contract (H9003) an overall rating of 4 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.