Kaiser Permanente Sr Advantage Liberty Giveback (HMO) Medicare Advantage Plan H1170-017 • 2026 • Butts County, GA

Kaiser Permanente Sr Advantage Liberty Giveback Overview

Coverage Overview for Kaiser Permanente Sr Advantage Liberty Giveback

Kaiser Permanente Sr Advantage Liberty Giveback is a Medicare Advantage HMO plan that provides Medicare Part A and Part B coverage through a network of participating providers. The monthly premium is $0.00, and the plan generally requires selection of a primary care provider (PCP) and use of in-network services, except in emergency situations.

Primary care visits have a $0 copay, specialist visits come with a $0-$50 copay, urgent care services carry a $50 copay, and ambulance transportation is $290 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $6750.00. After this limit is reached, in-network services are fully covered.

This plan is listed by CMS under Plan ID H1170-017. A summary of cost sharing is provided below.

Out-of-Pocket Costs

Kaiser Permanente Sr Advantage Liberty Giveback includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H1170-017.

Certain preventive services are covered 100% by Kaiser Permanente Sr Advantage Liberty Giveback as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.