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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 2026, please refer to our full plan details page.
BSW SeniorCare Advantage Platinum (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 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 $135.00. 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 features a low $50 drug deductible and offers excellent savings on generic medications. 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 cost $5 for a one-month supply at preferred pharmacies and also feature no copay when filled via standard mail order. Tier 3 preferred brand drugs require a $45 copay for a one-month supply across preferred pharmacies, standard pharmacies, and standard mail order. For higher-tier medications, the plan charges a 35% coinsurance for Tier 4 non-preferred drugs and a 32% coinsurance for Tier 5 specialty drugs.
Additional Benefits
The BSW SeniorCare Advantage Platinum (PPO) plan offers robust medical coverage, featuring no copays for primary care visits, telehealth, and annual preventive services. For specialized care, members pay a $20 copay for specialist visits, while emergency room visits incur a $130 copay that is waived if admitted. Inpatient hospital stays require a $250 daily copay for the first few days, after which there is no copay for the remainder of a Medicare-covered stay. This plan also provides valuable supplemental benefits, including dental care with no copays for preventive services and a $3,000 annual maximum. Vision and hearing benefits are covered with low copays for routine exams, alongside allowances of up to $150 annually for eyewear and $1,500 every three years for hearing aids. Additionally, members benefit from home health care and cardiac rehabilitation with no copays, as well as an over-the-counter allowance of $30 every three months.
Inpatient Hospital See details
BSW SeniorCare Advantage Platinum (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $250 daily copay for days 1 to 6 of acute stays and days 1 to 5 of psychiatric stays, followed by no copay for subsequent days up to day 90. Prior authorization is required, and additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BSW SeniorCare Advantage Platinum (PPO) covers outpatient hospital services with a $100 copay and 20% coinsurance, and ambulatory surgical center services with a $75 copay and no coinsurance. Outpatient substance abuse services require a $45 copay and no coinsurance, while outpatient blood services are covered with no copay and 20% coinsurance.
Partial Hospitalization See details
BSW SeniorCare Advantage Platinum (PPO) covers partial hospitalization services with a $40 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
BSW SeniorCare Advantage Platinum (PPO) covers ground and air ambulance services with a $75 copayment and no coinsurance, although prior authorization is required, while transportation services are not covered.
Emergency Services See details
BSW SeniorCare Advantage Platinum (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 admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $5,000 maximum with no copay and no coinsurance.
Primary Care See details
BSW SeniorCare Advantage Platinum (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Therapy services cost a $25 copay with no coinsurance, podiatry is not covered, and chiropractic care covers some services with a $15 copay and no coinsurance, though routine and other chiropractic services are not covered.
Preventive Services See details
BSW SeniorCare Advantage Platinum (PPO) covers preventive services, including annual physical exams, kidney disease education, and select screenings, with no copay and no coinsurance. Additional preventive services are partially covered, featuring physical and memory fitness benefits, though other services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are covered under the BSW SeniorCare Advantage Platinum (PPO), which includes annual routine hearing exams for a $20 copay and no coinsurance. Prescription and OTC hearing aids are partially covered with no copay and no coinsurance up to a $1,500 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 Platinum (PPO) offers partially covered vision services, featuring routine eye exams for a $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a $150 annual maximum benefit, though upgrades are excluded from coverage.
Dental Services See details
BSW SeniorCare Advantage Platinum (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.
Home Infusion bundled Services See details
BSW SeniorCare Advantage Platinum (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs require a 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by the BSW SeniorCare Advantage Platinum (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BSW SeniorCare Advantage Platinum (PPO) partially covers medical equipment with no copays, requiring a 20% coinsurance for durable medical equipment, prosthetic devices, and medical supplies. While diabetic equipment is covered with no copay and no coinsurance, diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered under the BSW SeniorCare Advantage Platinum (PPO), requiring prior authorization for all services. Covered diagnostic and diagnostic radiological services have no copay and no coinsurance, while therapeutic radiological services require a copay and 20% coinsurance. Lab services, outpatient X-rays, and diagnostic procedures and tests are not covered.
Home Health Services See details
Home Health Services are covered under the BSW SeniorCare Advantage Platinum (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BSW SeniorCare Advantage Platinum (PPO) with no copay and no coinsurance. However, some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and Supervised Exercise Therapy (SET) for symptomatic Peripheral Artery Disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
BSW SeniorCare Advantage Platinum (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $50 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BSW SeniorCare Advantage Platinum (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 plan.
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