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KelseyCare Advantage Signature (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for KelseyCare Advantage Signature (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on KelseyCare Advantage Signature (HMO) in 2026, please refer to our full plan details page.
KelseyCare Advantage Signature (HMO) is a HMO plan offered by UnitedHealth Group, Inc. available for enrollment in 2025 to people living in Houston metro area. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that KelseyCare Advantage Signature (HMO) 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 Signature (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 Signature (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.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3900.00 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
The KelseyCare Advantage Signature (HMO) plan features no drug deductible, allowing your prescription drug coverage to begin immediately. For Tier 1 preferred generics and Tier 6 select care drugs, you will pay no copay when utilizing preferred pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, with copays starting at just $4 for a one-month supply at preferred pharmacies. For higher-tier medications, the plan transitions to a coinsurance model to help manage your out-of-pocket costs. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs and Tier 5 specialty drugs carry a 30% coinsurance. These coinsurance percentages remain the same whether you fill your prescriptions at a preferred or standard pharmacy.
Additional Benefits
The KelseyCare Advantage Signature (HMO) plan offers robust core medical coverage with predictable out-of-pocket costs, featuring no copay for primary care visits and a $20 copay for specialist consultations. Inpatient hospital stays require a $150 daily copay for the first four days followed by no copay for days five through ninety, while emergency room visits carry a $125 copay. Outpatient surgical services and ambulance rides are also covered with flat copayments and no coinsurance, helping you manage your healthcare budget effectively. Beyond standard medical care, this plan provides valuable supplemental benefits including dental coverage up to a $2,500 annual maximum with no copay for preventive and comprehensive care. Members also benefit from no copay on home health services, a $125 annual allowance for eyewear, and prescription hearing aid coverage up to $750 per ear every three years. Additionally, routine vision and hearing exams are accessible with a budget-friendly $20 copay, and there is no copay for unlimited transportation to plan-approved health locations.
Inpatient Hospital See details
KelseyCare Advantage Signature (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $150 daily copay for days 1 through 4 and no copay for days 5 through 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
KelseyCare Advantage Signature (HMO) covers outpatient hospital and observation services with a $300 copay per stay and no coinsurance, and ambulatory surgical center services with a $200 copay and no coinsurance. Outpatient substance abuse services require a $20 copay per session with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
KelseyCare Advantage Signature (HMO) covers partial hospitalization services with a $175.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
KelseyCare Advantage Signature (HMO) covers ground and air ambulance services with a $275 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering unlimited one-way trips to plan-approved health-related locations with no copay or coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
KelseyCare Advantage Signature (HMO) covers emergency services with a $125 copay and no coinsurance, which is waived if admitted to the hospital within 3 days, and urgently needed services with a $25 copay and no coinsurance. Worldwide emergency services are partially covered up to a $20,000 maximum with no copay and a 20% coinsurance for emergency care and transportation, though worldwide urgent coverage is not covered.
Primary Care See details
KelseyCare Advantage Signature (HMO) offers primary care physician services with no copay and no coinsurance, while specialist visits, occupational therapy, and mental health services require a $20 copay and no coinsurance. Physical therapy has a $15 copay and no coinsurance, but podiatry is not covered, and only some chiropractic services are covered as routine and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered by KelseyCare Advantage Signature (HMO) with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and nutritional therapy. Non-covered services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for hair loss, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by KelseyCare Advantage Signature (HMO), including routine hearing exams and fitting evaluations for a $20 copay and no coinsurance. Prescription hearing aids are partially covered with no copay and no coinsurance up to $750 per ear every three years, but OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services are covered by KelseyCare Advantage Signature (HMO) with no deductibles, featuring a $20 copay and no coinsurance for one annual routine eye exam, though other eye exam services are not covered. Eyewear is also covered with no copay and no coinsurance up to a $125 annual maximum for one pair of contact lenses or eyeglasses, while separate eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are partially covered by KelseyCare Advantage Signature (HMO), offering up to a $2,500 annual maximum for preventive and comprehensive care with no copay and no coinsurance, while Medicare-covered dental services require a $20 copay and no coinsurance. Non-covered services under this plan include fluoride treatments, other diagnostic or preventive dental services, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
KelseyCare Advantage Signature (HMO) covers Home Infusion bundled Services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin carries a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
KelseyCare Advantage Signature (HMO) covers Dialysis Services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
KelseyCare Advantage Signature (HMO) covers medical equipment with no copay, though prior authorization is required. Durable medical equipment incurs a 15% to 20% coinsurance, and prosthetics, medical supplies, and diabetic therapeutic shoes require a 20% coinsurance, while diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by KelseyCare Advantage Signature (HMO) with no coinsurance, though prior authorization is required. Covered diagnostic procedures range from no copay up to $25, diagnostic radiology has a minimum $25 copay, and therapeutic radiology has a minimum $50 copay, while lab services and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the KelseyCare Advantage Signature (HMO) plan with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
KelseyCare Advantage Signature (HMO) covers cardiac rehabilitation services with no coinsurance, although prior authorization is required. Covered services require a $20 copay for cardiac, intensive cardiac, and SET for PAD services, and a $15 copay for pulmonary rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by KelseyCare Advantage Signature (HMO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
KelseyCare Advantage Signature (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to $25 every three months via reimbursement, and supplemental surgeries in an ambulatory surgical center for a $200 copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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