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BSW SeniorCare Advantage Platinum (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Platinum (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 Platinum (PPO) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Platinum (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 Platinum (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 Platinum (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 Platinum (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $129.00. 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 $50.00 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 $8950.00 (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 $8950.00 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 Platinum (PPO) plan has a $50 deductible for prescription drugs. After the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you'll pay a $5 copay for preferred generic drugs at a preferred pharmacy, or 32% coinsurance for non-preferred drugs at any pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. If you qualify for the low-income subsidy, your Part D premium will be $10.40.
Additional Benefits
The BSW SeniorCare Advantage Platinum (PPO) plan offers a range of benefits. This plan covers inpatient hospital stays with a copay and outpatient services with varying copays and coinsurance. It also includes coverage for ambulance, emergency, and primary care services, as well as preventive, hearing, vision, and dental services. Additional benefits include coverage for home infusion, dialysis, medical equipment, and diagnostic services. The plan also covers skilled nursing facility stays with a copay. However, this plan does not cover cardiac rehabilitation services and many other services like acupuncture and over-the-counter items.
Inpatient Hospital See details
Inpatient Hospital coverage requires prior authorization and has a $1,250 out-of-pocket maximum, with a $250 copay for days 1-5 and no copay for days 6-90 for Inpatient Hospital-Acute, and a $250 copay for days 1-5 and no copay for days 6-60 for Inpatient Hospital Psychiatric. Additional days, and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $100 copay and 20% coinsurance, Observation Services with 20% coinsurance, Ambulatory Surgical Center (ASC) Services with a $75 copay, Outpatient Substance Abuse services with a $45 copay for both individual and group sessions, and Outpatient Blood Services with 20% coinsurance. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the BSW SeniorCare Advantage Platinum (PPO) plan and requires prior authorization, with a copay of $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BSW SeniorCare Advantage Platinum (PPO) plan. Ground and Air Ambulance Services have a $75 copay, with no coinsurance, while Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BSW SeniorCare Advantage Platinum (PPO) plan. Emergency Services has a $120 copay, and Urgently Needed Services has a $50 copay, but both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
The BSW SeniorCare Advantage Platinum (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $20 copay, mental health specialty services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits, and opioid treatment program services with a $45 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by the BSW SeniorCare Advantage Platinum (PPO) plan. Medicare-covered preventive services and other preventive services are covered, while annual physical exams are not covered. Fitness benefits are covered, and services such as Health Education, In-Home Safety Assessment, and Adult Day Health Services are not covered.
Hearing Services See details
Hearing exams and fitting/evaluation for hearing aids are covered, with a $20 copay for hearing exams. Prescription hearing aids (all types) are covered up to a maximum of $1500 every three years. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear with a 30% coinsurance for contact lenses and a combined maximum benefit of $150 per year for in-network services. Eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are covered for one pair per year. Upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Platinum (PPO) plan offers comprehensive dental coverage with a maximum benefit of $3,000 per year, covering services like oral exams, dental x-rays, and other diagnostic services, with limitations on the number of visits and periodicity. Restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, and oral surgery are covered with a 50% coinsurance. Fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, 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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BSW SeniorCare Advantage Platinum (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits for BSW SeniorCare Advantage Platinum (PPO) include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, and Prosthetics/Medical Supplies with a 20% coinsurance and no copay; however, 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 under the BSW SeniorCare Advantage Platinum (PPO) plan. Diagnostic services do not have a copay, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $200.00, while Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Platinum (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 not covered by the BSW SeniorCare Advantage Platinum (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, or 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, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $50 per day; this plan does not cover additional days beyond Medicare-covered SNF stays, or non-Medicare-covered SNF stays.
Other Services See details
Other Services are not covered by the BSW SeniorCare Advantage Platinum (PPO) plan. The plan does not cover acupuncture, over-the-counter items, 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.
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