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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.

Essential+Choice (HMO-POS)

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.
 
Description
Who should join this plan?​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.​
You must:​
  • Be eligible for Medicare Part A and enrolled in Part B,
  • Continue to pay Part B premiums,
  • Live in the plan service area, and
  • Not have End-Stage Renal Disease (permanent kidney failure).
How much does it cost?​
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.​
What doctors can I use with this plan?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.​
 
Important Documents for KelseyCare Advantage Essential+Choice
  • 2019 Essential+Choice Summary of BenefitsPDF  
    SpanishPDF
  • 2019 Essential+Choice Evidence of CoveragePDF 
    Spanish (Coming Soon) PDF
  • 2019 Essential+Choice Annual Notice of ChangePDF 
    Spanish PDF

Need more information?
Call us at 713-442-JOIN (5646) or toll-free 1-800-663-7146. Or, chat with a Health Plan Specialist  online! It would be our pleasure to answer any questions you might have. TTY/TDD users may call 1-866-302-9336.

From October 1 through February 14, KelseyCare Advantage’s Health Plan Specialists are available from 8:00 a.m. to 8:00 p.m., seven days a week. From February 15 through September 30, KelseyCare Advantage’s Health Plan Specialists are available from 8:00 a.m. to 8:00 p.m., Monday through Friday. During this time on weekends and holidays, calls are handled by our voicemail system.
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