Kaiser Permanente Senior Advantage Solano (HMO)

Medicare Advantage Plan for California

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PARTCRX

Plan Summary

Insurance TypeMedicare Advantage Plan (Part C w/ RX)
Insurance ProviderKaiser Permanente
Plan IDH0524-8-0
CMS Rating1
Plan TypeHMO
Annual Deductible$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Why We Like This Plan

  • has both Health and Drug Coverage
  • has been rated 5 stars by CMS
  • was the best selling plan in Solano in 2018

Plan Details

Costs and Other Important Information

Plan Year:
2018
Optional Supplemental Benefits
Yes
Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)
$5,200 In-network
Other health plan deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$33.10
Monthly Health Plan Premium
$68.90

Benefits

Service
Cost
Inpatient hospital coverage
$285 for days 1 through 7
$0 for days 8 through 90
Outpatient hospital coverage
$0-250 per visit
Doctor visits
Primary:
$35 per visit
Specialist:
$35 per visit
Preventive care
$0 copay
Emergency care/Urgent care
Emergency:
$80 per visit (always covered)
Urgent care:
$35 per visit (always covered)
Diagnostic procedures/lab services/imaging
Diagnostic tests and procedures:
$35
Lab services:
$35
Diagnostic radiology services (e.g., MRI):
$45-205
Outpatient x-rays:
$45
Mental health services
$230 for days 1 through 7
$0 for days 8 through 90
Outpatient group therapy visit with a psychiatrist:
$17
Outpatient individual therapy visit with a psychiatrist:
$35
Outpatient group therapy visit:
$17
Outpatient individual therapy visit:
$35
Skilled Nursing Facility
$0 for days 1 through 20
$100 for days 21 through 100
Rehabilitation services
Occupational therapy visit:
$40
Physical therapy and speech and language therapy visit:
$0-40
Ambulance
$200
Transportation
Not covered
Foot care (podiatry services)
Foot exams and treatment:
$35
Routine foot care:
Not covered
Medical equipment/supplies
Durable medical equipment (e.g., wheelchairs, oxygen):
20% per item
Prosthetics (e.g., braces, artificial limbs):
20% per item
Diabetes supplies:
$0 copay
Wellness programs (e.g., fitness, nursing hotline)
Covered
Medicare Part B drugs
Chemotherapy:
$0-47
Other Part B drugs:
$0-47

Coverage Area for Kaiser Permanente Senior Advantage Solano (HMO)

StateCalifornia
CountyLos Angeles

Cost Sharing Information

All cost-sharing assumes in-network healthcare providers.

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offereds$6 copayNot offered
Tier 2: Non-Preferred GenericNot offered$18 copayNot offered
Tier 3: Preferred Brand NameNot offered$47 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$100 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred GenericNot offered$18 copayNot offered
Tier 2: Non-Preferred GenericNot offered$54 copayNot offered
Tier 3: Preferred Brand NameNot offered$141 copayNot offered
Tier 4: Non-Preferred Brand NameNot offered$300 copayNot offered
Tier 5: Specialty TierNot offered33% coinsuranceNot offered

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Care for older adults – medication review
Care for older adults – functional status assessment
Care for older adults – Pain screening
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan
Care Coordination

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

Physicians that accept Kaiser Permanente Senior Advantage Solano (HMO) for California

/
AFSHAR-SHAHIDI, NAHAL
4425 S CENTRAL AVE
LOS ANGELES, CA 90011
KASHANI, HOUMAN
747 WAREHOUSE ST
LOS ANGELES, CA 90021
JAVAHERIAN, NEDA
2020 ZONAL AVE
LOS ANGELES, CA 90089
QUINN, DAVID
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
CHAKRYAN, YERVAND
2020 ZONAL AVE STE 620
LOS ANGELES, CA 90089
TSUKAMOTO, MICHELLE
2020 ZONAL AVE
LOS ANGELES, CA 90089
BAHL, PANKAJ
2020 ZONAL AVE
LOS ANGELES, CA 90089
GUBER, KEVIN
2250 ALCAZAR ST
LOS ANGELES, CA 90089
OH, MARISA
2020 ZONAL AVE
LOS ANGELES, CA 90089
SHE, ROSEMARY
1441 EASTLAKE AVENUE
LOS ANGELES, CA 90089
EL-KHOUEIRY, ANTHONY
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
VAN ZYL, CARIN
2020 ZONAL AVE # IRD306
LOS ANGELES, CA 90089
MOTAMEDI, MONA
2020 ZONAL AVE
LOS ANGELES, CA 90089
WHANG, JANET
2020 ZONAL AVE STE IRD624
LOS ANGELES, CA 90089
DESAI, MANISH
2020 ZONAL AVE
LOS ANGELES, CA 90089
EVANS, MICHELE
2010 ZONAL AVE
LOS ANGELES, CA 90089
WANG, WILLIAM
2020 ZONAL AVE
LOS ANGELES, CA 90089
PRESS, MICHAEL
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
BANSAL, SUMATI
2020 ZONAL AVE
LOS ANGELES, CA 90089
SCHECHTER, NAOMI
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
NICHOLS, PETER
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
DIGANGI, MERCIE
2020 ZONAL AVE
LOS ANGELES, CA 90089
BRAVO, ROGELIO
2020 ZONAL AVE
LOS ANGELES, CA 90089
SHIBATA, DARRYL
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
GINSBERG, DAVID
1441 EASTLAKE AVE
LOS ANGELES, CA 90089
Details
NAHAL AFSHAR-SHAHIDI, MD
Phone Number
(323) 908-4200
Office Locations
4425 S CENTRAL AVE
LOS ANGELES, CA 90011
4425 S CENTRAL AVE LOS ANGELES CA, 90011

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