Kaiser Permanente Medicare Advantage Liberty (HMO)
Medicare Advantage Plan H2172-005 • 2026 • Spotsylvania County, VA
Kaiser Permanente Medicare Advantage Liberty (HMO) Medicare Advantage Plan H2172-005 • 2026 • Spotsylvania County, VA
Kaiser Permanente Medicare Advantage Liberty is a Medicare Advantage HMO plan offered by Kaiser Permanente for the 2026 plan year. It is identified by CMS Plan ID H2172-005 and uses a Health Maintenance Organization (HMO) provider network. The plan comes without prescription drug coverage.
Kaiser Permanente Medicare Advantage Liberty Overview
Plan Overview for H2172-005-0 |
|
|---|---|
| CMS Plan ID: | H2172-005-0 |
| Plan Type: | HMO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $5900.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Spotsylvania County, VA |
| Enrollment (Nationwide) | 1,247 beneficiaries |
| Enrollment (CMS – Local) | 0 beneficiaries in Spotsylvania County |
| Provided By: | Kaiser Permanente |
Plan Overview for Kaiser Permanente Medicare Advantage Liberty
This Medicare Advantage Health Maintenance Organization (HMO) plan provides Medicare Part A and Part B coverage through a network of participating providers. The monthly premium is $0.00, and services are generally covered when received from in-network providers, except in emergency situations.
Primary care visits have a $15 copay, specialist visits come with a $40 copay, lab services cost {lab_services_cost}, urgent care services carry a $40 copay, and ambulance transportation is $250 copay. These costs apply toward the annual out-of-pocket maximum (MOOP) of $5900.00. After this limit is reached, in-network services are fully covered for the remainder of the year.
This plan is listed by CMS under Plan ID {title_plan_id}. Cost-sharing details for key services are provided below.
Cost Sharing Expenses
Kaiser Permanente Medicare Advantage Liberty 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 H2172-005.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $15 copay |
| Specialist: | In-network: $40 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | In-network: $0 copay |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | Not covered |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $10-$150 copay |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $10 copay |
| Diagnostic tests and procedures: | In-network: $0 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $130 copay |
| Worldwide emergency care: | $130 copay |
| Urgent care: | $40 copay |
| Inpatient hospital care: | Tier 1 | $295 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
| Skilled Nursing Facility: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-100 |
| Ground ambulance: | In-network: $250 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $20 copay |
| Outpatient group therapy: | In-network: $10 copay |
| Inpatient psychiatric hospital care: | Tier 1 | $295 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $40 copay |
| Occupational therapy: | In-network: $40 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: 0% coinsurance |
| Durable medical equipment: | In-network: 0%-20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: $15-$47 copay, 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: $15-$47 copay, 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0-$40 copay |
| Dental x-rays: | In-network: $0-$40 copay |
| Cleaning: | In-network: $0-$40 copay |
| Periodontics: | In-network: 50% coinsurance |
| Endodontics: | In-network: 50% coinsurance |
| Restorative services: | In-network: 50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: $40 copay, 50% coinsurance |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $15-$40 copay |
| Contact lenses: | In-network: $0 copay |
| Eyeglass frames only: | In-network: $0 copay |
| Eyeglass lenses only: | In-network: $0 copay |
| Eyeglasses (frames & lenses): | In-network: $0 copay |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | Not covered |
| Fitting/evaluation: | In-network: $0 copay |
| Prescription hearing aids: | In-network: $0 copay |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | In-network: $0 copay |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Kaiser Permanente Medicare Advantage Liberty as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Ratings
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2026 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
What is the monthly premium for Kaiser Permanente Medicare Advantage Liberty (HMO)?
For 2026, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the MOOP for Kaiser Permanente Medicare Advantage Liberty in 2026?
The annual in-network MOOP is $5900.00 for 2026. After this limit is reached, covered in-network services are fully paid.
How many beneficiaries are enrolled in this plan?
Total enrollment is 1,247 beneficiaries based on the latest CMS data.
What is the prescription drug deductible for 2026?
The Part D deductible is $0.00.
Contact Information for Kaiser Permanente
| Contact Type | Details |
|---|---|
| Website: | Kaiser Permanente Plan Page |
| New Members: | 1-877-408-8607 |
| Existing Members: | 1-888-777-5536 |
| Plan Address: | 3495 Piedmont Rd. NE | Nine Piedmont Center | Atlanta, GA 30305 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- Kaiser Permanente (official source), http://kp.org/medicare — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Your coverage options" — Last accessed 25 May, 2025
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