Medicare Advantage Plan H0524-033-0 in Contra Costa County, CA Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) • 2026
Medicare Advantage Plan H0524-033-0 in Contra Costa County, CA Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO) • 2026
Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO), CMS Plan-ID H0524-033-0, is a 2026 Medicare Advantage Plan (Part C), with prescription drug coverage, by Kaiser Permanente. The plan uses a Health Maintenance Organization (HMO) provider network structure.
Based on the most recent CMS data, plan enrollments topped 36,165 members, with 35,956 in Contra Costa County, California.
Kaiser Permanente Sr Adv Enhanced Contra Costa Overview
| Plan ID H0524-033-0 Overview | |
|---|---|
| Health Plan ID: | H0524-033-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $89.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $3400.00 (In-Network) |
| Part B Give Back: | Not offered |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Contra Costa County, CA |
| Insured By: | Kaiser Permanente |
Explore the Benefits of Kaiser Permanente Sr Adv Enhanced Contra Costa
Kaiser Permanente Sr Adv Enhanced Contra Costa is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization (HMO) plan that combines hospital, medical, and drug coverage into one streamlined option. With a monthly premium of $89.00, it includes all benefits under Medicare Part A and Part B, along with built-in prescription drug coverage. The annual Part D deductible is $0.00. You’ll typically need to use doctors and providers in the plan’s network, except for emergency situations.
Primary care visits have a $0 copay, specialist visits come with a $10 copay, urgent care services carry a $0 copay, and ambulance transportation is $250 copay. These costs all apply toward the plan’s maximum out-of-pocket (MOOP) limit of $3400.00. Once that limit is met, all in-network healthcare services are fully covered for the rest of the year. That’s a major plus for those who want both medical and drug coverage bundled into one predictable package.
This plan is listed by CMS as H0524-033-0. You’ll find a summary of its cost sharing below, including what you can expect to pay for primary care, specialists, urgent care, and more. Still have questions? Check the FAQ section for more details.
We're Here to Help You Enroll
Cost-Sharing Overview
Kaiser Permanente Sr Adv Enhanced Contra Costa includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H0524-033-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $10 copay |
Medicare Advantage plans often include preventive and wellness benefits designed to help members stay healthy, identify risks early, and maintain an active lifestyle.
| Service | Enrollee Cost (in-network) |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | Not covered |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over the counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $150 copay |
| Wordwide emergency care: | $150 copay |
| Urgent care: | $0 copay |
| Inpatient hospital care: | Tier 1 | $260 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $100 per day for days 21-100 |
| Ground ambulance: | In-network: $250 copay |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | In-network: $0 copay |
| Outpatient group therapy: | In-network: $0 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $260 per day for days 1-5 | $0 per day for days 6-90 | $0 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $0-$10 copay |
| Occupational therapy: | In-network: $5-$10 copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 0%-20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | In-network: $0-$250 copay |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0 copay |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | In-network: $0-$47 copay, 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: $0-$47 copay, 0%-20% coinsurance |
This section details the dental services covered under your plan including Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Oral exam: | In-network: $0 copay |
| Dental x-rays: | In-network: $0 copay |
| Cleaning: | In-network: $0 copay |
| Periodontics: | In-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 the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Hearing exam: | Not covered |
| Fitting/evaluation: | Not covered |
| Prescription hearing aids: | Not covered |
| OTC hearing aids: | Not covered |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Routine eye exam: | In-network: $0 copay |
| Contact lenses: | Not covered |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | Not covered |
| Upgrades: | Not covered |
Medicare Advantage plans may include extra benefits and special needs services designed to support members with chronic conditions, mobility limitations, or other complex health needs.
| Service | Enrollee Cost (in-network) |
|---|---|
| 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 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 Sr Adv Enhanced Contra Costa as a Part B benefit.
Part D Prescription Drug Costs & Benefits
Kaiser Permanente Sr Adv Enhanced Contra Costa includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $5.90 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $5.90 |
| Low-Income Premium Subsidy: | $12.00 |
| Low-Income Premium Subsidy Paid by CMS: | $5.90 |
| 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 Contra Costa 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. | ||
How CMS Star Ratings Guide Your Choice
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Who Can Enroll in Kaiser Permanente Sr Adv Enhanced Contra Costa?
To qualify for enrollment in Kaiser Permanente Sr Adv Enhanced Contra Costa, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
If you fulfill these criteria, you can enroll in Kaiser Permanente Sr Adv Enhanced Contra Costa and enjoy the extensive healthcare benefits it offers.
When Should You Enroll in Kaiser Permanente Sr Adv Enhanced Contra Costa?
Knowing when you can enroll in Kaiser Permanente Sr Adv Enhanced Contra Costa is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
Steps to Enroll in Kaiser Permanente Sr Adv Enhanced Contra Costa
Enrolling in Kaiser Permanente Sr Adv Enhanced Contra Costa is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join Kaiser Permanente Sr Adv Enhanced Contra Costa through the official Medicare website.
- Directly with Kaiser Permanente Sr Adv Enhanced Contra Costa: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Here are some of the most frequently asked questions people have about plan ID H0524-033-0:
What’s the monthly premium for Kaiser Permanente Sr Adv Enhanced Contra Costa (HMO)?
The 2026 premium is $89.00 each month, and you must continue to pay your Part B premium.
How high can my costs go in a worst-case year?
Your costs top out at $3400.00 (for in-network services) in 2026; after that the plan pays 100% of covered services.
What’s the prescription-drug deductible for 2026?
You’ll pay the first $0.00 in drug costs before coinsurance kicks in.
How is this plan rated by Medicare?
CMS rates it ★4.5 out of 5 stars for 2026.
How many members does Kaiser Permanente Sr Adv Enhanced Contra Costa have?
CMS reports 36,165 members in the latest file.
Contact 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 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed September 26, 2025
- CMS.gov, Medicare Part C & D Performance — Last accessed October 10, 2025
- CMS.gov, Plan Benefits Package — Last accessed October 14, 2025
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed October 13, 2025
Learn more about how we use CMS data.
- Kaiser Permanente, http://kp.org/medicare — Last accessed October 13, 2025
- Medicare.gov, "Compare types of Medicare Advantage Plans" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Explore your Medicare coverage options" — Last accessed 25 May, 2025
You can compare Plan-ID H0524-033 with the full list of 2026 Medicare Advantage plans, organized by state and county.
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Page content independently curated and maintained by David W. Bynon, Medicare Technical Operator, using a standardized, data-driven methodology designed for accurate, non-commercial Medicare plan interpretation and resolution.
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