Your KelseyCare Advantage Classic (HMO) plan covers dental check-ups and cleanings that Original Medicare doesn't.
Your Classic plan offers preventive coverage. We partner with FCL Dental for exams, cleanings, and X-rays to ensure you maintain good dental health and a happy smile.
WANT MORE COVERAGE?
For $32.80 per month, you have the option to purchase comprehensive coverage for services that include crowns, dentures, fixed dental bridge, tooth extraction, and more. To purchase this Optional Supplemental Benefit (OSB) for comprehensive coverage, call 713-442-8343 (TTY: 711) to request an application.
It's essential to see an in-network dentist for coverage. Out-of-network services are not covered.
Below is a quick look at some of your plan’s highlights:
Benefit
Amount
Annual benefit maximum (Preventive and comprehensive combined with the purchase of the OSB)
$3,000*
Preventive co-insurance
0%
OSB comprehensive co-insurance – Type II Services (basic services)
20%
OSB comprehensive co-insurance – Type III Services (major services)
50%
Annual deductible with OSB
$25
*After the annual maximum is exhausted, any remaining charges are your responsibility
KEY TERMS TO UNDERSTAND YOUR BENEFIT
Coinsurance – Coinsurance is a % of the allowed amount that you pay for the service.
Annual Benefit Max – The annual benefit maximum is the most KelseyCare Advantage will pay for services in one year. Any amount over the annual benefit maximum is the responsibility of the member.
