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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 (HMO)

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. 
Description
 
Who should join this plan?​ 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.
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 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.​
What doctors can I use with this plan?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​
 
Important Documents for KelseyCare Advantage Essential
  • 2019 Essential Summary of BenefitsPDF  
    Spanish​PDF
  • 2019 Essential Evidence of CoveragePDF  
    Spanish (Coming Soon)PDF 
  • 2019 Essential Annual Notice of ChangesPDF 
    SpanishPDF

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 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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