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KelseyCare Advantage Core (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for KelseyCare Advantage Core (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on KelseyCare Advantage Core (HMO) in 2025, please refer to our full plan details page.
KelseyCare Advantage Core (HMO) is a HMO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Houston metro and nearby outlying areas. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that KelseyCare Advantage Core (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about KelseyCare Advantage Core (HMO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For KelseyCare Advantage Core (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by KelseyCare Advantage Core (HMO).
Additional Benefits
The KelseyCare Advantage Core (HMO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $325 copay for days 1-5, with no copay for days 6-90. Outpatient services have a $300 copay, while primary care visits, including specialist visits, range from $15-$20. The plan covers emergency services with a $125 copay, and ambulance services with a $275 copay. Dental services have a $25 deductible and a $1,500 annual maximum, while vision services include eye exams with a $20 copay and eyewear benefits. Hearing exams and hearing aid fittings have a $20 copay, and prescription hearing aids are covered up to $750 per ear every three years.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the KelseyCare Advantage Core (HMO) plan. For days 1-5, the copay is $325, and there is no copay for days 6-90.
Outpatient Services See details
Outpatient Services include outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services, observation services, and ambulatory surgical center services have a $300 copay, while individual and group sessions for outpatient substance abuse have a $20 copay.
Partial Hospitalization See details
Partial Hospitalization is covered by KelseyCare Advantage Core (HMO) with a $25 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $275 copay for both ground and air ambulance services; transportation services to any health-related location are not covered. There is no coinsurance for these services.
Emergency Services See details
Emergency Services are covered under the KelseyCare Advantage Core (HMO) plan with a $125 copay, and Urgently Needed Services have a $25 copay. Worldwide Emergency Coverage has a 20% coinsurance, while Worldwide Urgent Coverage is not covered. Worldwide Emergency Transportation also has a 20% coinsurance, and there is a $20,000 maximum plan benefit for Worldwide Emergency Services.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered under the Primary Care benefit. Chiropractic services have a $20 copay, while Occupational Therapy Services and Physician Specialist Services have a $20 copay, and Physical Therapy and Speech-Language Pathology Services have a $15 copay; Individual and Group Sessions for Mental Health Specialty Services and Psychiatric Services have a $20 copay, and Additional Telehealth Benefits have a $0-$15 copay.
Preventive Services See details
Preventive Services include coverage for Medicare-covered preventive services, Annual Physical Exams, Health Education, Nutritional/Dietary Benefits, Enhanced Disease Management, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. However, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $20 copay, routine hearing exams (1 every year), and fitting/evaluation for hearing aids (1 every year) with a $20 copay. Prescription hearing aids are covered up to $750 per ear every three years, and OTC hearing aids are also covered.
Vision Services See details
Vision services include eye exams with a $20 copay. Eyewear has a combined maximum benefit of $125 per year. Contact lenses and eyeglasses (lenses and frames) are covered, but eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The KelseyCare Advantage Core (HMO) plan covers dental services with a $25 deductible and a maximum benefit of $1,500 per year. The plan covers oral exams, dental x-rays, prophylaxis (cleaning), and oral and maxillofacial surgery, but fluoride treatment and orthodontics are not covered, and several services are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by KelseyCare Advantage Core (HMO), including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, and other Medicare Part B drugs with between 0% and 20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered, but require prior authorization. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by KelseyCare Advantage Core (HMO), with a 15-20% coinsurance for Durable Medical Equipment (DME) and a 20% coinsurance for Prosthetic Devices and Medical Supplies. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the KelseyCare Advantage Core (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Lab Services are not covered. Diagnostic Radiological Services have a copay up to $200, and Therapeutic Radiological Services have a copay up to $50, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the KelseyCare Advantage Core (HMO) plan with no copay or coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the KelseyCare Advantage Core (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by KelseyCare Advantage Core (HMO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, with no copay, but acupuncture, meal benefits, Dual Eligible SNPs, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management, Institution for Mental Disease Services, Services in an Intermediate Care Facility, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. This plan offers OTC items as a supplemental benefit, and provides nicotine replacement therapy.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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