There is no monthly plan premium to enroll in the Rx plan. However, you must maintain your Medicare Part B coverage to be a member of any Medicare Advantage plan. Most people will pay the standard Part B premium amount. Please call Social Security at 1-800-772-1213 for information about your Part B premium.

KelseyCare Advantage Rx members will receive most of their medical care from the doctors at Kelsey-Seybold Clinic. KelseyCare Advantage also contracts with an affiliate network of doctors to provide care that is not offered at Kelsey-Seybold. You can only use doctors who are part of our network. The health providers in our network can change at any time. A referral may be required to access some network doctors. If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither KelseyCare Advantage Rx nor the Original Medicare plan will pay for these services.

The KelseyCare Advantage Rx plan works well for Medicare beneficiaries that need comprehensive coverage and low out-of-pocket expenses for their hospital, medical, and prescription drug benefits. This plan also offers worldwide emergency coverage as well as coverage for routine vision, hearing, and medical transportation.

1. Be eligible for Medicare Part A and enrolled in Part B,
2. Continue to pay Part B premiums,
3. Live in the plan service area, and
4. Not have End-Stage Renal Disease (permanent kidney failure).

Deductible Stage

You will pay a yearly deductible of $100 on Tiers 3, 4 and 5 drugs. You must pay the full cost of your Tiers 3, 4 and 5 drugs until you reach the plan’s deductible amount. There is no deductible for KelseyCare Advantage for select insulins. During the Deductible Stage, your out-of-pocket costs for these select insulins will be $30-$35 for a 30-day supply. To find out which drugs are select insulins, review the most recent Drug List. 

Initial Coverage

You will pay a yearly deductible of $100 on Tiers 3, 4 and 5 drugs. You must pay the full cost of your Tiers 3, 4 and 5 drugs until you reach the plan’s deductible amount.  After you pay your yearly deductible, you pay the following until your total yearly drug cost reach $4,130. Total yearly drug costs are the total drug cost paid by both you and our Part D plan. 

You may get your drugs at network retail pharmacies.

* The preferred cost-sharing pharmacies in the Greater Houston area include Kelsey Pharmacy, HEB, CVS retail locations and CVS Caremark Mail Service.

Coverage Gap Stage

Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $4,130.

After you enter the coverage gap, you will continue to pay the initial coverage stage copays for Tiers 1 and 2 medications. For Tiers 3, 4 and 5 medications you will pay 25% of the plan’s cost for covered brand name drugs and 25% of the plan’s cost for covered generic drugs until your costs total $6,550, which is the end of the coverage gap. KelseyCare Advantage offers additional gap coverage for select insulins. During the Coverage Gap stage, your out-of-pocket costs for select insulins will be $30-$35 for a 30-day supply. To find out which drugs are select insulins, review the most recent Drug List. Not everyone will enter the coverage gap. For more information about the Part D Senior Savings model, you can refer to the 2021 Evidence of Coverage (EOC).

Catastrophic Coverage Stage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6,550, you pay the greater of: 5% of the cost, or $3.70 copay for generic (including brand drugs treated as generic) and a $9.20 copayment for all other drugs.

Plan Premium

The monthly fee you pay the plan for your health care. The amount shown does not include the Part B premium you already pay to the government.

The KelseyCare Advantage Rx+Choice plan works well for Medicare beneficiaries that need comprehensive coverage and low out-of-pocket expenses for their hospital, medical, and prescription drug benefits. This plan also offers worldwide emergency coverage as well as coverage for routine vision, hearing, and medical transportation. The Rx+Choice plan offers members the option to access certain specialists who are outside of the KelseyCare Advantage provider network.

1. Be eligible for Medicare Part A and enrolled in Part B,
2. Continue to pay Part B premiums,
3. Live in the plan service area, and
4. Not have End-Stage Renal Disease (permanent kidney failure).

KelseyCare Advantage Rx+Choice members will receive most of their medical care from the doctors at Kelsey-Seybold Clinic. KelseyCare Advantage also contracts with an affiliate network of doctors to provide care that is not offered at Kelsey-Seybold. You can use specialists who are in or out of the KelseyCare Advantage provider network. The health providers in our network can change at any time. Members can elect to have their Kelsey-Seybold Clinic physician “coordinate” their care or they can choose to “self-refer” for care from certain specialists outside of Kelsey-Seybold Clinic. Members receive a higher level of benefits and pay lower out-of-pocket costs when they use in-network providers.

Deductible Stage

You will pay a yearly deductible of $100 on Tiers 3, 4 and 5 drugs. You must pay the full cost of your Tiers 3, 4 and 5 drugs until you reach the plan’s deductible amount. There is no deductible for KelseyCare Advantage for select insulins. During the Deductible Stage, your out-of-pocket costs for these select insulins will be $30-$35 for a 30-day supply. To find out which drugs are select insulins, review the most recent Drug List. 

Initial Coverage

You will pay a yearly deductible of $100 on Tiers 3, 4 and 5 drugs. You must pay the full cost of your Tiers 3, 4 and 5 drugs until you reach the plan’s deductible amount.  After you pay your yearly deductible, you pay the following until your total yearly drug cost reach $4,130. Total yearly drug costs are the total drug cost paid by both you and our Part D plan. 

You may get your drugs at network retail pharmacies.

* The preferred cost-sharing pharmacies in the Greater Houston area include Kelsey Pharmacy, HEB, CVS retail locations and CVS Caremark Mail Service.

Coverage Gap Stage

Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $4,130.

After you enter the coverage gap, you will continue to pay the initial coverage stage copays for Tiers 1 and 2 medications. For Tiers 3, 4 and 5 medications you will pay 25% of the plan’s cost for covered brand name drugs and 25% of the plan’s cost for covered generic drugs until your costs total $6,550, which is the end of the coverage gap. KelseyCare Advantage offers additional gap coverage for select insulins. During the Coverage Gap stage, your out-of-pocket costs for select insulins will be $30-$35 for a 30-day supply. To find out which drugs are select insulins, review the most recent Drug List. Not everyone will enter the coverage gap. For more information about the Part D Senior Savings model, you can refer to the 2021 Evidence of Coverage (EOC).

Catastrophic Coverage Stage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6,550, you pay the greater of: 5% of the cost, or $3.70 copay for generic (including brand drugs treated as generic) and a $9.20 copayment for all other drugs.

Plan Premium

The monthly fee you pay the plan for your health care. The amount shown does not include the Part B premium you already pay to the government.

The KelseyCare Advantage Rx Select plan works well for Medicare beneficiaries that need comprehensive coverage and low out-of-pocket expenses for their hospital, medical and prescription drug benefits. This plan also offers worldwide emergency coverage as well as coverage for routine vision, hearing, and medical transportation. The Rx Select plan offers members the option to access certain specialists who are outside of the KelseyCare Advantage provider network.

1. Be eligible for Medicare Part A and enrolled in Part B,
2. Continue to pay Part B premiums,
3. Live in the plan service area, and
4. Not have End-Stage Renal Disease (permanent kidney failure).

KelseyCare Advantage Rx Select members will receive most of their medical care from the doctors at Kelsey-Seybold Clinic. KelseyCare Advantage also contracts with an affiliate network of doctors to provide care that is not offered at Kelsey-Seybold. You can use specialists who are in or out of the KelseyCare Advantage provider network. The health providers in our network can change at any time. Members can elect to have their Kelsey-Seybold Clinic physician “coordinate” their care or they can choose to “self-refer” for care from certain specialists outside of Kelsey-Seybold Clinic. Members receive a higher level of benefits and pay lower out-of-pocket costs when they use in-network providers.

Deductible Stage

You will pay a yearly deductible of $100 on Tiers 3, 4 and 5 drugs. You must pay the full cost of your Tiers 3, 4 and 5 drugs until you reach the plan’s deductible amount. There is no deductible for KelseyCare Advantage for select insulins. During the Deductible Stage, your out-of-pocket costs for these select insulins will be $30-$35 for a 30-day supply. To find out which drugs are select insulins, review the most recent Drug List. 

Initial Coverage

You will pay a yearly deductible of $100 on Tiers 3, 4 and 5 drugs. You must pay the full cost of your Tiers 3, 4 and 5 drugs until you reach the plan’s deductible amount. After you pay your yearly deductible, you pay the following until your total yearly drug cost reach $4,130. Total yearly drug costs are the total drug cost paid by both you and our Part D plan.

You may get your drugs at network retail pharmacies.

* The preferred cost-sharing pharmacies in the Greater Houston area include Kelsey Pharmacy, HEB, CVS retail locations and CVS Caremark Mail Service.

Coverage Gap Stage

Most Medicare drug plans have a coverage gap (also called the “donut hole”). This means that there’s a temporary change in what you will pay for your drugs. The coverage gap begins after the total yearly drug cost (including what our plan has paid and what you have paid) reaches $4,130.

After you enter the coverage gap, you will continue to pay the initial coverage stage copays for Tiers 1 and 2 medications. For Tiers 3, 4 and 5 medications you will pay 25% of the plan’s cost for covered brand name drugs and 25% of the plan’s cost for covered generic drugs until your costs total $6,550, which is the end of the coverage gap. KelseyCare Advantage offers additional gap coverage for select insulins. During the Coverage Gap stage, your out-of-pocket costs for select insulins will be $30-$35 for a 30-day supply. To find out which drugs are select insulins, review the most recent Drug List. Not everyone will enter the coverage gap. For more information about the Part D Senior Savings model, you can refer to the 2021 Evidence of Coverage (EOC).

Catastrophic Coverage Stage

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $6,550, you pay the greater of: 5% of the cost, or $3.70 copay for generic (including brand drugs treated as generic) and a $9.20 copayment for all other drugs.

Plan Premium

The monthly fee you pay the plan for your health care. The amount shown does not include the Part B premium you already pay to the government.