A non-government entity
BSW SeniorCare Advantage Basic (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Basic (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 Basic (PPO) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Basic (PPO) is a PPO plan offered by Baylor Scott & White Holdings available for enrollment in 2025 to people living in Central Texas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that BSW SeniorCare Advantage Basic (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 Basic (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 Basic (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 $250.00 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:
Sign up for BSW SeniorCare Advantage Basic (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BSW SeniorCare Advantage Basic (PPO) plan has a $250 deductible for prescription drugs. After you meet your deductible, your cost will vary depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will pay a $7 copay for preferred generic drugs at a preferred pharmacy, and a $0 copay for preferred generic drugs through standard mail order. You will pay 30% coinsurance for non-preferred drugs, no matter the pharmacy. After your yearly out-of-pocket drug costs reach $2000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The BSW SeniorCare Advantage Basic (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services include copays and coinsurance depending on the service. You'll also find coverage for emergency services, primary care, hearing, vision, dental, and more, with specific copays, coinsurance, and annual limits for some services. This plan also provides coverage for home health, medical equipment, and skilled nursing facility services, with specific cost-sharing arrangements. It's important to note that some services, such as preventive services, dental, and home infusion, have specific limitations and exclusions, so review the details carefully.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the BSW SeniorCare Advantage Basic (PPO) plan, with a copay of $325 for days 1-6 and a copay of $0 for days 7-90 for Inpatient Hospital-Acute; Inpatient Hospital Psychiatric has a copay of $318 for days 1-5 and a copay of $0 for days 6-90. Additional Days and Non-Medicare-covered Stay for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $350 copay and 20% coinsurance, observation services with 20% coinsurance, and Ambulatory Surgical Center (ASC) Services with a $275 copay. Outpatient Substance Abuse services include individual and group sessions with a copay between $45.00 and $45.00. Outpatient Blood Services are also covered with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the BSW SeniorCare Advantage Basic (PPO) plan, with a $40 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BSW SeniorCare Advantage Basic (PPO) plan. Ground and air ambulance services have a $325 copay with no coinsurance, while transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a copay of $120 and no coinsurance, while Urgently Needed Services has a copay of $50 and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
The BSW SeniorCare Advantage Basic (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $35 copay, physician specialist services with a $35 copay, and mental health specialty services with a $40 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $35 copay, telehealth services, and opioid treatment program services with a $45 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
Preventive services are covered, but annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. Fitness Benefit, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered.
Hearing Services See details
Hearing services include routine hearing exams with a $40 copay. Fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered up to $1,000 every three years. Prescription hearing aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and also include coverage for eyewear. Eyewear has a combined maximum benefit of $150 per year. Contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered every year. Upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Basic (PPO) plan covers dental services, including oral exams (1 every six months), dental x-rays (full mouth x-rays once every 60 months, bitewing x-rays once every 12 months), other diagnostic dental services, prophylaxis (cleaning) (1 every six months), other preventive dental services, restorative services with 50% coinsurance, adjunctive general services with 50% coinsurance, endodontics with 50% coinsurance, periodontics with 50% coinsurance, prosthodontics (removable) with 0-50% coinsurance, implant services with 50% coinsurance, prosthodontics (fixed) with 50% coinsurance, and oral and maxillofacial surgery with 50% coinsurance, but does not cover fluoride treatment or orthodontics. The plan has a maximum benefit coverage of $3500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BSW SeniorCare Advantage Basic (PPO) plan, including Medicare Part B insulin drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the BSW SeniorCare Advantage Basic (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. For DME, there is a 20% coinsurance and no copay, and for Prosthetic Devices and Medical Supplies, there is a 20% coinsurance and no copay. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BSW SeniorCare Advantage Basic (PPO) plan. Diagnostic Radiological Services have a copay of up to $300 and Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Basic (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the BSW SeniorCare Advantage Basic (PPO) plan, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. There is a copay for Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BSW SeniorCare Advantage Basic (PPO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
The BSW SeniorCare Advantage Basic (PPO) plan does not cover acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, case management (long term care), institution for mental disease services for individuals 65 or older, services in an intermediate care facility for individuals with intellectual disabilities, case management, tobacco cessation counseling for pregnant women, freestanding birth center services, respiratory care services, family planning services, nursing home services, home and community based services, personal care services, and self-directed personal assistance services. Over-the-counter (OTC) items are covered with a maximum benefit of $30 every three months.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved