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BayCarePlus Complete (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BayCarePlus Complete (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BayCarePlus Complete (HMO) in 2026, please refer to our full plan details page.
BayCarePlus Complete (HMO) is a HMO plan offered by BayCare Health System, Inc. available for enrollment in 2025 to people living in Hillsborough, Pasco, Pinellas and Polk counties. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BayCarePlus Complete (HMO) 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 BayCarePlus Complete (HMO).
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 BayCarePlus Complete (HMO), 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 $90.00 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 Maximum Out-Of-Pocket cost of $2000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 BayCarePlus Complete (HMO) prescription drug plan features a low annual drug deductible of $90. For Tier 1 preferred generic medications, members enjoy no copay for one, two, or three-month supplies at standard pharmacies and standard mail order. Tier 2 generic drugs are also highly affordable, with standard pharmacy copays ranging from $10 for a one-month supply to $30 for a three-month supply. For brand-name and specialty medications, the plan utilizes a mix of copays and coinsurance. Tier 3 preferred brand drugs have a $47 copay for a one-month supply, or a reduced $121 copay for a three-month standard mail order. Tier 4 non-preferred drugs require 33% coinsurance, while Tier 5 specialty drugs require 32% coinsurance for a one-month supply.
Additional Benefits
The BayCarePlus Complete (HMO) plan offers robust health coverage featuring no copay and no coinsurance for primary care doctor visits and covered preventive services like annual physicals. For inpatient hospital stays, members pay a $150 daily copay for the first five days and no copay for subsequent days, while emergency room visits carry a $125 copay that is waived if admitted. Specialist visits and outpatient therapies require a low $15 copay, ensuring affordable access to essential medical care. This plan also includes valuable supplemental benefits, such as dental coverage up to a $3,000 annual limit and a $300 annual allowance for eyeglasses or contact lenses with no copay. Routine hearing and vision exams are available for a $15 copay, and prescription hearing aids are covered with copayments ranging from $699 to $999. Additionally, members receive a $145 over-the-counter item allowance every three months with no copay to help manage everyday health needs.
Inpatient Hospital See details
Inpatient Hospital services under BayCarePlus Complete (HMO) are covered with no coinsurance and require prior authorization, costing a $150 daily copay for days 1 through 5 and no copay for days 6 and beyond for both acute and psychiatric stays. This benefit is partially covered as upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under BayCarePlus Complete (HMO) are covered with no coinsurance, featuring copays ranging from $0 to $125 for outpatient hospital services and a $125 copay per stay for observation services. Ambulatory surgical center services require a $75 copay, outpatient substance abuse sessions have a $10 to $15 copay, and outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by BayCarePlus Complete (HMO) with a $55.00 copay and no coinsurance, though prior authorization is required for some services.
Ambulance and Transportation Services See details
BayCarePlus Complete (HMO) covers ambulance services with a $200 copay and no coinsurance for both ground and air transport, which requires prior authorization. Transportation services are partially covered, offering up to 16 one-way taxi trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
BayCarePlus Complete (HMO) covers emergency services with a $125 copay and no coinsurance (waived if admitted within 24 hours), and urgently needed services with a $20 copay and no coinsurance. Worldwide emergency and urgent care are also covered with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BayCarePlus Complete (HMO) covers primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, occupational therapy, and opioid treatment require a $15 copay and no coinsurance. Mental health, psychiatric, and telehealth services are covered with no coinsurance and copays ranging from $0 to $20, while podiatry is not covered, and some chiropractic services are covered with a $20 copay and no coinsurance but routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by BayCarePlus Complete (HMO) with no copay and no coinsurance for covered services like annual physicals, kidney disease education, and fitness benefits. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
BayCarePlus Complete (HMO) covers annual hearing exams with a $15 copay, no coinsurance, and no deductible, with a referral required. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $699 to $999 for up to two devices per year, but inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are covered by BayCarePlus Complete (HMO), offering one routine eye exam per year for a $15 copay and no coinsurance with a referral, while other eye exams are not covered. Eyewear is also covered with no copay or coinsurance up to a $300 annual limit for one pair of eyeglasses or contact lenses, though individual eyeglass frames and lenses are not covered separately.
Dental Services See details
BayCarePlus Complete (HMO) features partially covered dental services up to a $3,000 annual limit, with Medicare-covered services requiring a $15 to $150 copay and no coinsurance. Other covered preventive and comprehensive dental services have no copay and coinsurance ranging from no coinsurance to 50%, while other diagnostic or preventive services, adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BayCarePlus Complete (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy and other Part B drugs carry no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by BayCarePlus Complete (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
BayCarePlus Complete (HMO) covers durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes with no copay and a 20% coinsurance, subject to prior authorization. While these medical equipment benefits are covered, diabetic supplies are not covered under this plan.
Diagnostic and Radiological Services See details
BayCarePlus Complete (HMO) partially covers diagnostic and radiological services, requiring prior authorization for all covered services. Diagnostic radiological services are offered with no copay and no coinsurance, and therapeutic radiological services require a 20% coinsurance and no copay, while diagnostic procedures, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by BayCarePlus Complete (HMO) with no copay and no coinsurance, although a referral is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by BayCarePlus Complete (HMO) with no coinsurance and a referral requirement, though some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered. For these excluded services, a $15 copay applies.
Skilled Nursing Facility (SNF) See details
BayCarePlus Complete (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $150 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered 100 days are not covered.
Other Services See details
BayCarePlus Complete (HMO) partially covers Other Services, offering over-the-counter (OTC) items and chronic illness meal benefits with no copay and no coinsurance, while acupuncture is not covered. Eligible members receive a $145 allowance every three months for OTC items, but unused funds do not carry forward to the next period.
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