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BayCarePlus Rewards (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BayCarePlus Rewards (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BayCarePlus Rewards (HMO) in 2025, please refer to our full plan details page.
BayCarePlus Rewards (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 Rewards (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 Rewards (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 Rewards (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. Additionally, this plan comes with a Part B Premium reduction of $134.00. You must continue to pay paying your reduced 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 $3900.00 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 Rewards (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, you will pay a $10 copay for preferred generic drugs at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for Medicare 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 Rewards (HMO) plan offers coverage for a wide range of services. Inpatient hospital stays have a $200 copay for days 1-6, and no copay for days 7-90. The plan also covers outpatient services, including primary care, with copays ranging from $20-$25, and emergency services with a $125 copay. Additional benefits include hearing, vision, and dental services, with copays varying by service. Home health and preventive services are covered with no copay, while skilled nursing facility care has a copay depending on the length of stay. The plan also covers ambulance, diagnostic, and rehabilitation services with varying copays and coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $200 copay for days 1-6, and no copay for days 7-90. Additional days for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are also covered, and there is no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the BayCarePlus Rewards (HMO) plan. Outpatient Hospital Services and Observation Services have a copay of $225, Ambulatory Surgical Center (ASC) Services have a $125 copay, and Individual and Group Sessions for Outpatient Substance Abuse have copays ranging from $20 to $25.
Partial Hospitalization See details
Partial Hospitalization is covered by the BayCarePlus Rewards (HMO) plan, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BayCarePlus Rewards (HMO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered by BayCarePlus Rewards (HMO). Emergency Services have a $125 copay, while Urgently Needed Services have a $20 copay, and there is no coinsurance for either. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BayCarePlus Rewards (HMO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, mental health specialty services with a copay of $20-$25, other health care professional services with a copay of $20-$25, psychiatric services with a copay of $20-$25, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay of $0-$25, and opioid treatment program services with a $25 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Some additional preventive services are not covered, including Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services includes hearing exams with a $25 copay, routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $599 and $899, but prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $25 copay, as well as coverage for contact lenses, and eyeglasses (lenses and frames) with a combined maximum benefit of $150 every year. Eyeglass lenses and frames are not covered.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a copay of $40-$200, and other services with a $2,000 maximum benefit per year. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with limitations on the number of visits. Restorative services and prosthodontics, fixed have a coinsurance of 0% - 50% and 50% respectively. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BayCarePlus Rewards (HMO) and require prior authorization, with a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered by the BayCarePlus Rewards (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered by the BayCarePlus Rewards (HMO) plan, including durable medical equipment with 20% coinsurance and no copay, prosthetics/medical supplies with 20% coinsurance and no copay, and diabetic equipment, including diabetic supplies with 10% coinsurance and diabetic therapeutic shoes/inserts with 20% coinsurance, all with no copay. Durable medical equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BayCarePlus Rewards (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100, while Lab Services are not covered. Diagnostic Radiological Services have a copay of up to $125, and Therapeutic Radiological Services have a coinsurance of 20%. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the BayCarePlus Rewards (HMO) plan with no copay and no coinsurance, but require a referral, while additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD are not covered. A doctor referral is required, and there is a copay for some services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BayCarePlus Rewards (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $172 per day.
Other Services See details
Other Services are not covered by the BayCarePlus Rewards (HMO) plan. Specifically, 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 are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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