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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 2026, 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 2026.
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 $6750.00 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 features an annual drug deductible of $200. Under this plan, you will pay no copay for Tier 1 preferred generics and Tier 6 select care drugs when using preferred pharmacies or preferred mail-order services. For Tier 2 generic medications, copays start as low as $5 for a one-month supply at preferred locations, while standard pharmacies charge up to $15. Tier 3 preferred brand drugs require a $40 copay for a one-month supply at preferred pharmacies, compared to a $47 copay at standard pharmacies. Higher-tier medications are subject to coinsurance rather than flat copays, with Tier 4 non-preferred drugs requiring 35% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance. Managing your prescriptions through preferred pharmacies or mail-order options provides the most cost-effective rates under this plan.
Additional Benefits
The KelseyCare Advantage Freedom (HMO-POS) plan offers robust medical coverage with no copay for primary care visits, preventive care, and home health services. For specialist visits, urgent care, and routine vision or hearing exams, members pay predictable flat copayments with no coinsurance. Inpatient hospital stays require a $375 daily copay for the first five days with no copay for days six through 90, while outpatient surgical and hospital services carry copays between $300 and $350. This plan also features helpful supplemental benefits, including ten one-way transportation trips per year, an annual $175 eyewear allowance, and a $25 quarterly over-the-counter allowance with no copays. Other covered dental services and prescription hearing aids up to $750 per ear also feature no copays or coinsurance. For specialized needs like durable medical equipment, dialysis, and Part B medications, members are responsible for a 15% to 20% coinsurance.
Inpatient Hospital See details
KelseyCare Advantage Freedom (HMO-POS) partially covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a $375 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Additional hospital days, upgrades, and non-Medicare-covered stays are not covered under this benefit.
Outpatient Services See details
KelseyCare Advantage Freedom (HMO-POS) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital and observation services and a $300 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $20 copay with no coinsurance, while outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
KelseyCare Advantage Freedom (HMO-POS) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive these covered services.
Ambulance and Transportation Services See details
KelseyCare Advantage Freedom (HMO-POS) covers ground and air ambulance services with a $325 copay and no coinsurance per trip. Transportation services are partially covered, offering up to 10 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
KelseyCare Advantage Freedom (HMO-POS) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within three days, and urgent care with a $40 copay and no coinsurance. Worldwide emergency services are partially covered up to a $20,000 maximum plan benefit with no copay and a 20% coinsurance for emergency care and transportation, though worldwide urgent care is not covered.
Primary Care See details
KelseyCare Advantage Freedom (HMO-POS) covers primary care physician services with no copay and no coinsurance, while specialist visits and occupational therapy require a $35 copay and no coinsurance. Physical therapy is covered with a $15 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by KelseyCare Advantage Freedom (HMO-POS) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, and health education. A variety of supplemental services are not covered under this benefit, including in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, and alternative therapies.
Hearing Services See details
KelseyCare Advantage Freedom (HMO-POS) covers routine and Medicare-covered hearing exams for a $35 copay and no coinsurance, alongside annual fitting evaluations for a $25 copay and no coinsurance. Prescription hearing aids are partially covered with no copay or coinsurance up to a $750 maximum per ear every three years, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
KelseyCare Advantage Freedom (HMO-POS) offers partially covered vision services, featuring one routine eye exam per year for a $35 copay and no coinsurance, while other eye exams are not covered. Eyewear is covered with no copay and no coinsurance up to a $175 annual maximum for one pair of contact lenses or eyeglasses, though individual eyeglass lenses, frames, and upgrades are excluded.
Dental Services See details
KelseyCare Advantage Freedom (HMO-POS) offers partially covered dental services up to a $2,000 annual limit, with a $35 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for other covered services. Sub-services that are not covered under this plan include other diagnostic dental services, fluoride treatment, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
KelseyCare Advantage Freedom (HMO-POS) covers Home Infusion bundled Services with no copay, requiring prior authorization and step therapy. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and up to 20% coinsurance (with no minimum coinsurance), while Medicare Part B insulin is covered with a $35 copay and up to 20% coinsurance.
Dialysis Services See details
KelseyCare Advantage Freedom (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive this covered benefit.
Medical Equipment See details
Medical equipment is partially covered by KelseyCare Advantage Freedom (HMO-POS), offering no copay for all covered items, though prior authorization is required. Durable medical equipment carries a 15% to 20% coinsurance, and prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require a 20% coinsurance, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by KelseyCare Advantage Freedom (HMO-POS) with no coinsurance, though prior authorization is required. Covered diagnostic tests range from no copay to a $25 copay, diagnostic radiology requires a minimum $25 copay, and therapeutic radiology requires a minimum $50 copay, while lab services and outpatient x-ray services are not covered.
Home Health Services See details
KelseyCare Advantage Freedom (HMO-POS) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
KelseyCare Advantage Freedom (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance, though prior authorization is required. While some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
KelseyCare Advantage Freedom (HMO-POS) covers skilled nursing facility (SNF) care with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, but a prior three-day hospital stay is not, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by KelseyCare Advantage Freedom (HMO-POS), including over-the-counter (OTC) items with no copay and no coinsurance up to $25 every three months, and supplemental surgeries in an ambulatory surgical center for a $300.00 copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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