Kaiser Permanente Senior Advantage Liberty (HMO) is a Medicare Advantage (Part C) Plan by Kaiser Permanente.
This page features plan details for 2024 Kaiser Permanente Senior Advantage Liberty (HMO) H1170 – 014 – 0 available in Atlanta Full Metro Area.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Kaiser Permanente Senior Advantage Liberty (HMO) is offered in the following locations.
Kaiser Permanente Senior Advantage Liberty (HMO) offers the following coverage and cost-sharing.
Insurer: | Kaiser Permanente |
Health Plan Deductible: | $0.00 |
MOOP: | $6,000 In-network |
Drugs Covered: | No |
Ready to sign up for Kaiser Permanente Senior Advantage Liberty (HMO) ?
Part B | Part C | Part B Give Back | Total |
---|---|---|---|
$174.70 | $0.00 | $0.00 | $174.70 |
Kaiser Permanente Senior Advantage Liberty (HMO) also provides the following benefits.
$0 |
In-network | No |
$6,000 In-network |
Yes |
In-network | Yes, contact plan for further details |
$0-275 copay per visit (Authorization is required.) (Referral is not required.) |
Primary | $0 copay (Not applicable.) (Not applicable.) |
Specialist | $0-40 copay per visit (Authorization is not required.) (Referral is required.) |
$0 copay (Authorization is not required.) (Referral is not required.) |
Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Urgent care | $40 copay per visit (always covered) (Not applicable.) (Not applicable.) |
Diagnostic tests and procedures | $0-35 copay (Authorization is required.) (Referral is required.) |
Lab services | $0-35 copay (Authorization is required.) (Referral is required.) |
Diagnostic radiology services (e.g., MRI) | $0-245 copay (Authorization is required.) (Referral is required.) |
Outpatient x-rays | $0-50 copay (Authorization is required.) (Referral is required.) |
Hearing exam | $40 copay (Authorization is not required.) (Referral is not required.) |
Fitting/evaluation | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – inner ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – outer ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Hearing aids – over the ear | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Oral exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Cleaning | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Dental x-ray(s) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Diagnostic services | $0 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Restorative services | $28-580 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Periodontics | $0-400 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Extractions | $22 copay (There are no limits.) (Authorization is required.) (Referral is required.) |
Prosthodontics, other oral/maxillofacial surgery, other services | $0-480 copay or 75% coinsurance (There are no limits.) (Authorization is required.) (Referral is required.) |
Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Upgrades | Not covered (Not applicable.) (Not applicable.) |
Occupational therapy visit | $40 copay (Authorization is not required.) (Referral is required.) |
Physical therapy and speech and language therapy visit | $40 copay (Authorization is required.) (Referral is required.) |
$225 copay (Not applicable.) (Not applicable.) |
$0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
Foot exams and treatment | $40 copay (Authorization is not required.) (Referral is required.) |
Routine foot care | Not covered (Not applicable.) (Not applicable.) |
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 per item (Authorization is not required.) (Not applicable.) |
Covered (Authorization is not required.) (Referral is not required.) |
Chemotherapy | $0-47 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Other Part B drugs | $0-47 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
Part B Insulin drugs | $0-35 copay (Authorization is required.) (Not applicable.) |
$295 per day for days 1 through 6 $0 per day for days 7 through 90 $0 per day for days 90 and beyond (Authorization is required.) (Referral is required.) |
Inpatient hospital – psychiatric | $295 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 | $20 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit with a psychiatrist | $40 copay (Authorization is not required.) (Referral is not required.) |
Outpatient group therapy visit | $20 copay (Authorization is not required.) (Referral is not required.) |
Outpatient individual therapy visit | $40 copay (Authorization is not required.) (Referral is not required.) |
$0 per day for days 1 through 20 $203 per day for days 21 through 100 (Authorization is required.) (Referral is required.) |
Monthly Premium | $9.00 |
Deductible | nan |
Comprehensive dental: | Monthly Premium: | $9.00 |
Comprehensive dental: | Deductible: | N/A |
Hearing exam: | Monthly Premium: | $9.00 |
Hearing exam: | Deductible: | N/A |
Hearing aids: | Monthly Premium: | $9.00 |
Hearing aids: | Deductible: | N/A |
Ready to sign up for Kaiser Permanente Senior Advantage Liberty (HMO) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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