KelseyCare Advantage

KelseyCare Advantage MA HMO for Retirees

KelseyCare Advantage Medicare health maintenance organization (MA HMO) is a Medicare Advantage Plan that provides health coverage to Medicare-enrolled retirees, surviving spouses, and their dependents who are enrolled in Medicare Parts A & B and live in select Texas counties.

Medical coverage is provided through a network of doctors and specialists in the Kelsey-Seybold network. You must use a provider in this network, however, you do not need to designate a primary care physician (PCP) or get referrals to specialists.

As with all Texas Employees Group Benefits Programs (GBP) coverage, you must continue to pay for Medicare Part B premiums; however, you pay less for dependent premiums and the plan has no yearly deductible – it even covers the Medicare deductible.

Program benefits

  • Physicians and lab services
  • Hospital services
  • Extended care services (based on medical necessity)
  • Prescription drug program
  • Behavioral health care benefits
  • Access to wellness programs

Split households

A split household is a household of at least two people, where at least one member is enrolled in Medicare and one member is not eligible for Medicare.

For example:
Rita and Gus are married and both are currently enrolled in HealthSelectSM of Texas. Rita is a state retiree who is 65 years old and enrolled in Medicare. Gus is also retired, but he is 64 years old and not yet eligible for Medicare. Rita can enroll in KelseyCare Advantage MA HMO while Gus stays enrolled in HealthSelect of Texas.

If more than one person in a household is enrolled in Medicare, all Medicare-enrolled household members must be enrolled in the same GBP health coverage plan.

For example:
Rosie and Mario are both 65, retired, enrolled in Medicare, and enrolled in HealthSelect of Texas Secondary. Their daughter Gabriella lives with them, is disabled and enrolled in Medicare, and enrolled in HealthSelect of Texas Secondary. Rosie, Mario, and Gabriella must all be enrolled in the same GBP health coverage plan. Rosie cannot enroll in KelseyCare Advantage MA HMO while Mario and Gabriella stay with HealthSelect of Texas Secondary.

Denial of coverage

Your KelseyCare Advantage enrollment must be accepted by the Center for Medicare and Medicaid Services (CMS). CMS may deny your enrollment for issues such as not being enrolled in Medicare Parts A and B. If you are denied enrollment in the KelseyCare Advantage MA HMO, you will continue with your current GBP/Medicare coverage.

Eligibility

To qualify for the KelseyCare Advantage MA HMO, you or/and your family must:

  • Be enrolled in Medicare Part A (hospital) and  Part B (other medical) coverage
  • Not have end-stage renal disease*, and
  • Live in the service area
The service area includes the following counties:
  • Brazoria
  • Chambers
  • Ft. Bend
  • Galveston
  • Harris
  • Liberty
  • Montgomery
  • Waller Counties

Resources