Call to Speak with an Enrollment Specialist
Questions About Medicare Advantage
Answers to Your Most Frequent Questions
General Information
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How much do I pay for Medicare coverage?
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As a KelseyCare Advantage member, will I have to use one clinic or doctor?
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When can I make an appointment?
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Do I have to renew my enrollment with KelseyCare Advantage every year or is renewal automatic?
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Does KelseyCare Advantage offer dental coverage in 2022?
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Does KelseyCare Advantage provide coverage outside the Houston area?
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How do KelseyCare Advantage plans work?
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What out-of-network services are covered if I enroll in one of the Point-of-Service (POS) plans?
About KelseyCare Advantage Plans
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When can I join KelseyCare Advantage?
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How can I compare my options?
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Where is KelseyCare Advantage available?
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Can I choose my doctors?
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Does my plan cover prescription drugs?
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How can I get more information?
Doctors and Appointments
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How do I choose a primary care physician (PCP)?
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How do I schedule appointments?
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Do I need to see my PCP to get a referral to other providers?
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What happens if I go to a doctor who’s not in the KelseyCare Advantage network?
Pharmacies
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Where can I get my prescriptions filled?
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What is a pharmacy that offers preferred cost sharing?
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What if I must use an out-of-network pharmacy?
Prescription Drugs
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What is the KelseyCare Advantage Formulary?
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How will I find out if my drug’s coverage has changed?
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Are there programs to help people with limited financial resources pay for their prescription drugs?
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What do I do before I can talk to my doctor about changing my drugs or requesting an exception?
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What if I have unexpected medication changes due to level-of-care changes?
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What is a Medication Therapy Management (MTM) Program?
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What if my drug isn’t on the formulary or there are restrictions on my coverage?
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How do I request an exception to the KelseyCare Advantage Formulary?
Always at Your Service
Call Member Services at at 713-442-CARE (2273) or toll-free at 1-800-535-8343 (TTY: 711) from 8 a.m. to 8 p.m., seven days a week, from October 1 to March 31 and 8 a.m. to 8 p.m., Monday through Friday, from April 1 to September 30.