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Best Medicare Advantage Plans for 2018 Rating is from U.S. News and World Report, a leading publisher of annual authoritative rankings including Best Medicare Plans. Our plan does not have a direct relationship with U.S. News. This award was not given by Medicare. Our overall rating from Medicare for 2018 is 5.0. Our plan’s official CMS Star Rating can be found at www.Medicare.gov.

Our Plans

Coverage that offers peace of mind

Shopping for a Medicare plan can be challenging and confusing, but it doesn’t have to be.  With KelseyCare Advantage, you’ll have care delivered by the doctors of Kelsey-Seybold Clinic, Houston’s largest and most renowned private multi-specialty physician group.   KelseyCare Advantage was designed by the doctors of Kelsey-Seybold Clinic to provide Medicare beneficiaries with benefit plans that offer high quality care, financial protection and highly-rated customer service.  
 

Four KelseyCare Advantage Plans

KelseyCare Advantage offers 4 Medicare Advantage plans, each offering all of the benefits of Medicare without all of the cost.  You’ll have low copayments or coinsurance, worldwide emergency coverage, $0 copayment for routine vision exams, transportation to medical appointments and the protection of a $3,400 out-of-pocket maximum for in-network services.   An out-of-pocket maximum is the most you will have to pay for Medicare-covered services during a year for health care services you receive. Once you have reached your out-of-pocket maximum, KelseyCare Advantage begins to pay 100 percent of your Medicare-covered benefits.
 
NEW for 2019!
Evidence of Coverage -  Searchable and easy to use. Click the link of the plan you are enrolled in, you will be taken to the electronic version of the EOC.
Rx Plan:
Rx+Choice Plan
Essential Plan:
Essential+Choice Plan:
 
Please refer to the Summary of Benefits for a list of copayments and cost-sharing.  
Monthly PremiumIncludes Part D Drug Coverage
Includes
Point-of-Service Coverage
Summary of Benefits (PDF)Annual Notice of Change (PDF)Evidence of Coverage (PDF)
Rx
(HMO)
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$0   English 
Español

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Rx+Choice
(HMO-POS)
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$77 English 
Español

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Español

 
Essential
(HMO) Learn-Essential.png
$0 

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Español

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Español

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Español

Essential
+Choice
(HMO-POS)
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$0  English 
Español
English
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Español

 
Benefits-At-A-Glance
Our plan covers benefits that are important to you, such as doctor office visits, inpatient hospital care, outpatient surgery and more. Please see below for a listing of some of the benefits covered by KelseyCare Advantage.
 

Note: This is just a summary. A complete benefit description is available by viewing a Summary of Benefits or Evidence of Coverage (Member Handbook).

  Essential & Essential+Choice Plans (Medical Coverage only)Rx & Rx+Choice Plans(Medical & Drug Coverage)
 Copayment or Coinsurance AmountCopayment or Coinsurance Amount
Physician and Lab Services
Physician office visit$5 $5
Specialist office visit$20 $35
E-Visit$0 PCP / $10 Specialist $0 PCP / $25 Specialist
Video Visit$0 PCP / $20 Specialist $0 PCP / $35 Specialist
Routine physical exams$0$0
Fitness Benefit$0 - SilverSneakers®$0 - SilverSneakers®
Diagnostic x-rays, mammography, and lab tests$0$0
High Tech Radiology (ex MRI, CT)$150$150
Immunizations$0$0
Well woman exam$0$0
Hearing Testing$20$35
Hearing Aid Allowance$500 per year$125 per year /
$75 Per year
Speech, Physical and Occupational Therapy$20$35
Allergy Testing$0$0
Allergy serum$0$0
Allergy serum administration$0$0
Routine eye exam$0$0
Eyewear Allowance$75 per year$75 per year
Hospital Services
Inpatient Hospital Care$500$500
Outpatient/Services surgery$225 Ambulatory Surgery Center
$250 Hospital Facility
$225 Ambulatory Surgery Center
$300 Hospital Facility
Emergency Care$75 $75
Urgent Care$50 $50
Extended Care Services
Skilled nursing facility$0 days 1-20
$125 per day days 21-100
$0 days 1-20
$125 per day days 21-100
Home Health$10$10
Other Medical Services
Durable Medical Equipment20%20%
Prosthesis20%20%
Ambulance$100 $100
Behavioral Health
Inpatient mental health$500$500
Outpatient Mental Health Hospital Care $250 Hospital Facility $300 Hospital Facility
Outpatient Mental Health Care$20 Group Visit
$35 Individual Visit
$20 Group Visit
$35 Individual Visit

 

 
Our Service Area
Our service area includes the following counties in Texas:
Our Service Area Harris, Montgomery, Fort Bend and Galveston
(excluding the island).
If you are unsure if your residential address falls into one of these four counties, please contact our Sales department for more information.
    
Document Request
If you would like an Evidence of Coverage, Abridged Formulary or Provider/Pharmacy Directory mailed to you here are your options: We can also give you information in Braille, in large print, other languages or other alternate formats, upon request.
 

Find the plan that’s right for you

Often when potential KelseyCare Advantage members contact us, they are worried about all of their choices. We look out for them with a local team that is happy to take the time to explain exactly what they can expect from us AND how much it’s going to cost. That’s where the KelseyCare Advantage plan really shines. We treat potential members the way we would want our own loved ones to be treated. And if we’re not a good fit, we’ll tell you. To learn more about KelseyCare Advantage, call one of our knowledgeable Health Plan Specialists at 713-442-JOIN (5646). 

We’re available:

From October 1 through March 31, seven days a week from 8:00 a.m. to 8:00 p.m.
From April 1 through September 30, Monday through Friday from 8:00 a.m. to 8:00 p.m. 
Medicare & You Handbook
Medicare & You Medicare's Official Medicare & You Handbook

Learn as much as possible about the coverage available to you through Medicare.

Medicare & You

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