What's new?
Stay up to date on important insurance plan, wellness, and prevention information through our newsletters.
Greater Houston Plan Updates for 2023!
Good news! In 2023 Part D Prescription drug coverage is now included in your KelseyCare Advantage Greater Houston Plan. Here are some highlights on what this means for you.
Insulin
First, you won’t pay more than $35 for a one-month supply of each insulin product covered by our plan, no matter what cost-sharing tier it’s on.
Enhanced Drug Coverage
Second, as a part of our enhanced drug coverage for 2023, KelseyCare Advantage is covering the following Tier 2 drugs: Sildenafil (generic Viagra), Vitamin D2, Folic Acid, and Vitamin B12.
Pharmacies
We want to make it as easy as possible for you to get your prescriptions on time and our Kelsey Pharmacies offer a few options for your convenience:
- You can pick-up your prescription from any Kelsey Pharmacy.
- Same & next day courier delivery, at no cost!
- Mail delivery
- Refills can be requested online at keleypharmacy.com, with the Kelsey Pharmacy app, or by calling a Kelsey Pharmacy location.
In addition to the Kelsey Pharmacies, you can also fill prescriptions at CVS retail stores or through their mail-order; or at HEB Pharmacies.
Preferred Retail and Mail Order Cost-Sharing (Initial Coverage Limit)
Below you will find the copay grid for the preferred retail cost-sharing, initial coverage limit. Please keep in mind that you may experience additional savings by using a preferred retail pharmacy, instead of a standard retail cost-sharing pharmacy.
| Tier | 30-day supply | 60-day supply | 90-day supply |
| Tier 1 (Preferred Generic) | $0 copay | $0 copay | $0 copay |
| Tier 2 (Generic) | $0 copay | $0 copay | $0 copay |
| Tier 3 (Preferred brand) | $40 copay | $80 copay | $100 copay |
| Tier 4 (Non-preferred drug) | $80 copay | $160 copay | $200 copay |
| Tier 5 (Specialty Tier) | 31% coinsurance | 31% coinsurance | A long-term supply is not available for drugs in Tier 5 |
| Tier 6 (Select Care Drugs) | $0 copay | $0 copay | $0 copay |
Standard Retail Cost-Sharing (Initial Coverage Limit)
For your review, here is the copay grid for the standard retail cost-sharing, initial coverage limit.
| Tier | 30-day supply | 60-day supply | 90-day supply |
| Tier 1 (Preferred Generic) | $3 copay | $6 copay | $9 copay |
| Tier 2 (Generic) | $15 copay | $30 copay | $45 copay |
| Tier 3 (Preferred brand) | $45 copay | $90 copay | $135 copay |
| Tier 4 (Non-preferred drug) | $90 copay | $180 copay | $270 copay |
| Tier 5 (Specialty Tier) | 31% coinsurance | 31% coinsurance | A long-term supply is not available for drugs in Tier 5 |
| Tier 6 (Select Care Drugs) | $0 copay | $0 copay | $0 copay |
More Information / Questions
For more information on your prescription drug benefits, please refer to your Greater Houston Plan Annual Notice of Change or Summary of Benefits. You can also give our Member Services department a call with any questions that you may have about your plan coverage at: 1-866-534-0556 (TTY: 711).
Disclaimer
KelseyCare Advantage, a product of KS Plan Administrators, LLC is an HMO and POS Medicare Advantage plan with a Medicare contract. Enrollment in KelseyCare Advantage depends on contract renewal. This information is not a complete description of benefits.
Limitations, copayments, and restrictions may apply. Benefits, premiums and/or copayments/coinsurance may change on January 1 of each year. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary.