KelseyCare Advantage

What KelseyCare Advantage does

KelseyCare Advantage is a Medicare Advantage (Part C) health plan operated by KS Plan Administrators, LLC, serving Medicare-eligible individuals in the Greater Houston, Texas market. Founded in 2007, the plan offers three core products — Signature (HMO), Freedom (HMO-POS), and Core (HMO) — all priced at a $0 monthly premium with varying levels of prescription drug coverage, dental, vision, hearing, transportation, and fitness benefits. The plan's central differentiator is structural integration with Kelsey-Seybold Clinic, a 1,000+ physician multi-specialty group operating across 44+ Greater Houston locations on a single shared electronic medical record, enabling open-access specialist visits without referrals and coordinated care across primary, specialty, pharmacy, and ancillary services.

The technology platform is anchored by the Epic-based MyKelseyOnline patient portal (appointment scheduling, prescription refills, test results, provider messaging), three virtual care modalities (on-demand VideoVisitNOW, scheduled Video Visits, and asynchronous E-Visits), and FHIR R4 APIs hosted on Microsoft Azure Healthcare APIs for CMS-mandated interoperability. Supplemental benefits are delivered through partnerships: Optum Rx for Part D pharmacy benefit management (65,000+ network pharmacies, 3,100+ medications), United Healthcare for dental network (3x expansion in recent year), Your Vision Plan for vision services, and Optum Behavioral Health for mental health and substance use disorder services.

The business model is capitation-based: the plan receives per-member-per-month payments from CMS for delivering Medicare Parts A, B, and (in most plans) D coverage, with member cost-sharing on drug tiers as a secondary revenue element. Distribution combines direct-to-consumer channels (licensed local agents, the kelseycareadvantage.com website, online enrollment portal), a dedicated broker/agent network with training resources, and physical Kelsey-Seybold clinic touchpoints across Greater Houston. The member base consists of Medicare-eligible seniors (65+), Medicare beneficiaries under 65 with qualifying disabilities, and veterans with TRICARE or VA drug coverage. No revenue, member count, or funding data is publicly disclosed; ownership is private with KS Plan Administrators, LLC as the parent entity.

Name

KelseyCare Advantage

Legal name

KS Plan Administrators, LLC

Website

https://kelseycareadvantage.com

Company type

Private

Founded year

2007

Operating status

Operating

Headcount range

101–250 employees

Short description

KelseyCare Advantage is a regional Medicare Advantage plan serving Greater Houston through three $0-premium HMO/HMO-POS products, structurally integrated with Kelsey-Seybold Clinic's 1,000+ physician network operating on a single electronic medical record. The plan offers comprehensive medical, Part D drug, dental, vision, hearing, transportation, and fitness benefits.

Ownership category

akta.pro rank

Product category

Medicare Advantage Health Insurance

NAICS

Direct Health and Medical Insurance Carriers (524114)

SIC

Hospital & Medical Service Plans (6324), Accident & Health Insurance (6321), Insurance Agents, Brokers & Service (6411)

akta.pro primary industry

Medicare Advantage (MA) Plans (FSAIAGAA)

akta.pro secondary industries

MA-PD Plans (Medicare Advantage with Prescription Drug Coverage) (FSAIAGAG), Medicare Quality, Risk Adjustment & Stars Analytics/Services (FSAIAGAJ)

Keywords

• Medicare Advantage plans
• HMO health insurance
• Medicare Part D coverage
• Prescription drug benefits
• Supplemental health benefits

Headquarters

HQ city

Pearland

HQ country

United States

HQ region

North America

Offices2 records

Markets served

GTM type

B2C

Offering type

Services

Cost components

Personnel, Operations, Marketing or Sales, Technology or R&D, Infrastructure, Supply Chain

Revenue model

1. Medicare Advantage Premium (Part C): KelseyCare Advantage is a Medicare Advantage (Part C) plan that receives capitation payments from the federal Medicare program in exchange for providing Part A (hospital) and Part B (medical) coverage to enrolled members. All plans carry a $0 monthly premium for members.
2. Part D Prescription Drug Coverage: Medicare Part D drug coverage is embedded in KelseyCare Advantage Freedom and Signature plans (HMO-POS and HMO respectively), with Optum Rx administering the pharmacy benefit. Revenue is generated through Medicare Part D subsidies and member cost-sharing (copays, coinsurance, and deductibles on drug tiers).

Pricing tiers

Go-to-market motion2 records

Distribution channels4 records

Marketing channels8 records

Core offering

KelseyCare Advantage is a Medicare Advantage (Part C) health plan that bundles hospital, medical, and prescription drug coverage with supplemental benefits (dental, vision, hearing, transportation, and fitness) for Medicare-eligible members. It is offered through three $0-premium plan variants — Signature (HMO), Freedom (HMO-POS), and Core (HMO) — that route members into the integrated Kelsey-Seybold Clinic network across Greater Houston.

Product overview

KelseyCare Advantage is a Medicare Advantage plan offered by KS Plan Administrators, LLC with a Medicare contract, providing HMO and HMO-POS plans to Medicare-eligible seniors in Greater Houston. The product portfolio consists of three core insurance plans—Signature (HMO), Freedom (HMO-POS), and Core (HMO)—all offering $0 premiums with varying levels of dental, vision, hearing, prescription drug, transportation, and fitness benefits. These plans are integrated with the Kelsey-Seybold Clinic network of 1,000+ physicians across 44+ locations and 65+ specialties. Member engagement is facilitated through the MyKelseyOnline patient portal, which provides access to virtual care options including VideoVisitNOW (on-demand), scheduled Video Visits, and E-Visits. Value-added benefits include One Pass fitness, comprehensive dental coverage, vision services, and hearing aid allowances. Prescription drug coverage is administered through Optum Rx with access to 3,100+ medications across 65,000+ network pharmacies.

Differentiator

Problem solved

Functional benefit

Brands

• Signature: HMO plan with $0 premiums, prescription drug benefits, coordinated care through Kelsey-Seybold network including dental, vision, unlimited transportation, and fitness benefits.
• Freedom
• Core

Products and services

• Signature Plan (HMO) $0-premium HMO Medicare Advantage plan with prescription drug coverage, comprehensive dental (up to $2,500/year, 0% coinsurance), vision, unlimited transportation, hearing aid allowance ($750/ear every 3 years), and One Pass fitness benefit, all delivered through the integrated Kelsey-Seybold provider network. Designed for Medicare-eligible seniors (65+) in Greater Houston seeking comprehensive in-network coverage.
• Freedom Plan (HMO-POS) $0-premium HMO-POS Medicare Advantage plan with full Medicare Parts A and B coverage, Part D prescription drug benefits (Tier 3-5 drugs subject to $200 deductible), $2,000 annual dental maximum, and the option to see out-of-network doctors without a referral. Targets Medicare-eligible members in Greater Houston who want flexibility beyond the Kelsey-Seybold network.
• Core Plan (HMO) $0-premium HMO Medicare Advantage plan focused on essential medical benefits without prescription drug coverage, with $1,500 annual dental maximum, unlimited transportation, and strong support for primary, specialty, and preventive care. Designed for Medicare-eligible members who already have separate drug coverage (e.g., VA/TRICARE).

Quantifiable outcome

• Comprehensive dental coverage up to $2,500/year with 0% coinsurance on Signature plan; dental network is three times larger than previous year
• +4 more outcomes

Named customers3 records

Segments1 record

Ideal customer profiles3 records

Technology focussed No

API detail

Has API

Yes

API docs

API detail

Core technology

AI maturity

App detail

Integration7 records

Feature4 records

Partnerships

14 partnerships are on record, tiered core.

• Kelsey-Seybold CliniccoreOthersKelsey-Seybold Clinic is the primary care provider network for KelseyCare Advantage, offering 1,000+ physicians in 65+ specialties across 44+ locations in Greater Houston. All KelseyCare Advantage plans provide open access to Kelsey-Seybold providers without referrals. The integrated care model uses a single medical record shared across all providers.
• Optum RxcoreTechnology or IntegrationOptum Rx serves as the pharmacy benefit manager (PBM) for KelseyCare Advantage's Part D prescription drug coverage. Handles coverage determinations, appeals, prior authorizations, mail-order prescriptions, and the Medicare Prescription Payment Plan. Contact: 1-800-707-8194.
• United Healthcare (UHC) Dental NetworkcoreTechnology or IntegrationKelseyCare Advantage leverages the United Healthcare dental network, which is described as three times larger than the previous year, offering preventive and comprehensive dental coverage to members through a searchable directory.
• Your Vision PlancoreTechnology or IntegrationKelseyCare Advantage partners with Your Vision Plan (kca.yourvisionplan.com) for in-network vision provider search, offering routine vision and post-cataract services to members.
• United Behavioral Health (Optum Behavioral Health)coreTechnology or IntegrationConfidential behavioral health and substance abuse treatment is accessed through United Behavioral Health (Optum). Members use access code 'KELSEY' on the Optum Behavioral Health website (provider.liveandworkwell.com) or call 1-800-817-4808. All behavioral health or chemical dependency treatment must be authorized by Optum Behavioral Health.
• Next Level Urgent CarecoreChannel Partner/ Reseller/ DistributorPreferred contracted urgent care provider for KelseyCare Advantage members in the Greater Houston area. Part of the contracted care network ensuring appropriate copayment amounts and care coordination.
• CareNow Urgent CarecoreChannel Partner/ Reseller/ DistributorPreferred contracted urgent care provider for KelseyCare Advantage members in the Greater Houston area. Members can visit any urgent care facility but contracted relationships ensure coordinated care and appropriate copayments.
• Live and Work Well (Optum)coreTechnology or IntegrationMental health and substance use disorder resources portal (liveandworkwell.com) with access code 'KELSEY'. Provides articles, self-care tools, provider search, and confidential help at no additional cost. Crisis hotline via 988. Mental health/substance abuse crisis: call or text 988.
• CHI St Luke's HospitalcoreChannel Partner/ Reseller/ DistributorNetwork hospital within KelseyCare Advantage's hospital network, providing emergency and inpatient services to members throughout Houston and surrounding areas.
• Memorial Hermann HospitalcoreChannel Partner/ Reseller/ DistributorNetwork hospital within KelseyCare Advantage's hospital network, providing emergency and inpatient services to members throughout Houston and surrounding areas.
• HCA HealthcarecoreChannel Partner/ Reseller/ DistributorNetwork hospital system including Woman's Hospital of Texas and Texas Orthopedic Hospital. HCA Healthcare is part of the contracted hospital network for KelseyCare Advantage members.
• River Oaks HospitalcoreChannel Partner/ Reseller/ DistributorNetwork hospital within KelseyCare Advantage's hospital network serving members in the Houston metropolitan area.
• Huntsville Memorial HospitalcoreChannel Partner/ Reseller/ DistributorNetwork hospital within KelseyCare Advantage's hospital network serving members in the Huntsville and surrounding areas.
• MyKelseyOnlinecoreTechnology or IntegrationPatient portal powered by Epic MyChart, enabling members to schedule appointments, request prescription refills, view test results, and message their care team. Help line: 713-442-6565, 7 days/week 7am–9pm.

Scale indicators5 records

Recent moves6 records

Expansion highlights5 records

Direct peers

• Memorial Hermann Health Plan: Houston-based integrated delivery system that operates its own MA plan, directly comparable to KelseyCare Advantage as a regional provider-sponsored MA plan competing in the same Greater Houston market with a similar integrated-care value proposition.
• Alignment Health: Technology-enabled Medicare Advantage insurer focused on senior care coordination, often through provider partnerships. Comparable to KelseyCare Advantage in its MA-only focus, supplemental benefits emphasis, and tech-forward member engagement model.
• Devoted Health: MA-focused health plan emphasizing integrated provider networks and a high-touch senior member experience, including $0 premium plans with rich supplemental benefits — directly comparable product strategy to KelseyCare Advantage.
• Clover Health: Tech-enabled Medicare Advantage insurer using its Clover Assistant software platform to coordinate care with provider partners. Comparable to KelseyCare Advantage as a smaller, technology-forward MA-only carrier with a strong focus on care coordination.

Broad incumbents

• UnitedHealthcare (AARP Medicare Advantage): Largest U.S. MA carrier offering AARP-branded MA plans in Greater Houston with $0-premium PPO and HMO products. Competes head-to-head with KelseyCare Advantage and represents the dominant incumbent against which all Houston MA plans are benchmarked.
• Humana: Second-largest U.S. MA carrier with strong Houston market presence, broad HMO/PPO MA product portfolio, and well-developed broker distribution. Comparable to KelseyCare Advantage in MA product structure but with materially larger scale and geographic diversification.
• Aetna (CVS Health): National MA carrier competing in Greater Houston with HMO/PPO plans and integrated retail-clinic touchpoints through CVS/MinuteClinic. Comparable as a broad MA incumbent with similar $0-premium positioning and supplemental benefits.
• Blue Cross Blue Shield of Texas (HCSC): Largest Texas-domestic health plan with strong MA presence in Houston. Comparable as a broad regional incumbent offering HMO and PPO MA products with similar benefits structures and broker-channel distribution.
• Wellcare (Centene): Centene-owned MA carrier with significant presence in Texas including Houston, focused on government-sponsored health plans. Comparable as a broad MA incumbent competing in the same value-conscious senior segment.

Emerging players

• ChenMed: Physician-led, value-based primary care model serving MA members through owned clinics, with growing presence in Texas. Comparable to KelseyCare Advantage in its tight integration between provider group and MA plan, though ChenMed is a primary-care-only model rather than a full multispecialty network.

Market position

Strengths4 records

Weaknesses5 records

Competitive moat5 records

Key risks6 records

Key highlights6 records

Customer concentration

• Xx.com/kcadvantagetx

Revenue estimate

Valuation estimate

Number of profiles

Funding overview

Funding rounds

Investors

Funding detail is available on the Subscription and Enterprise plan.Contact sales →

M&A

Investments

M&A and investment is available on the Subscription and Enterprise plan.Contact sales →

Frequently asked questions about KelseyCare Advantage