KelseyCare Advantage Core (HMO) Medicare Advantage Plan H0332-001 • 2027
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4500.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Not Included
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- See List
- Total Enrollment
- 759 beneficiaries
KelseyCare Advantage Core (HMO) Introduction
KelseyCare Advantage Core is a Medicare Advantage HMO plan offered by KelseyCare Advantage. It uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $4500.00 in-network maximum out-of-pocket. CMS Plan ID H0332-001 identifies this plan.
Plan Benefits
KelseyCare Advantage Core has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H0332-001.
Compare 2027 plan benefits with 2026.
Office Visits
| Covered Service | 2027 | 2026 |
|---|---|---|
| Primary care | In-network: $0 copay | In-network: $0 copay |
| Specialist | In-network: $20 copay | In-network: $20 copay |
Preventive and Wellness Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Annual wellness exam | In-network: $0 copay | In-network: $0 copay |
| Telehealth benefit | In-network: $0-$15 copay | In-network: $0-$15 copay |
| Routine chiropractic | Not covered | Not covered |
| Fitness benefits | Coming soon | In-network: $0 copay |
| Health education | In-network: $0 copay | In-network: $0 copay |
| Counseling services | Not covered | Not covered |
| Over-the-counter drug benefits | In-network: $0 copay | In-network: $0 copay |
| Health transportation (non-emergency) | Coming soon | In-network: $0 copay |
Diagnostic, Lab, and Imaging Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diagnostic radiology services | In-network: $25-$200 copay | In-network: $25-$200 copay |
| Lab services | In-network: $0 copay | In-network: $0 copay |
| Outpatient x-rays | In-network: $0 copay | In-network: $0 copay |
| Diagnostic tests and procedures | In-network: $0-$25 copay | In-network: $0-$25 copay |
Emergency and Urgent Care Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Emergency room care | $125 copay | $125 copay |
| Worldwide emergency care | Coming soon | 20% coinsurance |
| Urgent care | $25 copay | $25 copay |
| Inpatient hospital care | Tier 1 $325 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Tier 1 $325 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
| Skilled Nursing Facility | Tier 1 $0 per day for days 1-20 $221 per day for days 21-100 |
Tier 1 $0 per day for days 1-20 $218 per day for days 21-100 |
| Ground ambulance | In-network: $275 copay | In-network: $275 copay |
Mental Health Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Outpatient individual therapy | In-network: $20 copay | In-network: $20 copay |
| Outpatient group therapy | In-network: $20 copay | In-network: $20 copay |
| Inpatient psychiatric hospital care | Tier 1 $325 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Tier 1 $325 per day for days 1-5 $0 per day for days 6-90 $0 per stay |
Rehabilitation Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Physical therapy and speech and language therapy | In-network: $15 copay | In-network: $15 copay |
| Occupational therapy | In-network: $20 copay | In-network: $20 copay |
Medical Equipment and Supplies
| Covered Service | 2027 | 2026 |
|---|---|---|
| Diabetes supplies | In-network: $0 copay | In-network: $0 copay |
| Durable medical equipment | In-network: 20% coinsurance | In-network: 15%-20% coinsurance |
| Prosthetics | In-network: 20% coinsurance | In-network: 20% coinsurance |
Medicare Part B Drugs
| Covered Service | 2027 | 2026 |
|---|---|---|
| Chemotherapy | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered) | In-network: 0%-20% coinsurance | In-network: 0%-20% coinsurance |
Dental Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Oral exam | In-network: $0 copay | In-network: $0 copay |
| Dental x-rays | In-network: $0 copay | In-network: $0 copay |
| Cleaning | In-network: $0 copay | In-network: $0 copay |
| Periodontics | Not covered | Not covered |
| Endodontics | Not covered | Not covered |
| Restorative services | In-network: $0 copay | In-network: $0 copay |
| Implant services | Not covered | Not covered |
| Orthodontics | Not covered | Not covered |
| Oral/Maxillofacial surgery | In-network: $0 copay | In-network: $0 copay |
Vision Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Routine eye exam | In-network: $0 copay | In-network: $0 copay |
| Contact lenses | In-network: $0 copay | In-network: $0 copay |
| Eyeglass frames only | Not covered | Not covered |
| Eyeglass lenses only | Not covered | Not covered |
| Eyeglasses (frames & lenses) | In-network: $0 copay | In-network: $0 copay |
| Upgrades | Not covered | Not covered |
Hearing Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Hearing exam | In-network: $0 copay | In-network: $0 copay |
| Fitting/evaluation | In-network: $20 copay | In-network: $20 copay |
| Prescription hearing aids | In-network: $0 copay | In-network: $0 copay |
| OTC hearing aids | Not covered | Not covered |
Additional and Special Needs Services
| Covered Service | 2027 | 2026 |
|---|---|---|
| Adult day health services | Not covered | Not covered |
| Home-based palliative care | Not covered | Not covered |
| Personal emergency response system | Coming soon | Not covered |
| Weight management programs | Not covered | Not covered |
| Wigs for chemotherapy-related hair loss | Coming soon | Not covered |
| Alternative therapies | Not covered | Not covered |
| Massage therapy | Not covered | Not covered |
| Home/bathroom safety devices | Not covered | Not covered |
Certain preventive services are covered 100% by KelseyCare Advantage Core as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Performance Ratings (Contract ID: H0332)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for KelseyCare Advantage
- Website
- KelseyCare Advantage Plan Page
- Providers
- KelseyCare Advantage Providers Page
- Formulary
- KelseyCare Advantage Formulary Page
- Pharmacy
- KelseyCare Advantage Pharmacy Page
- New Member Health Plan Help
- (800)663-7146
- New Member Health Plan TTY
- (800)735-2989
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Plan Availability
KelseyCare Advantage Core (H0332-001-0) is available in the following locations:
Frequently Asked Questions
Here are some of the most frequently asked questions about this plan (click to open).
Frequently Asked Questions About KelseyCare Advantage Core (HMO)
How much does plan H0332-001 cost per month?
The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.
What is the MOOP for KelseyCare Advantage Core in 2027?
The 2027 in-network MOOP is $4500.00. Once this limit is reached, covered in-network costs are fully covered.
How many beneficiaries are enrolled in this plan?
CMS reports 759 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2027?
For 2027, the prescription drug deductible is $0.00.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| KelseyCare Advantage (official source) | http://www.kelseycareadvantage.com | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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