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KelseyCare Advantage Essential+Choice

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Essential + ChoiceThis plan provides the medical benefits of Medicare parts A and B, 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.

With this plan, you have the option of accessing doctors who are in or out of the KelseyCare Advantage provider network.

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  Description
Plan Summary The KelseyCare Advantage Essential+Choice 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. The Essential+Choice plan offers members the option to access doctors who are outside of the KelseyCare Advantage provider network.
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+Choice plan. However, you must maintain your Medicare Part B coverage to be a member of the Essential+Choice plan. The 2010 premium for Medicare Part B is $110.50 per month.
Doctor and Hospital Choice KelseyCare Advantage Essential+Choice has formed a network of doctors, specialists and hospitals. You can use doctors who are in or out of the KelseyCare Advantage provider network. The health providers in our network can change at any time. Members can elect to have their Kelsey-Seybold Clinic physician "coordinate" their care and receive a higher level of benefits coverage, or they can choose to "self-refer" for care outside of Kelsey-Seybold Clinic. Participants receive a higher level of benefits and pay lower out-of-pocket costs when they use network providers.
Documents for Download For a description of the KelseyCare Advantage Essential+Choice 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