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Best Medicare Advantage Plans for 2019 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 2019 is 5.0. Our plan’s official CMS Star Rating can be found at www.Medicare.gov.

Optional Supplemental Dental Coverage

 
KelseyCare Advantage is excited to offer our members the option of purchasing Supplemental Dental Coverage effective January 1, 2020. Our plan offers some extra benefits that are not covered by Original Medicare and are not included in your benefits package as a plan member. These extra benefits are called “Optional Supplemental Benefits”. If you want these optional supplemental benefits, you must sign up and purchase them.
 
Adding Optional Supplemental Benefits to your plan
You must be enrolled a KelseyCare Advantage plan and have a plan ID number in order to enroll into an Optional Supplemental Benefit Plan. Enrolling into an Optional Supplemental Benefit Plan is optional and has a monthly premium of $38.80.
 
Enrolling in Optional Supplemental Benefits
To enroll in an Optional Supplemental Benefit Plan, call KelseyCare Advantage Sales at 713-442-JOIN (5646). In general, you must first be enrolled in the plan and have a plan ID number. Enrollment into the Optional Supplemental Benefit Plan may be requested at the time of enrollment into KelseyCare Advantage or any time after membership in the current benefit year. You can enroll in Optional Supplemental Benefits by providing a completed supplemental benefits enrollment application during one of the following times: Between October 15, 2019 and December 7, 2019, for coverage to become effective January 1, 2020 or anytime during the 2020 benefit year for coverage to begin the first day of the following month.
 
Detailed coverage rules, procedure descriptions and cost share information can be found here
 
How to choose a network Dentist:

http://fcldental.com/provider-search

 

Covered Dental Services

FCL Dental Coverage Table:
You may receive the following dental services: Benefits received out of network are not covered, you will be responsible for all costs.

Coverage Description
Monthly Premium Amount$38.80
Deductible (For Type II and Type III Services) $25
Copayment (Type I – Preventive services)$25 per visit
Annual Maximum (After the annual maximum is exhausted, any remaining charges are your responsibility)$3,000
Waiting Period for Type III Services12 Months

  

Percentage of Covered Dental Expenses Payable:
Covered charges in excess of the Deductible or Copayment Amount will be paid FCL Dental up to the Maximum Contract Year Payment or Orthodontia Lifetime Maximum (if applicable) at the Coinsurance Rates below:

Service Type Service Description Coverage Rate Amount you pay
Type IPreventative Services100%$25 Copayment per visit
Type IIBasic Services80%20% of the cost
Type IIIMajor Services50%50% of the cost
 
ID Card for KelseyCare Advantage members who have purchased Optional Supplemental Dental Benefits
Your KelseyCare Advantage member ID number begins with “KCA” and is the same ID number you use for your optional supplemental dental benefits, if you have purchased supplemental dental benefits.
  • Show your dental office your KelseyCare Advantage Medical ID
  • Your dental provider will contact our Member Service Department to confirm your eligibility, plan benefits, and more.
In addition to showing the dental office your KelseyCare Advantage ID card, you may print the dental card here.