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Benefits

How to Choose the Right Plan for You

When you enroll in KelseyCare Advantage, you can choose from a KelseyCare Advantage plan available in your area, each with benefits tailored to specific needs and budgets. All plans provide Original (also called Traditional) Medicare Parts A and B coverage in addition to other benefits. And all plans give you access to Kelsey-Seybold Clinic’s premier multispecialty physician group and referrals to other contracted providers.

2021 Plans with drug coverage:

2021 Plans Without Drug Coverage

  • Essential Plan

    Plan Summary

    This plan provides the coverage of Medicare Part A (hospital) and Medicare Part B (medical), but does not provide prescription drug coverage.

    This plan may be right for you if you have prescription drug coverage through another source such as TRICARE, federal employee health benefits coverage, VA benefits, state pharmaceutical assistance programs, or private insurance, such as employer-sponsored drug coverage.

    If you have prescription drug coverage through a former employer, you should contact the employer to be sure your drug coverage won’t be interrupted by enrolling in KelseyCare Advantage Essential.

    You’ll pay no monthly plan premium to enroll in the Essential plan. The Essential plan includes a Part B premium reduction of up to $10 per month. Which means you'll pay $10 less for your Part B by joining this plan. If Medicaid is paying your Part B premium, however, you will not get the Part B premium reduction offered by the plan. You must maintain your Medicare Part B coverage to be a member of the Essential 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 Essential members receive most of their medical care from a Kelsey-Seybold Clinic. KelseyCare Advantage 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 affiliate 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 Essential nor the Original Medicare plan will pay for these services.

    The KelseyCare Advantage Essential plan works well for Medicare beneficiaries that need comprehensive coverage and low out-of-pocket expenses for their hospital and medical benefits, but don’t need prescription drug coverage. This plan also offers worldwide emergency coverage as well as coverage for routine vision, routine 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).

    Benefits Summary

    This is a summary of what our plan covers and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please refer to the Evidence of Coverage, this legal member contract is the primary source of the coverage information and supersedes all other information.

    Covered Services What You Pay
    Physician Services / Doctor Office Visits PCP - $0
    Specialist - $20
    Annual Wellness Visit $0
    Telehealth Benefit E-Visit PCP - $0
    E-Visit Spec - $15
    Video Visit PCP - $0
    Video Visit Spec - $15
    Preventive Health Screenings $0
    Inpatient Hospital Care $150 per day for days 1-4
    $0 for days 5-90
    $600 maximum per stay
    Skilled Nursing Facility Care (SNF) $0/day - days 1-20
    $125/day - days 21-100
    Outpatient Diagnostic Tests and Therapeutic Services & Supplies Diagnostic labs & x-rays $0
    Cardiac Stress Test - $25
    Advanced Radiology - $150
    MRI - $150
    PET scan - $150
    Radiation Th, IMRT - $50
    Emergency Care $120
    Ambulance Services $200
    Urgently Needed Services $25
    Convenient Care $25 per visit. CVS Minute Clinics only
    Over-the-Counter Items (OTC) $25 every quarter for approved OTC items through select pharmacy locations.
    Outpatient Hospital Observation $250
    Outpatient Hospital Services ASC - $225
    Hospital $250
    Outpatient Surgery ASC - $225
    Hospital $250
    Outpatient Rehab Services PT and OT - $10
    Speech - $20
    Wound Care/Lymphedema - $20
    Outpatient Mental Health Care Individual or Group - $20
    Outpatient Substance Abuse Services Individual or Group - $20
    Durable Medical Equipment (DME) and Related Supplies

    Continous blood glucose monitors 15% at retail pharmacy and 20% at DME vendor. Preferred continous blood glucose monitors are Dexcom and Libre, all other CGM's are excluded

    All other DME is 20% coinsurance.

    Prosthetic Devices and Related Supplies 20% coinsurance
    Medicare Part B Prescription Prescription Drugs 20% coinsurance (including chemotherapy)
    Services to Treat Kidney Disease 20% coinsurance for renal dialysis treatment
    $0 for education services
    Pulmonary Rehabilitation Services $20
    Cardiac Rehabilitation Services $20
    Chiropractic Services $20
    Acupuncture $20
    Podiatry Services $20
    Home Health Agency Care $10
    Inpatient Mental health Care $150 per day, days 1-4
    $0 for days 5-90
    $600 maximum per stay
    Medical Nutrition Therapy $0
    Dental Services $20 copay - Medicare covered
    Preventive Dental $25 for routine services
    Cleaning: 1 every 6 months
    Dental X-ray(s): 1 per year
    Oral Exam: 1 every 36 months
    Diabetes Self Management Training, Diabetic Services and Supplies 0% for testing supplies
    20% for diabetic shoes & inserts
    20% for insulin pump & supplies
    Immunizations $0
    Transportation $0
    Smoking Cessation $0
    Hearing Services Diagnostic - $20
    Routine - $0
    Hearing Aid Fitting - $20
    Maximum allowance of $750 per ear towards the cost of hearing aid(s) every 3 years
    Vision Care Diagnostic - $20
    Routine - $0
    $75 plan allowance per year

    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. 

    Plan Monthly Premium
    Essential $0
  • Essential+Choice Plan

    Plan Summary

    This plan provides the coverage of Medicare Part A (hospital) and Medicare Part B (medical), but does not provide prescription drug coverage.

    This plan may be right for you if you have prescription drug coverage through another source such as TRICARE, federal employee health benefits coverage, VA benefits, state pharmaceutical assistance programs, or private insurance, such as employer-sponsored drug coverage.

    If you have prescription drug coverage through a former employer, you should contact the employer to be sure your drug coverage won’t be interrupted by enrolling in KelseyCare Advantage Essential+Choice.

    This plan offers a point-of-service benefit. With this plan, you have the option of accessing certain specialists in or out of the KelseyCare Advantage provider network.

    The KelseyCare Advantage Essential+Choice plan works well for Medicare beneficiaries that need comprehensive coverage and low out-of-pocket expenses for their hospital and medical benefits, but don’t need prescription drug coverage. This plan also offers worldwide emergency coverage, as well as coverage for routine vision, routine hearing, and medical transportation. The Essential+Choice plan offers members the option to access certain specialists who are outside of the KelseyCare Advantage provider network without a referral.

    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).

    You’ll pay no monthly plan premium to enroll in the Essential+Choice plan. You must maintain your Medicare Part B coverage to be a member of the Essential+Choice 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 Essential+Choice members receive most of their medical care from a Kelsey-Seybold Clinic. KelseyCare Advantage contracts with an affiliate network of doctors to provide care that is not offered at Kelsey-Seybold. The point-of-service benefit means you can use certain specialists who are in or out of the KelseyCare Advantage provider network without a referral. 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.

    Benefits Summary

    This is a summary of what our plan covers and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please refer to the Evidence of Coverage, this legal member contract is the primary source of the coverage information and supersedes all other information.


    Covered Services What You Pay
    Physician Services / Doctor Office Visits PCP - $0
    Specialist - $20
    Annual Wellness Visit $0
    Telehealth Benefit E-Visit PCP - $0
    E-Visit Spec - $15
    Video Visit PCP - $0
    Video Visit Spec - $15
    Preventive Health Screenings $0
    Inpatient Hospital Care $150 per day, days 1-4
    $0 for days 5-90
    $600 maximum per stay
    Skilled Nursing Facility Care (SNF) $0/day - days 1-20
    $125/day - days 21-100
    Outpatient Diagnostic Tests and Therapeutic Services & Supplies Diagnostic labs & x-rays $0
    Cardiac Stress Test - $25
    Advanced Radiology - $150
    MRI - $150
    PET scan - $150
    Radiation Th, IMRT - $50
    Emergency Care $120
    Ambulance Services $200
    Urgently Needed Services $25
    Convenient Care $25 per visit. CVS Minute Clinics only
    Over-the-Counter Items (OTC) $25 every quarter for approved OTC items through select pharmacy locations.
    Outpatient Hospital Observation $250
    Outpatient Hospital Services ASC - $225
    Hospital $250
    Outpatient Surgery ASC - $225
    Hospital $250
    Outpatient Rehab Services PT and OT - $10
    Speech - $20
    Wound Care/Lymphedema - $20
    Outpatient Mental Health Care Individual or Group - $20
    Outpatient Substance Abuse Services Individual or Group - $20
    Durable Medical Equipment (DME) and Related Supplies

    Continuous blood glucose monitors 15% at retail pharmacy and 20% at DME vendor. Preferred continous blood glucose monitors are Dexcom and Libre, all other CGM's are excluded

    All other DME is 20% coinsurance.

    Prosthetic Devices and Related Supplies 20% coinsurance
    Medicare Part B Prescription Prescription Drugs 20% coinsurance (including chemotherapy)
    Services to Treat Kidney Disease 20% coinsurance for renal dialysis treatment
    $0 for education services
    Pulmonary Rehabilitation Services $20
    Cardiac Rehabilitation Services $20
    Chiropractic Services $20
    Acupuncture $20
    Podiatry Services $20
    Home Health Agency Care $10
    Inpatient Mental health Care $150 per day, days 1-4
    $0 for days 5-90
    $600 maximum per stay
    Medical Nutrition Therapy $0
    Dental Services $20 copay - Medicare covered
    Preventive Dental $25 copay for routine services
    Cleaning: 1 every 6 months
    Dental X-ray(s): 1 per year
    Oral Exam: 1 every 36 months
    Diabetes Self Management Training, Diabetic Services and Supplies 0% for testing supplies
    20% for diabetic shoes & inserts
    20% for insulin pump & supplies
    Immunizations $0
    Transportation $0
    Smoking Cessation $0
    Hearing Services Diagnostic - $20
    Routine - $0
    Hearing Aid Fitting - $20
    Maximum allowance of $750 per ear towards the cost of hearing aid(s) every 3 years
    Vision Care Diagnostic - $20
    Routine - $0
    $75 plan allowance per year

    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.

    Plan Monthly Premium
    Essential + Choice $0
  • Essential Select Plan

    Plan Summary

    This plan provides the coverage of Medicare Part A (hospital) and Medicare Part B (medical), but does not provide prescription drug coverage.

    This plan may be right for you if you have prescription drug coverage through another source such as TRICARE, federal employee health benefits coverage, VA benefits, state pharmaceutical assistance programs, or private insurance, such as employer-sponsored drug coverage.

    If you have prescription drug coverage through a former employer, you should contact the employer to be sure your drug coverage won’t be interrupted by enrolling in KelseyCare Advantage Essential Select.

    This plan offers a point-of-service benefit. With this plan, you have the option of accessing certain specialists in or out of the KelseyCare Advantage provider network.


    You’ll pay no monthly plan premium to enroll in the Essential Select plan. You must maintain your Medicare Part B coverage to be a member of the Essential Select 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 Essential Select members receive most of their medical care from a Kelsey-Seybold Clinic. KelseyCare Advantage contracts with an affiliate network of doctors to provide care that is not offered at Kelsey-Seybold. The point-of-service benefit means you can use certain specialists who are in or out of the KelseyCare Advantage provider network without a referral. 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.

    The KelseyCare Advantage Essential Select plan works well for Medicare beneficiaries that need comprehensive coverage and low out-of-pocket expenses for their hospital and medical benefits, but don’t need prescription drug coverage. This plan also offers worldwide emergency coverage, as well as coverage for routine vision, routine hearing, and medical transportation. The Essential Select plan offers members the option to access certain specialists who are outside of the KelseyCare Advantage provider network without a referral.

    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).

    Benefits Summary

    This is a summary of what our plan covers and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please refer to the Evidence of Coverage, this legal member contract is the primary source of the coverage information and supersedes all other information.


    Covered Services What You Pay
    Physician Services / Doctor Office Visits PCP - $0
    Specialist - $20
    Annual Wellness Visit $0
    Telehealth Benefit E-Visit PCP - $0
    E-Visit Spec - $15
    Video Visit PCP - $0
    Video Visit Spec - $15
    Preventive Health Screenings $0
    Inpatient Hospital Care $150 per day, days 1-4
    $0 for days 5-90
    $600 maximum per stay
    Skilled Nursing Facility Care (SNF) $0/day - days 1-20
    $125/day - days 21-100
    Outpatient Diagnostic Tests and Therapeutic Services & Supplies Diagnostic labs & x-rays $0
    Cardiac Stress Test - $25
    Advanced Radiology - $150
    MRI - $150
    PET scan - $150
    Radiation Th, IMRT - $50
    Emergency Care $120
    Ambulance Services $200
    Urgently Needed Services $25
    Convenient Care $25 per visit. CVS Minute Clinics only
    Over-the-Counter Items (OTC) $25 every quarter for approved OTC items through select pharmacy locations.
    Outpatient Hospital Observation $250
    Outpatient Hospital Services ASC - $225
    Hospital $250
    Outpatient Surgery ASC - $225
    Hospital $250
    Outpatient Rehab Services PT and OT - $10
    Speech - $20
    Wound Care/Lymphedema - $20
    Outpatient Mental Health Care Individual or Group - $20
    Outpatient Substance Abuse Services Individual or Group - $20
    Durable Medical Equipment (DME) and Related Supplies Continuous blood glucose monitors 15% at retail pharmacy and 20% at DME vendor. Preferred continuous blood glucose monitors are Dexcom and Libre, all other CGM's are excluded.

    All other DME is 20% coinsurance.
    Prosthetic Devices and Related Supplies 20% coinsurance
    Medicare Part B Prescription Prescription Drugs 20% coinsurance (including chemotherapy)
    Services to Treat Kidney Disease 20% coinsurance for renal dialysis treatment
    $0 for education services
    Pulmonary Rehabilitation Services $20
    Cardiac Rehabilitation Services $20
    Chiropractic Services $20
    Acupuncture $20
    Podiatry Services $20
    Home Health Agency Care $10
    Inpatient Mental health Care $150 per day, days 1-4.
    $0 for days 5-90
    $600 maximum per stay
    Medical Nutrition Therapy $0
    Dental Services $20 copay - Medicare covered
    Preventive Dental $25 for routine services
    Cleaning: 1 every 6 months
    Dental X-ray(s): 1 per year
    Oral Exam: 1 every 36 months
    Diabetes Self Management Training, Diabetic Services and Supplies 0% for testing supplies
    20% for diabetic shoes & inserts
    20% for insulin pump & supplies
    Immunizations $0
    Transportation Not Covered
    Smoking Cessation $0
    Hearing Services Diagnostic - $20
    Routine - $0
    Hearing Aid Fitting - $20
    Maximum allowance of $750 per ear towards the cost of hearing aid(s) every 3 years
    Vision Care Diagnostic - $20
    Routine - $0
    $75 plan allowance per year

    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.   

    Plan Monthly Premium
    Essential Select $0

2020 Plans With Drug Coverage

2020 Plans Without Drug Coverage

Value-Added Benefits

Every KelseyCare Advantage plan includes added benefits to help you get even more for your Medicare dollar, from vision coverage to health club membership.

See our value-added benefits

Always at Your Service

Call KelseyCare Advantage at 713-442-JOIN (5646) from 8 a.m. to 8 p.m., seven days a week.

We’ll help you evaluate your options and find a solution that meets your needs.


Call KelseyCare Advantage at 713-442-JOIN (5646) from 8 a.m. to 8 p.m., seven days a week.


We’ll help you evaluate your options and find a solution that meets your needs.

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