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KelseyCare Advantage Essential

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EssentialThis plan provides the medical benefits of Medicare part A (your hospital coverage) and Medicare part B (your medical coverage), plus much more, 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 may want to contact the employer to be sure your drug coverage won’t be interrupted by enrolling in KelseyCare Advantage.

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  Description
Plan Summary 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 coverage for routine vision, routine hearing and medical transportation.
Eligibility
  • 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.
Premium There is no monthly plan premium to enroll in the Essential plan. However, you must maintain your Medicare Part B coverage to be a member of the Essential plan. The 2010 premium for Medicare Part B is $110.50 per month. Additionally, as a member of the Essential plan, KelseyCare Advantage will contribute $30.00 toward the cost of your Medicare Part B premium each month.
Doctor and Hospital Choice KelseyCare Advantage Essential has formed a network of doctors, specialists and hospitals. You can only use doctors who are part of our network. The health 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.
Documents for Download For a description of the KelseyCare Advantage Essential benefits, download the Summary of Benefits PDF  PDF 2010. For comprehensive documentation of the benefits, limitations and exclusions for this plan, download the Evidence of Coverage PDF  PDF 2010.
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Last Updated: 10/01/09