In this section
Set Up Your Premium Payment
KelseyCare Advantage offers three convenient methods to pay your monthly premium. Simply download the form below that best suits your needs, then send the completed form to us by mail, email, or fax. You will receive a confirmation by phone or email each time your payment is received.
Electronic Funds Transfer (EFT)
To pay your plan premium by Electronic Funds Transfer (EFT) each month, download, complete, and return the form below. Your monthly plan premium will be automatically withdrawn from your bank account.
Electronic Funds Transfer (EFT) PDF
Social Security Benefit Deduction
To pay your plan premium by deduction from your Social Security Benefit, download, complete, and return the form below. Once the form is received, KelseyCare Advantage will submit the premium withhold request on your behalf to your selected Benefit Administrator for the next available effective date.
Railroad Retirement Benefit Deduction
To pay your plan premium by deduction from your Railroad Retirement Benefit, download, complete, and return the form below. Once the form is received, KelseyCare Advantage will submit the premium withhold request on your behalf to your selected Benefit Administrator for the next available effective date.
Railroad Retirement Benefit PDF
Where to Send Your Form
MAIL:
KelseyCare Advantage
ATTN: Enrollment
P.O. Box 841569
Pearland, TX 77584
FAX: 713-442-9536
Need Answers?
Call our Concierge team at 713-442-CARE (2273) or toll-free at 1-866-535-8343 (TTY: 711).
From October 1 to March 31
8 a.m. - 8 p.m.
7 days a week
From April 1 to September 30
8 a.m. - 8 p.m.
Monday - Friday
Start Your Medicare Enrollment Enroll Now