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KelseyCare Advantage Freedom (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for KelseyCare Advantage Freedom (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on KelseyCare Advantage Freedom (HMO-POS) in 2025, please refer to our full plan details page.
KelseyCare Advantage Freedom (HMO-POS) is a HMO-POS 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 Freedom (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about KelseyCare Advantage Freedom (HMO-POS).
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 Freedom (HMO-POS), 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.
This plan has a $200.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $10000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $6500.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 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
The KelseyCare Advantage Freedom (HMO-POS) plan has a $200 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies, and specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The KelseyCare Advantage Freedom (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services like primary care have no copay. The plan also covers hearing and vision services with copays for exams, along with dental services and home health services with no copay. This plan includes coverage for emergency services, ambulance, and transportation services with copays. It also offers benefits like home infusion, dialysis, and medical equipment, but some services may require prior authorization or have coinsurance. Additionally, the plan covers over-the-counter items, but excludes services like acupuncture and private duty nursing.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both acute and psychiatric inpatient stays. For days 1-5, there is a $375 copay, and for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $350 copay, observation services with a $350 copay, ambulatory surgical center services with a $300 copay, and outpatient substance abuse services with a $20 copay for individual and group sessions. Outpatient blood services are also covered, with three pints deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered under the KelseyCare Advantage Freedom (HMO-POS) plan, with a $25 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by KelseyCare Advantage Freedom (HMO-POS), with a $275 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered for 10 one-way trips per year via bus/subway or other transportation, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the KelseyCare Advantage Freedom (HMO-POS) plan, with a $125 copay. Urgently Needed Services have a $40 copay, and Worldwide Emergency Services are covered with 20% coinsurance for Worldwide Emergency Coverage and Worldwide Emergency Transportation, but Worldwide Urgent Coverage is not covered.
Primary Care See details
Primary Care benefits include coverage for primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $35 copay, mental health specialty services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits with a $0-$15 copay, and Opioid Treatment Program Services with a $0-$20 copay and 20% coinsurance. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, health education, nutritional/dietary benefits, enhanced disease management, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs with no copay. In-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $35 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids with a $25 copay. Prescription hearing aids are covered up to $750 every three years, while OTC hearing aids are also covered.
Vision Services See details
Vision services include routine eye exams with a $35 copay, and eyewear benefits. Contact lenses and eyeglasses (lenses and frames) are covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include a $35 copay for Medicare dental services. Other dental services include coverage for oral exams, dental x-rays, and prophylaxis (cleaning), each with a limit of one visit per year, and a $2,000 maximum plan benefit. Fluoride treatment, maxillofacial prosthetics, implant services, and orthodontics are not covered. Orthodontic services are covered under Diagnostic and Preventive Dental (16b).
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the KelseyCare Advantage Freedom (HMO-POS) plan, but require prior authorization. The coinsurance for these services is 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with a 15-20% coinsurance and Prosthetics/Medical Supplies with a 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the KelseyCare Advantage Freedom (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $25, while Diagnostic Radiological Services have a copay of at most $200 and Therapeutic Radiological Services have a copay of at most $50; however, Lab Services and Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the KelseyCare Advantage Freedom (HMO-POS) plan with no copay and no coinsurance, but Additional Hours of Care and Personal Care Services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the KelseyCare Advantage Freedom (HMO-POS) plan, but the specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the KelseyCare Advantage Freedom (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Other 2, though the plan does not cover Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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. The plan covers Over-the-Counter (OTC) Items, including Nicotine Replacement Therapy (NRT) and Naloxone, and Other 2 services have a $300 copay and require prior authorization.
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