2023 KelseyCare Advantage Silver Freedom (HMO-POS)

KelseyCare Advantage Silver Freedom (HMO-POS) H0332-003 is a 2023 Medicare Advantage Plan or Part-C by KelseyCare Advantage available to residents in Texas. This plan does not provide extra prescription drug (Part-D) coverage. KelseyCare Advantage KelseyCare Advantage Silver Freedom (HMO-POS) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $3,450 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $3,450 out-of-pocket. This can be an extremely nice safety net.

KelseyCare Advantage works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for KelseyCare Advantage Silver Freedom (HMO-POS) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from KelseyCare Advantage and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from KelseyCare Advantage except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Texas.

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2023 KelseyCare Advantage Medicare Advantage Plan Overview

Name:	KelseyCare Advantage Silver Freedom (HMO-POS)
Plan ID:	H0332 003 0
Provider:	KelseyCare Advantage
Year:	2023
Type:	Local HMO *
Combined Premium (C+D):	$0/mo
MOOP:	$3,450/yr
Similar Plan:	H0332-004

What type of plan is KelseyCare Advantage Silver Freedom (HMO-POS)

KelseyCare Advantage Silver Freedom (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your primary care physician will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your primary care physician approval, called a referral. Services received from an out-of-network provider are not typically covered.

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

How much does KelseyCare Advantage Silver Freedom (HMO-POS) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. KelseyCare Advantage charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. KelseyCare Advantage Silver Freedom (HMO-POS) by KelseyCare Advantage MOOP is $3,450. Once you spend $3,450 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what KelseyCare Advantage Silver Freedom (HMO-POS) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from KelseyCare Advantage helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

Contact lenses

In-Network Vision	$0 copay

Eyeglass frames

Vision	Not covered

Eyeglass lenses

Vision	Not covered

Eyeglasses (frames and lenses)

In-Network Vision	$0 copay

Other

Vision	Not covered

Routine eye exam

In-Network Vision	$0 copay

Upgrades

Vision	Not covered

In-Network Transportation	$0 copay
Out-of-Network Skilled Nursing Facility	50% per stay
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $125 per day for days 21 through 100

Occupational therapy visit

Out-of-Network Rehabilitation services	50% coinsurance
In-Network Rehabilitation services	$10 copay

Physical therapy and speech and language therapy visit

In-Network Rehabilitation services	$10-20 copay
Out-of-Network Rehabilitation services	$10-250 copay or 0-50% coinsurance

Cleaning

In-Network Preventive dental	$0 copay

Dental x-ray(s)

In-Network Preventive dental	$0 copay

Fluoride treatment

Preventive dental	Not covered

Oral exam

In-Network Preventive dental	$0 copay

Out-of-Network Preventive care	50% coinsurance
In-Network Preventive care	$0 copay
Out-of-Network Outpatient hospital coverage	20% coinsurance per visit
In-Network Outpatient hospital coverage	$250 copay per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

Inpatient hospital - psychiatric

In-Network Mental health services	$325 per stay
Out-of-Network Mental health services	40% per stay

Outpatient group therapy visit

In-Network Mental health services	$20 copay
Out-of-Network Mental health services	$10-250 copay or 0-50% coinsurance

Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$20 copay
Out-of-Network Mental health services	$10-250 copay or 0-50% coinsurance

Outpatient individual therapy visit

Out-of-Network Mental health services	$10-250 copay or 0-50% coinsurance
In-Network Mental health services	$20 copay

Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$20 copay
Out-of-Network Mental health services	$10-250 copay or 0-50% coinsurance

Chemotherapy

Out-of-Network Medicare Part B drugs	20% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

Other Part B drugs

In-Network Medicare Part B drugs	20% coinsurance
Out-of-Network Medicare Part B drugs	20% coinsurance

Diabetes supplies

In-Network Medical equipment/supplies	$0 copay
Out-of-Network Medical equipment/supplies	50% coinsurance per item

Durable medical equipment (e.g., wheelchairs, oxygen)

In-Network Medical equipment/supplies	15-20% coinsurance per item
Out-of-Network Medical equipment/supplies	50% coinsurance per item

Prosthetics (e.g., braces, artificial limbs)

Out-of-Network Medical equipment/supplies	50% coinsurance per item
In-Network Medical equipment/supplies	20% coinsurance per item

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$3,450 In-network $10,000 Out-of-network
In-Network Inpatient hospital coverage	$325 per stay
Out-of-Network Inpatient hospital coverage	40% per stay

Fitting/evaluation

In-Network Hearing	$20 copay

Hearing aids

In-Network Hearing	$0 copay

Hearing exam

In-Network Hearing	$20 copay
Out-of-Network Hearing	20% coinsurance

Health plan deductible	$0
In-Network Ground ambulance	$200 copay
Out-of-Network Ground ambulance	$10-250 copay or 0-50% coinsurance

Foot exams and treatment

In-Network Foot care (podiatry services)	$20 copay
Out-of-Network Foot care (podiatry services)	$10-250 copay or 0-50% coinsurance

Routine foot care

Foot care (podiatry services)	Not covered

Emergency

Emergency care/Urgent care	$120 copay per visit (always covered)

Urgent care

Emergency care/Urgent care	$25 copay per visit (always covered)

Primary

In-Network Doctor visits	$0 copay
Out-of-Network Doctor visits	$10-250 copay or 0-50% coinsurance per visit

Specialist

In-Network Doctor visits	$20 copay per visit
Out-of-Network Doctor visits	$10-250 copay or 0-50% coinsurance per visit

Diagnostic radiology services (e.g., MRI)

In-Network Diagnostic procedures/lab services/imaging	$0-150 copay
Out-of-Network Diagnostic procedures/lab services/imaging	20% coinsurance

Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$0-25 copay
Out-of-Network Diagnostic procedures/lab services/imaging	20% coinsurance

Lab services

Out-of-Network Diagnostic procedures/lab services/imaging	$10-250 copay or 0-50% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$0 copay

Outpatient x-rays

In-Network Diagnostic procedures/lab services/imaging	$0 copay
Out-of-Network Diagnostic procedures/lab services/imaging	$10-250 copay or 0-50% coinsurance

Diagnostic services

Comprehensive dental	Not covered

Endodontics

Comprehensive dental	Not covered

Extractions

In-Network Comprehensive dental	50% coinsurance

Non-routine services

In-Network Comprehensive dental	50% coinsurance

Periodontics

In-Network Comprehensive dental	50% coinsurance

Prosthodontics, other oral/maxillofacial surgery, other services

In-Network Comprehensive dental	50% coinsurance

Restorative services

In-Network Comprehensive dental	50% coinsurance

In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	Yes, contact plan for further details

KelseyCare Advantage Silver Freedom (HMO-POS) Reviews

Is KelseyCare Advantage Silver Freedom (HMO-POS) a good plan? KelseyCare Advantage Silver Freedom (HMO-POS) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare KelseyCare Advantage Silver Freedom Reviews among several different plans.

2022 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing

Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity

Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Pain Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Controlling Blood Pressure
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy

Member Experience with H0332-003 Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination

Member Complaints and Changes in Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement

Health Plan Customer Service Rating for KelseyCare Advantage

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language

Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language

Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement

Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs

Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for KelseyCare Advantage Silver Freedom (HMO-POS) requires you to live in that plan’s service area. The service area is listed below:

State:	Texas Medicare
County:	Brazoria County MA Plans Fort Bend County MA Plans Galveston County MA Plans Harris County MA Plans Montgomery County MA Plans

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How much does KelseyCare Advantage Silver Freedom (HMO-POS) cost?

KelseyCare Advantage charges a $0 monthly premium. A monthly premium is the fee you pay to the plan in exchange for coverage. The premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

How much is KelseyCare Advantage Silver Freedom (HMO-POS) MOOP?

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. KelseyCare Advantage Silver Freedom (HMO-POS) by KelseyCare Advantage MOOP is $3,450. Once you spend $3,450 you will pay nothing for Part A or Part B covered services.

What type of plan is KelseyCare Advantage Silver Freedom (HMO-POS)?

KelseyCare Advantage Silver Freedom (HMO-POS) is a Local HMO *. With a health maintenance organization you will be required to receive most of your health care from an in-network provider. HMOs require that you select a primary care physician (PCP).

With a HMO-POS point-of-service you have the option to go out-of-network or see a specialist without a referral. But, you may pay more for out-of-network care you receive than from an in-network provider.

Is KelseyCare Advantage Silver Freedom (HMO-POS) a good plan?

KelseyCare Advantage Silver Freedom (HMO-POS) received a 5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance.

Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.