Kaiser Permanente Medicare Advantage Basic (HMO) H5050-001-0 Plan Details
Kaiser Permanente Medicare Advantage Basic (HMO) H5050-001-0 Plan Details
Navigating your Medicare Advantage options for 2025 can be overwhelming, but we're here to help. With Kaiser Permanente Medicare Advantage Basic (HMO) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Based on May, 2025 CMS enrollment data, an estimated 2,492 Medicare beneficiaries are enrolled in this plan.
Kaiser Permanente Medicare Advantage Basic Overview
| Plan ID H5050-001-0 Overview | |
|---|---|
| Health Plan ID: | H5050-001-0 |
| Medicare Advantage Plan Type: | HMO |
| Plan Year: | 2025 |
| Monthly Premium: | $99.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $4,200.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | See List |
| Insured By: | Kaiser Permanente |
Plan Availability
Kaiser Permanente Medicare Advantage Basic (H5050-001-0) is available in the following locations (click to open):
Explore the Benefits of Kaiser Permanente Medicare Advantage Basic
Kaiser Permanente Medicare Advantage Basic is a Medicare Advantage HMO plan designed to keep your care simple and cost-effective. With a monthly premium of $99.00, it covers all core Medicare Part A and Part B benefits while encouraging you to choose a primary care provider and stay within the plan’s network. This coordinated approach helps you stay organized and manage expenses with confidence.
Primary care visits have a $0 copay, specialist visits come with a $30 copay, lab services cost $0 copay, urgent care services carry a $25 copay, and ambulance transportation is $200 copay. These expenses apply toward your maximum out-of-pocket (MOOP) limit of $4,200.00 . After reaching that amount, your in-network care is fully covered for the rest of the year — making this plan a dependable option for people who value structure, predictability, and cost control.
This plan is listed by CMS as H5050-001-0. 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.
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Out-of-Pocket Costs
Kaiser Permanente Medicare Advantage Basic 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 H5050-001-0.
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: | $0 Copay |
| Specialist: | $30 Copay Prior Authorization Required, Referral Required |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $125 Copay |
| Urgent care: | $25 Copay |
| Ground ambulance: | $200 Copay |
| Inpatient hospital care: | $200.00 per day for days 1 through 3 $0.00 per day for days 4 and beyond |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $50.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $30 Copay Prior Authorization Required, Referral Required |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $20 Copay |
| Routine chiropractic: | Not Covered |
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: | $30 Copay |
| Outpatient group therapy: | $20 Copay |
| Inpatient psychiatric hospital care: | $200.00 per day for days 1 through 3 $0.00 per day for days 4 and beyond |
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: | $30 Copay Prior Authorization Required, Referral Required |
| Occupational therapy: | $30 Copay Prior Authorization Required, Referral Required |
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: | $0 Copay Prior Authorization Required |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 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: | $200 Copay Prior Authorization Required, Referral Required |
| Lab services: | $0 Copay Prior Authorization Required, Referral Required |
| Outpatient x-rays: | $0 Copay Prior Authorization Required, Referral Required |
| Diagnostic tests and procedures: | $0 Copay Prior Authorization Required, Referral Required |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 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) |
|---|---|
| Medicare Covered Preventive Dental | $30 Copay Prior Authorization Required |
| Oral exam | |
| Dental x-rays | |
| Cleaning | |
| Periodontics | |
| Endodontics | |
| Restorative Services |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | $0 Copay Prior Authorization Required, Referral Required |
| Hearing aids | Not Covered |
| Hearing exam | $30 Copay Prior Authorization Required, Referral Required |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $0 to $30 Copay |
| Routine eye exam (in-network) | $ to $30 Copay 1 Every year |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $350.00 Every year |
Certain preventive services are covered 100% by Kaiser Permanente Medicare Advantage Basic as a Part B benefit.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
Understanding CMS Star Ratings
The Centers for Medicare & Medicaid Services (CMS) reviews and rates Medicare Advantage (Part C) and drug plans (Part D) annually, using a 5-star system to measure aspects such as member satisfaction, preventive services, and management of chronic conditions.
Higher star ratings generally indicate better plan performance, which can be a useful factor to consider when deciding on a plan that aligns with your healthcare goals and preferences.
| CMS Measure | Star Rating |
|---|---|
| 2025 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.
Am I Eligible for Kaiser Permanente Medicare Advantage Basic ?
To enroll in Kaiser Permanente Medicare Advantage Basic , you must meet the following criteria:
- Be eligible for Medicare Part A and Part B.
- Reside in the plan’s service area.
If you meet these requirements, you are eligible to enroll in Kaiser Permanente Medicare Advantage Basic and benefit from its comprehensive coverage options.
When Can I Enroll in Kaiser Permanente Medicare Advantage Basic ?
To ensure you don’t miss your chance to enroll in Kaiser Permanente Medicare Advantage Basic , be aware of these important enrollment periods:
- Initial Enrollment Period (IEP): Your IEP offers a seven-month window around your 65th birthday to sign up for Medicare.
- Annual Enrollment Period (AEP): The AEP, occurring from October 15 to December 7 each year, allows you to enroll in or make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31, the MA OEP provides an opportunity to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing insurance coverage, may qualify you for a SEP, giving you a chance to make adjustments outside the standard periods.
Need help figuring out the right time to enroll? Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) to get assistance from a licensed insurance agent.
How to Sign Up for Kaiser Permanente Medicare Advantage Basic
Enrolling in Kaiser Permanente Medicare Advantage Basic 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 Medicare Advantage Basic through the official Medicare website.
- Directly with Kaiser Permanente Medicare Advantage Basic : 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 H5050-001-0:
Is there a premium for this plan in 2025?
The 2025 premium is $99.00 each month, and you must continue to pay your Part B premium.
How high can my costs go in a worst-case year?
For 2025, the maximum you’d spend out-of-pocket in-network is $4,200.00 .
How is this plan rated by Medicare?
The latest CMS score is ★4.0 out of 5 stars; anything 4 or higher earns quality bonuses.
How many members does Kaiser Permanente Medicare Advantage Basic have?
As of last month, about 2,492 beneficiaries are enrolled.
Contact Kaiser Permanente
| Website: | Kaiser Permanente Plan Page |
|---|---|
| Providers: | Kaiser Permanente Providers Page |
| New Member Health Plan Help: | (800)598-2296 |
| New Member Health Plan TTY: | 711 |
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.
- Kaiser Permanente, http://kp.org/medicare, Last Accessed June 1, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 25 May, 2025
- Medicare.gov, "Joining a plan", Last Accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed 25 May, 2025
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
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