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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 2026, please refer to our full plan details page.
BSW SeniorCare Advantage Basic (PPO) is a PPO plan offered by Baylor Scott & White Health available for enrollment in 2025 to people living in Central Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
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:
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Drug Coverage
The BSW SeniorCare Advantage Basic (PPO) plan features an annual drug deductible of $250. For Tier 1 preferred generics, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $5 copay for a one-month supply. Tier 2 generic drugs also feature no copay through standard mail order, with copays starting at $7 at preferred pharmacies and $14 at standard pharmacies. For Tier 3 preferred brand drugs, copays start at $47 for a one-month supply at preferred, standard, and standard mail-order pharmacies. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 35% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance. This plan structure offers distinct savings opportunities depending on the drug tier and your choice of pharmacy.
Additional Benefits
The BSW SeniorCare Advantage Basic (PPO) plan offers comprehensive medical coverage with no copay for primary care doctor visits, telehealth, and home health services. For acute inpatient hospital stays, there is a $325 daily copay for days one through six, after which there is no copay. Emergency room visits require a $130 copay, while outpatient hospital services carry a $350 copay and 20% coinsurance. Supplemental benefits include preventive dental care with no copay and comprehensive services covered up to $3,000 annually with 50% coinsurance. Routine eye and hearing exams both require a $40 copay, but the plan offers allowances of up to $150 annually for eyewear and $1,000 every three years for hearing aids with no copay. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and members receive a $30 quarterly allowance for over-the-counter health items.
Inpatient Hospital See details
BSW SeniorCare Advantage Basic (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. For acute stays, there is a $325 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $318 daily copay for days 1 through 5 and no copay for days 6 through 90. Additional days, upgrades, and non-Medicare-covered stays are not covered under this plan.
Outpatient Services See details
BSW SeniorCare Advantage Basic (PPO) covers outpatient hospital services with a $350 copay and 20% coinsurance, and ambulatory surgical center services with a $275 copay and no coinsurance. Outpatient substance abuse services require a $45 copay with no coinsurance, while outpatient blood services carry no copay and a 20% coinsurance.
Partial Hospitalization See details
BSW SeniorCare Advantage Basic (PPO) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
BSW SeniorCare Advantage Basic (PPO) partially covers ambulance and transportation services, offering ground and air ambulance coverage with a $325 copay and no coinsurance, subject to prior authorization. However, transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
BSW SeniorCare Advantage Basic (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $5,000 maximum with no copay and no coinsurance.
Primary Care See details
Primary care benefits under the BSW SeniorCare Advantage Basic (PPO) plan feature no copay and no coinsurance for primary care provider visits and telehealth services. Most other covered services, including specialist visits and physical therapy, require a copay ranging from $15 to $45 with no coinsurance, while chiropractic services are only partially covered and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by BSW SeniorCare Advantage Basic (PPO) with no copay and no coinsurance for annual physicals, kidney education, glaucoma screenings, and diabetes self-management. Additional preventive services are partially covered, offering physical and memory fitness benefits, but sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling are not covered.
Hearing Services See details
BSW SeniorCare Advantage Basic (PPO) covers routine hearing exams and fittings once per year with a $40 copay and no coinsurance. Prescription and OTC hearing aids are partially covered with no copay or coinsurance up to a $1,000 combined maximum every three years, though inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
BSW SeniorCare Advantage Basic (PPO) features partially covered vision services, offering one routine eye exam per year for a $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $150 annual maximum for contacts or eyeglasses, though upgrades are not covered.
Dental Services See details
BSW SeniorCare Advantage Basic (PPO) partially covers dental services up to a $3,000 annual maximum, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and 50% coinsurance. Fluoride treatment, maxillofacial prosthetics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BSW SeniorCare Advantage Basic (PPO) with no copay and require prior authorization. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by BSW SeniorCare Advantage Basic (PPO) with no copay and 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under the BSW SeniorCare Advantage Basic (PPO) with no copay and a 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies, though prior authorization is required. While diabetic equipment is covered with no copay or coinsurance, diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
BSW SeniorCare Advantage Basic (PPO) partially covers diagnostic and radiological services with prior authorization required, though diagnostic procedures, lab services, and outpatient X-rays are not covered. Covered diagnostic and diagnostic radiological services feature no copay and no coinsurance, while therapeutic radiological services require a copayment and a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by BSW SeniorCare Advantage Basic (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the BSW SeniorCare Advantage Basic (PPO) plan, as all individual sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BSW SeniorCare Advantage Basic (PPO) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and the plan allows for admission without a prior three-day hospital stay, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
BSW SeniorCare Advantage Basic (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $30 every three months. Acupuncture, meal benefits, and nicotine replacement therapy are not covered under this benefit.
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