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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, the copay for a standard generic drug is $35. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The BayCarePlus Complete (HMO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and partial hospitalization. You'll also have coverage for ambulance services, emergency care, and primary care services. Primary care benefits include mental health, chiropractic, and other professional services with varying copays. This plan also includes preventive services, hearing exams, and vision care with copays for exams and eyewear. Dental services have a maximum annual benefit, and home infusion bundled services are covered. Additional benefits include medical equipment, home health services with no copay, and skilled nursing facility coverage.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, with a $150 copay for days 1-6 and no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are covered with no copay. Non-Medicare-covered stay and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric is not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $125 copay, observation services with a $125 copay, ambulatory surgical center (ASC) services with a $75 copay, and outpatient substance abuse services with a $10 copay for individual sessions and a $5 copay for group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the BayCarePlus Complete (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $200 copay per service, and transportation services to a plan-approved health-related location with 16 one-way taxi trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $125, $20, and $125, respectively, with no coinsurance. Worldwide Urgent Coverage also has a $125 copay with no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The BayCarePlus Complete (HMO) plan covers primary care services, including chiropractic, occupational therapy, physician specialist, mental health specialty, other health care professional, psychiatric, physical therapy, speech-language pathology, additional telehealth, and opioid treatment program services. Chiropractic services have a $20 copay, and routine chiropractic care is not covered. Occupational therapy services have a $10 copay. Physician specialist services have a $10 copay, and Mental Health Specialty Services have a $10 copay for individual sessions and a $5 copay for group sessions. Other health care professional services have a copay between $10 and $20. Psychiatric services have a $10 copay for individual sessions and a $5 copay for group sessions. Physical therapy and speech-language pathology services have a $10 copay. Additional Telehealth Benefits have a copay between $0 and $20, and Opioid Treatment Program Services have a $10 copay.
Preventive Services See details
The BayCarePlus Complete (HMO) plan covers preventive services, including an annual physical exam, and other services like fitness benefits and telemonitoring services. However, some preventive services are not covered, including health education, in-home safety assessments, and counseling services.
Hearing Services See details
Hearing Services includes hearing exams, with a $10 copay, and prescription hearing aids, with a copay between $699 and $999, and fitting/evaluation for hearing aids, with no copay. Prescription hearing aids are covered for two visits every year, and routine hearing exams are covered for one visit every year. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams with a $10 copay and eyewear benefits including contact lenses with a maximum plan benefit coverage amount of $350 every year, eyeglasses (lenses and frames) with a maximum plan benefit coverage amount of $300 every year, and upgrades with a maximum plan benefit coverage amount of $300 every year; however, eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a copay of $15-$150, as well as other dental services with a maximum benefit of $3,000 per year. Other services include oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, with limitations on the number of visits and specific details available. Restorative services, prosthodontics, removable, and prosthodontics, fixed are covered with a coinsurance of 0-50% and 50% respectively, while some services like adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the BayCarePlus Complete (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance; however, Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Durable Medical Equipment and Prosthetics/Medical Supplies require prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the BayCarePlus Complete (HMO) plan. Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of up to $90, and Therapeutic Radiological Services have a 20% coinsurance.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but a referral is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BayCarePlus Complete (HMO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BayCarePlus Complete (HMO) plan, with a $0 copay for days 1-20, and a $150 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and a Meal Benefit. This plan covers OTC items up to $140 every three months and offers a meal benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs, 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 are not covered.
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