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KelseyCare Advantage Rx

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RxThis is a Medicare Advantage plan with Part D benefits. KelseyCare Advantage Rx provides prescription drug coverage in addition to the medical benefits of Medicare parts A and B, plus much more.

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  Description
Plan Summary The KelseyCare Advantage Rx plan works well for Medicare beneficiaries that need comprehensive coverage and low out of pocket expenses for their hospital, medical and prescription drug benefits. 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 Rx plan. However, you must maintain your Medicare Part B coverage to be a member of the Rx plan. The 2010 premium for Medicare Part B is $110.50 per month.
Doctor and Hospital Choice KelseyCare Advantage Rx 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 Rx nor the Original Medicare plan will pay for these services.
Documents for Download For a description of the KelseyCare Advantage Rx 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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H0332_WB10001_091809
Last Updated: 10/01/09