Kaiser Permanente Medicare Advantage Liberty (HMO)

H2172 - 005 - 0
3.5 out of 5 stars (3.5 / 5)

kaiser-permanente medicare provider logo

Kaiser Permanente Medicare Advantage Liberty (HMO) is a Medicare Advantage (Part C) Plan by Kaiser Permanente.

This page features plan details for 2024 Kaiser Permanente Medicare Advantage Liberty (HMO) H2172 – 005 – 0 available in DC, MD, VA.

IMPORTANT: This page has been updated with plan and premium data for 2024.

Locations

Kaiser Permanente Medicare Advantage Liberty (HMO) is offered in the following locations.

Plan Overview

Kaiser Permanente Medicare Advantage Liberty (HMO) offers the following coverage and cost-sharing.

Insurer:Kaiser Permanente
Health Plan Deductible:$0.00
MOOP:$6,900 In-network
Drugs Covered:No

Ready to sign up for Kaiser Permanente Medicare Advantage Liberty (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

Premium Breakdown

Kaiser Permanente Medicare Advantage Liberty (HMO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.
Part B Part C Part B Give Back Total
$174.70 $0.00 $0.00 $174.70
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

Kaiser Permanente Medicare Advantage Liberty (HMO) also provides the following benefits.

Health plan deductible

$0

Other health plan deductibles?

In-network No

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$6,900 In-network

Optional supplemental benefits

Yes

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-network No

Outpatient hospital coverage

$0-200 copay per visit (Authorization is required.) (Referral is required.)

Doctor visits

Primary$15 copay per visit (Not applicable.) (Not applicable.)
Specialist$40 copay per visit (Authorization is required.) (Referral is required.)

Preventive care

$0 copay (Authorization is required.) (Referral is required.)

Emergency care/Urgent care

Emergency$100 copay per visit (always covered) (Not applicable.) (Not applicable.)
Urgent care$40 copay per visit (always covered) (Not applicable.) (Not applicable.)

Diagnostic procedures/lab services/imaging

Diagnostic tests and procedures$0 copay (Authorization is required.) (Referral is required.)
Lab services$0 copay (Authorization is required.) (Referral is required.)
Diagnostic radiology services (e.g., MRI)$10-150 copay (Authorization is required.) (Referral is required.)
Outpatient x-rays$10 copay (Authorization is required.) (Referral is required.)

Hearing

Hearing exam$40 copay (Authorization is required.) (Referral is required.)
Fitting/evaluation$0 copay (There are no limits.) (Authorization is required.) (Referral is required.)
Hearing aids – inner earNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – outer earNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Hearing aids – over the earNot covered (There are no limits.) (Not applicable.) (Not applicable.)

Preventive dental

Office visit$40.00 (Authorization is not required.) (Referral is not required.)
Oral examCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
CleaningCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Fluoride treatmentCovered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)
Dental x-ray(s)Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Comprehensive dental

Non-routine services50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
Diagnostic services0% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
Restorative services50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
Endodontics50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
Periodontics50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
Extractions$40 copay or 50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)
Prosthodontics, other oral/maxillofacial surgery, other services50% coinsurance (Limits may apply.) (Authorization is required.) (Referral is required.)

Vision

Routine eye exam$15-40 copay (There are no limits.) (Authorization is required.) (Referral is required.)
OtherNot covered (There are no limits.) (Not applicable.) (Not applicable.)
Contact lenses$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
Eyeglasses (frames and lenses)$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
Eyeglass frames$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
Eyeglass lenses$0 copay (Limits may apply.) (Authorization is required.) (Referral is required.)
UpgradesNot covered (Not applicable.) (Not applicable.)

Rehabilitation services

Occupational therapy visit$40 copay (Authorization is required.) (Referral is required.)
Physical therapy and speech and language therapy visit$40 copay (Authorization is required.) (Referral is required.)

Ground ambulance

$250 copay (Not applicable.) (Not applicable.)

Transportation

$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.)

Foot care (podiatry services)

Foot exams and treatment$40 copay (Authorization is required.) (Referral is required.)
Routine foot careNot covered (Not applicable.) (Not applicable.)

Medical equipment/supplies

Durable medical equipment (e.g., wheelchairs, oxygen)0-20% coinsurance per item (Authorization is required.) (Not applicable.)
Prosthetics (e.g., braces, artificial limbs)20% coinsurance per item (Authorization is required.) (Not applicable.)
Diabetes supplies$0 copay (Authorization is required.) (Not applicable.)

Wellness programs (e.g., fitness, nursing hotline)

Covered (Authorization is required.) (Referral is required.)

Medicare Part B drugs

Chemotherapy$15-47 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.)
Other Part B drugs$15-47 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.)
Part B Insulin drugs$15-35 copay (Authorization is required.) (Not applicable.)

Inpatient hospital coverage

$300 per day for days 1 through 5
$0 per day for days 6 through 90
$0 per day for days 90 and beyond (Authorization is required.) (Referral is required.)

Mental health services

Inpatient hospital – psychiatric$300 per day for days 1 through 5
$0 per day for days 6 through 90 (Authorization is required.) (Referral is required.)
Outpatient group therapy visit with a psychiatrist$10 copay (Authorization is required.) (Referral is required.)
Outpatient individual therapy visit with a psychiatrist$20 copay (Authorization is required.) (Referral is required.)
Outpatient group therapy visit$10 copay (Authorization is required.) (Referral is not required.)
Outpatient individual therapy visit$20 copay (Authorization is required.) (Referral is not required.)

Skilled Nursing Facility

$0 per day for days 1 through 20
$203 per day for days 21 through 100 (Authorization is required.) (Referral is required.)

Package #1

Monthly Premium$18.00
Deductiblenan

Package #2

Monthly Premium$23.00
Deductiblenan

Optional Benefits

Package #1

Comprehensive dental:Monthly Premium:$20.00
Comprehensive dental:Deductible:N/A
Eyewear:Monthly Premium:$20.00
Eyewear:Deductible:N/A
Hearing aids:Monthly Premium:$20.00
Hearing aids:Deductible:N/A

Ready to sign up for Kaiser Permanente Medicare Advantage Liberty (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 TTY 711.

8am – 11pm EST. 7 days a week

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