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Kaiser Permanente Medicare Advantage Liberty (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Kaiser Permanente Medicare Advantage Liberty (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Kaiser Permanente Medicare Advantage Liberty (HMO) in 2025, please refer to our full plan details page.
Kaiser Permanente Medicare Advantage Liberty (HMO) is a HMO plan offered by Kaiser Foundation Health Plan, Inc. available for enrollment in 2025 to people living in DC, MD, VA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Kaiser Permanente Medicare Advantage Liberty (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Kaiser Permanente Medicare Advantage Liberty (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Kaiser Permanente Medicare Advantage Liberty (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by Kaiser Permanente Medicare Advantage Liberty (HMO).
Additional Benefits
The Kaiser Permanente Medicare Advantage Liberty (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $300 copay for the first six days, with no copay for subsequent days. Outpatient services, primary care, and preventive services often have low or no copays. The plan covers various services, including ambulance, emergency services, vision, hearing, and dental. Many services have copays, such as specialist visits, hearing exams, and dental services. The plan also covers medical equipment, home health, and skilled nursing facilities with varying cost-sharing.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For the first 6 days of an Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stay, there is a $300 copay, and days 7-90 have no copay; additional days 91-999 for Inpatient Hospital-Acute have no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for outpatient hospital services with a copay between $0 and $200, observation services with a copay between $0 and $200, and ambulatory surgical center services with a $200 copay. Outpatient substance abuse services, including individual sessions with a $20 copay and group sessions with a $10 copay, and outpatient blood services with no copay are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization and a doctor referral. The copay for this benefit is $15.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $250 copay for both ground and air ambulance services, and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, Urgently Needed Services have a $40 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
The Kaiser Permanente Medicare Advantage Liberty (HMO) plan covers primary care physician services and chiropractic services with a $15 copay, and occupational therapy services with a $40 copay. Additionally, it covers physician specialist services and physical therapy with a $40 copay, mental health specialty services with a $20 copay for individual sessions and a $10 copay for group sessions, other health care professional services with a copay between $15 and $40, and psychiatric services with a $20 copay for individual sessions and a $10 copay for group sessions. Additional telehealth benefits have no copay, and opioid treatment program services have a $40 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, an annual physical exam with no copay, and additional preventive services including health education, fitness benefit, and remote access technologies, all with no copay. Kidney disease education services and other preventive services, like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visit, are also covered with no copay. In-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $40 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered, with a maximum benefit of $1,000 per ear every three years. Routine hearing exams, prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$40, and eyewear with 20% coinsurance for contact lenses, but upgrades are not covered. Routine eye exams have a copay of $15-$40, and the plan offers a combined maximum of $200 for all eyewear every two years.
Dental Services See details
Dental services, including Medicare dental services and other dental services, are covered. Medicare dental services have a $40 copay, while other dental services have a copay of $0 - $40. Orthodontic services are covered up to a maximum of $500 per year, while restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery have a 50% coinsurance. Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Kaiser Permanente Medicare Advantage Liberty (HMO) plan, including Medicare Part B Insulin Drugs with a copay of $15.00 - $35.00, Medicare Part B Chemotherapy/Radiation Drugs with a copay of $15.00 - $47.00 and 0% - 20% coinsurance, and Other Medicare Part B Drugs with a copay of $15.00 - $47.00 and 0% - 20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the Kaiser Permanente Medicare Advantage Liberty (HMO) plan, requiring prior authorization and a doctor's referral. You will pay 20% coinsurance for this service.
Medical Equipment See details
Medical Equipment benefits with the Kaiser Permanente Medicare Advantage Liberty (HMO) plan cover Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with no copay, and lab services with no copay. Diagnostic Radiological Services have a copay of at most $150, Therapeutic Radiological Services have a copay of at most $40, and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Kaiser Permanente Medicare Advantage Liberty (HMO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice. Specifically, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Kaiser Permanente Medicare Advantage Liberty (HMO) plan. There is no copay for days 1-20, and a $203 copay for days 21-100. However, additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services for the Kaiser Permanente Medicare Advantage Liberty (HMO) plan include coverage for Over-the-Counter (OTC) items with a maximum benefit of $50 every three months, and "Other 1" services with 0% - 20% coinsurance. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. "Other 2" services are covered with a $200 copay.
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