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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.

Frequently Asked Questions

KelseyCare Advantage offers answers to frequently asked questions about our Medicare Advantage plans, our provider network and other important topics.  These links will guide you to further information on our website or from other sources. Should you have any further questions about anything, including your Medicare benefits, please Contact Us.​ 

FAQ Categories

General Information
 
How much do I pay for Medicare coverage? 
Part A Monthly Premiums
Most people do not pay for Part A, because they have paid Medicare taxes for 40 or more quarters while working. Those with 30 to 39 quarters of covered employment can buy Part A coverage.  
 
Part B Monthly Premiums
Part B does have a monthly premium. Most people will pay the standard premium amount.  You also pay a Part B deductible each year before Medicare starts to pay its share. The Part B premium and deductible can change every year. 
As a KelseyCare Advantage member, will I have to use one clinic or doctor?
When you join KelseyCare Advantage, you generally must receive your care from a network provider. Network providers are the doctors and other health care professionals, medical groups, hospitals, and other health care facilities that have an agreement with us to accept our payment in full. We have arranged for these providers to deliver covered services to members in our plan. The cornerstone of the KelseyCare Advantage network is Kelsey-Seybold Clinic. 

In most cases, care you receive from a non-Kelsey-Seybold doctor will not be covered.

Here are two exceptions

  • The plan covers emergency care or urgently needed care that you get from a non-network provider.
  • If you need medical care that Medicare requires our plan to cover and the providers in our network cannot provide this care, you can get this care from a non-network provider. An authorization should be obtained from the plan prior to seeking care. In this situation, you will pay the same as you would pay if you got the care from a network provider. 
You may decide to see any Kelsey-Seybold Clinic primary care physician or specialist within the clinic at any time without a referral. It is not necessary to notify Member Services if you decide to change doctors. Simply schedule an appointment with the Kelsey-Seybold physician of your choice. However, you can contact Member Services if you need assistance. 

Important Note about Affiliate Contract Providers: When Kelsey-Seybold Clinic does not have the staff specialist you need at any of their locations, you can be referred to a specialist who has been selected by Kelsey-Seybold physicians. Your PCP will submit a request to KelseyCare Advantage for approval of non-Kelsey-Seybold providers. Both you and the specialist to whom you are referred will receive written confirmation if the service is approved.

For a list of current network providers, download a Provider Directory, or search for a Kelsey-Seybold Clinic provider by specialty, location, gender or languages spoken. 
When can I make an appointment?
Once enrolled in our Medicare Advantage plan, you may schedule an appointment with any Kelsey-Seybold Clinic physician. You will need to present a KelseyCare Advantage membership card at the time of your appointment.

For personal assistance in finding a doctor or scheduling an appointment, call the KelseyCare Advantage concierge. Our knowledgeable representatives are ready to assist KelseyCare Advantage members. Call 713-442-9540 or toll free 1-866-535-8405. You may also schedule a future appointment online at Kelsey-Seybold Clinic.
How do KelseyCare Advantage plans work?
KelseyCare Advantage is a Medicare Advantage plan that is contracted and approved by Medicare. As a KelseyCare Advantage member, you receive all your Medicare benefits through the KelseyCare Advantage plan that you select.

To join KelseyCare Advantage, you must have Medicare Part A and Part B. You will continue to pay your monthly Medicare Part B premium to Medicare. 

Once you join a KelseyCare Advantage plan, you use the health insurance card provided by the plan. KelseyCare Advantage offers extra Medicare benefits and often lower co-payments than the original Medicare plan. KelseyCare Advantage contracts with Kelsey-Seybold Clinic, which means you can choose physicians and other health care providers who are part of Kelsey-Seybold Clinic.

About KelseyCare Advantage Plan


Am I protected?
How can I get more information?

Am I protected?
All Medicare Advantage plans agree to stay in the program for a full year at a time. Each year, the plans decide whether to continue for another year. Even if a Medicare Advantage plan leaves the program, you will not lose Medicare coverage. If a plan decides to discontinue, it must send you a letter at least 90 days before your coverage will end. The letter will explain your options for Medicare coverage in your area.

How can I get more information?
Please call a KelseyCare Advantage health plan specialist at:

713-442-2ERS (2377) or
Toll free 1-877-853-9075
TTY/TDD 1-866-302-9336
8:00 a.m. to 5:00 p.m., Monday - Friday. 
Doctors
How do I choose a PCP?
How do I schedule appointments?
Do I need to see my PCP to get a referral to other providers?
What happens if I go to a doctor who’s not in the KelseyCare Advantage network?
How can I find a KelseyCare Advantage provider in my area?
 
How do I choose a PCP? When you become a member of KelseyCare Advantage, you will choose a Kelsey-Seybold doctor to be your Primary Care Physician (PCP).  Your routine or basic care will come from your PCP. Your PCP can also coordinate the rest of the covered services you need. You may select a physician who specializes in Family Medicine or Internal Medicine as your PCP. In addition to a PCP, you also have the right to designate an OB/GYN and access care from that physician without a referral.
 
Download a PDF of our Provider Directory, or search for a provider by specialty, location, gender or languages spoken.
 
How do I schedule appointments? 
For personal assistance in finding a doctor or scheduling an appointment, call the Kelsey-Seybold Clinic Customer Service Contact Center at 713-442-0000. The Contact Center is open 24 hours a day, 7 days a week. You may also schedule a future appointment on-line at Kelsey-Seybold Clinic
Do I need to see my PCP to get a referral to other providers? You may see any Kelsey-Seybold Clinic physician without a referral. However, you will get most of your routine or basic care from your PCP. Your PCP can also coordinate your covered services. You will need a referral to obtain services from a non-Kelsey-Seybold Clinic doctor, hospital or other health care provider. If you don't obtain a referral ahead of time from your Kelsey-Seybold Clinic physician, you may have to pay for these services yourself.
 
What happens if I go to a doctor who’s not in the KelseyCare Advantage network? If you choose to go to a doctor outside of our network, you must pay for these services yourself. Neither KelseyCare Advantage nor the original Medicare plan will pay for these services.
 
How can I find a KelseyCare Advantage provider in my area? You may search for a provider by specialty, location, gender or languages spoken. You can also call a KelseyCare Advantage member services representative at: 713-442-2ERS (2377) or
Toll free 1-877-853-9075
TTY/TDD 1-866-302-9336