KelseyCare Advantage Freedom (HMO-POS) Medicare Advantage Plan H0332-004 • 2027 • Liberty County, TX
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6850.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $200.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Liberty County, TX
- Local Enrollment
- 146 beneficiaries in Liberty County
KelseyCare Advantage Freedom (HMO-POS) Introduction
CMS Plan ID H0332-004 identifies KelseyCare Advantage Freedom, a Medicare Advantage HMO-POS plan offered by KelseyCare Advantage. The plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. Its costs for the 2027 plan year include a $0.00 monthly premium, $0.00 medical deductible, and $6850.00 in-network maximum out-of-pocket. The 2027 Part D prescription drug deductible is $200.00.
Eligible Medicare beneficiaries residing in Liberty County, Texas can enroll in this plan. CMS reports local enrollment of 146 beneficiaries for this plan in Liberty County. New members can contact the plan at (800)663-7146 (TTY (800)735-2989) for help and additional plan information.
Compare Similar Plans in Liberty County
Compare this plan with the two most-enrolled HMO-POS plans available in Liberty County, Texas. Enrollment is based on CMS local enrollment data.
| Plan Detail | KelseyCare Advantage Freedom | AARP Medicare Advantage from UHC TX-0015 | Wellcare TexanPlus Classic Simple |
|---|---|---|---|
| CMS Plan ID | H0332-004-0 |
H4527-037-0 |
H4506-003-0 |
| Local Enrollment | 146 | 1,024 | 422 |
| Monthly Premium | $0.00 | $0.00 | $0.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $6,850.00 | $6,900.00 | $3,400.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $35 copay | $0-$65 copay | $5 copay |
| Part D Deductible | $200.00 | $685.00 | $700.00 |
| CMS Star Rating | 4.5 | 4.0 | 4.0 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | Not covered |
| Hearing | $0 copay | $0 copay | Not covered |
Plan Benefits
KelseyCare Advantage Freedom 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 H0332-004.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H0332-004-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $10-$60 copay, 40% coinsurance - Specialist
- In-network: $35 copay
Out-of-network: $10-$60 copay, 40% coinsurance
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
- Telehealth benefit
- In-network: $0-$15 copay
- Routine chiropractic
- Not covered
- Fitness benefits
- Coming soon
- Health education
- In-network: $0 copay
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $25-$250 copay
Out-of-network: 40% coinsurance - Lab services
- In-network: $0 copay
Out-of-network: 40% coinsurance - Outpatient x-rays
- In-network: $0 copay
Out-of-network: 40% coinsurance - Diagnostic tests and procedures
- In-network: $0-$25 copay
Out-of-network: 40% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $40 copay
- Inpatient hospital care
- In-network:
Tier 1
$395 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
40% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
40% per stay - Ground ambulance
- In-network: $350 copay
Out-of-network: $400 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $20 copay
Out-of-network: 40% coinsurance - Outpatient group therapy
- In-network: $20 copay
Out-of-network: 40% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$395 per day for days 1-5
$0 per day for days 6-90
$0 per stay
Out-of-network:
40% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $15-$20 copay
Out-of-network: 40% coinsurance - Occupational therapy
- In-network: $35 copay
Out-of-network: 40% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: $0 copay
Out-of-network: 40% coinsurance - Durable medical equipment
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 40% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- In-network: $0 copay
- Endodontics
- In-network: $0 copay
- Restorative services
- In-network: $0 copay
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: 40% coinsurance - Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- Not covered
- Eyeglass lenses only
- Not covered
- Eyeglasses (frames & lenses)
- In-network: $0 copay
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
Out-of-network: 40% coinsurance - Fitting/evaluation
- In-network: $25 copay
Out-of-network: 40% coinsurance - Prescription hearing aids
- In-network: $0 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by KelseyCare Advantage Freedom as a Part B benefit.
Prescription Drug Coverage
KelseyCare Advantage Freedom includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | ($22.90) |
| Supplemental Part D Premium: | $$22.90 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $6.27 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $200.00 annual Part D deductible. You'll pay this deductible at the pharmacy before KelseyCare Advantage starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, KelseyCare Advantage Freedom may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $5.00 copay | Coming soon |
| Preferred Brand | $40.00 copay | Coming soon |
| Non-Preferred Drug | 35% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| Select Care Drugs | $0.00 copay | Coming soon |
| *Deductible does not apply. | ||
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
- New Member Part D Help
- (800)663-7146
- New Member Part D TTY Users
- (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.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | CMS Version |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | CY2027 Landscape (202609.1) |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | 2027 Star Ratings Data Tables |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | PBP Benefits-2027 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | 2026-09 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| KelseyCare Advantage (official source) | http://www.kelseycareadvantage.com | October 4, 2026 |
| Medicare.gov | Compare types of 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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