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BSW SeniorCare Advantage (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BSW SeniorCare Advantage (PPO) in 2026, please refer to our full plan details page.
BSW SeniorCare Advantage (PPO) is a PPO plan offered by Baylor Scott & White Health available for enrollment in 2025 to people living in Dallas/Ft. Worth Metro Area. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BSW SeniorCare Advantage (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BSW SeniorCare Advantage (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For BSW SeniorCare Advantage (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has a $300.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The BSW SeniorCare Advantage (PPO) Medicare plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or standard mail order, compared to a $5 copay for a one-month supply at standard pharmacies. Tier 2 generic drugs also have no copay through standard mail order, but require a $7 copay at preferred pharmacies and a $14 copay at standard pharmacies for a one-month supply. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at both preferred and standard pharmacies, as well as through standard mail order. Tier 4 non-preferred drugs carry a 35% coinsurance across all pharmacy options, while Tier 5 specialty drugs have a 29% coinsurance for a one-month supply. Choosing standard mail order or preferred retail pharmacies offers the greatest savings on your prescription drug costs with this plan.
Additional Benefits
The BSW SeniorCare Advantage (PPO) plan provides comprehensive medical coverage with no copay and no coinsurance for primary care visits, annual physicals, and home health services. Specialist visits, physical therapy, and routine vision and hearing exams are covered with affordable copays and no coinsurance. For emergency care and hospital stays, the plan features flat copays and no coinsurance, with inpatient daily copays waived after the first several days of your stay. Supplemental benefits include preventive dental care with no copay and comprehensive dental services covered up to a $3,500 annual limit. Members also benefit from no copay on prescription hearing aids up to $1,100 every three years, a $150 annual eyewear allowance, and an $80 quarterly allowance for over-the-counter items. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by BSW SeniorCare Advantage (PPO) with no coinsurance, requiring a $320 daily copay for days 1 to 6 of acute stays (no copay for days 7 to 90) and a $318 daily copay for days 1 to 5 of psychiatric stays (no copay for days 6 to 90). Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BSW SeniorCare Advantage (PPO) covers outpatient services, including outpatient hospital care with a $350 copay and 20% coinsurance, and ambulatory surgical center services with a $275 copay and no coinsurance. Outpatient substance abuse sessions require a $45 copay with no coinsurance, and outpatient blood services feature no copay with 20% coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under BSW SeniorCare Advantage (PPO) with a $40 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
BSW SeniorCare Advantage (PPO) covers ground and air ambulance services with a $325 copay and no coinsurance, though prior authorization is required. For transportation services, some services are covered, but transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
BSW SeniorCare Advantage (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance up to a maximum benefit limit of $5,000.
Primary Care See details
BSW SeniorCare Advantage (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialists, occupational therapy, and physical therapy require a $35 copay and no coinsurance. Mental health, psychiatric, and opioid treatment services require copays ranging from $40 to $45 with no coinsurance, whereas podiatry is not covered. Chiropractic services are partially covered with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
BSW SeniorCare Advantage (PPO) offers partially covered preventive services with no copay and no coinsurance for annual physical exams, kidney disease education, and fitness benefits. However, several additional services are not covered, including health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
Hearing services are partially covered by BSW SeniorCare Advantage (PPO), with routine exams and evaluations requiring a $40 copay and no coinsurance. Prescription and OTC hearing aids are available with no copay and no coinsurance up to an $1,100 maximum every three years, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BSW SeniorCare Advantage (PPO), with other eye exam services and eyewear upgrades not covered. Routine eye exams have a $40 copay and no coinsurance, and eligible eyewear has no copay and no coinsurance up to a $150 annual combined maximum.
Dental Services See details
BSW SeniorCare Advantage (PPO) partially covers dental services with no copay and no coinsurance for preventive care, and no copay with 0% to 50% coinsurance for comprehensive services, up to a $3,500 annual maximum. Fluoride treatments, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
BSW SeniorCare Advantage (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a 0% to 20% coinsurance.
Dialysis Services See details
BSW SeniorCare Advantage (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by BSW SeniorCare Advantage (PPO), with durable medical equipment and prosthetics requiring no copay and a 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
BSW SeniorCare Advantage (PPO) partially covers diagnostic and radiological services with prior authorization required. Diagnostic services feature no copay and no coinsurance, but diagnostic procedures, tests, and lab services are not covered. Diagnostic radiological services have no copay and no coinsurance, while therapeutic radiological services require a copay and 20% coinsurance, and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by BSW SeniorCare Advantage (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
BSW SeniorCare Advantage (PPO) does not cover Cardiac Rehabilitation Services, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all not covered by the plan.
Skilled Nursing Facility (SNF) See details
BSW SeniorCare Advantage (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by BSW SeniorCare Advantage (PPO), which provides over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $80 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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