713-442-JOIN (5646) Enroll Now Contact Us Why KelseyCare Advantage Explore Our Plans Prepare to Enroll New to Medicare Already a Member? Need more assistance? Call to 713-442-5646 to speak with an enrollment specialist, or Contact Us Online KelseyCare Advantage Home > Plan Detail Gold Freedom 2022 Benefits Summary This is a summary of what our plan covers and what you pay. It does not list every service that we cover or list every limitation or exclusion. To get a complete list of services we cover, please refer to the Evidence of Coverage, this legal member contract is the primary source of the coverage information and supersedes all other information. Download the Summary of Benefits 2022 Medical Benefits 2022 Premiums 2022 Prescription Drug Benefits Plan Summaries Medical Coverage Prescription Drug Coverage Comprehensive Dental Over-the-Counter Allowance COVID-19 Coverage Wellness Benefit Allowance Hearing & Vision Allowances $0 Tier 1 and Tier 2 Medications No Referrals for Out-of-Network Services And more You Must: Be eligible for Medicare Part A and enrolled in Part B, Continue to pay Part B premiums, Live in the plan service area, and How Much Does it Cost The monthly plan premium to enroll in the Gold Freedom plan is $0. Additionally, you must maintain your Medicare Part B coverage to be a member of any Medicare Advantage plan. Most people will pay the standard Part B premium amount. Please call Social Security at 1-800-772-1213 for information about your Part B premium. Also of Interest: Vision ServicesAppeals and GrievancesMedical Benefits KelseyCare Advantage Administrative Offices 11511 Shadow Creek Pkwy Pearland, TX 77584 Members: 713-442-CARE (2273) Toll-free: 1-866-535-8343 (TTY: 711) General Information: Call KelseyCare Advantage at 713-442-JOIN (5646) October 1–March 31 7 days a week 8 a.m. to 8 p.m. April 1–September 30 Monday–Friday 8 a.m. to 8 p.m. Connect With Us Facebook Twitter Youtube Instagram Linked In Resources Provider Portal Interoperability and Patient Access Privacy & Disclaimers Find a Location Find a Pharmacy Find a Prescription Drug Find a Doctor Sitemap Medicare Compliance Compliance and Fraud Discrimination Notice Emergency Notices Multi-Language Services Retiree Group Plans Greater Houston Plan (Shell) City of Houston Transport Workers Union KelseyCare Advantage is offered by KS Plan Administrators, LLC, a Medicare Advantage HMO with a Medicare contract. Enrollment in KelseyCare Advantage depends on contract renewal. The formulary, pharmacy network, and/or provider network may change at any time. You will receive notice when necessary. ©2021 KelseyCare Advantage. All rights reserved. H0332_WB22 Last Updated 10/25/21 X Cookies help us improve your website experience. By using our website, you agree to our use of cookies. Confirm