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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 2026, 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 2026.
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 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 $3700.00 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 features an annual drug deductible of $90. For Tier 1 preferred generic drugs, members pay no copay for up to a three-month supply at standard pharmacies or through standard mail order. Tier 2 generic drugs require a $10 copay for a one-month supply and a $30 copay for a three-month supply at standard pharmacies or via mail order. For Tier 3 preferred brand drugs, copays start at $47 for a one-month supply at standard pharmacies, and $121 for a three-month supply through standard mail order. Higher tier medications require coinsurance, with Tier 4 non-preferred drugs carrying a 33% coinsurance and Tier 5 specialty drugs requiring 32% coinsurance for a one-month supply.
Additional Benefits
The BayCarePlus Rewards (HMO) plan offers comprehensive healthcare coverage with no copay for primary care visits, preventive care, and home health services. Members benefit from low copayments and no coinsurance for specialist visits, physical therapy, and urgent care. Additionally, inpatient hospital stays require a $200 daily copay for the first five days with no copay for subsequent days, while emergency room visits have a $125 copay that is waived upon admission. The plan also features strong supplemental benefits, including preventive dental coverage up to a $2,000 annual maximum and eyewear coverage up to a $150 annual limit, both with no copays. Routine hearing exams and prescription hearing aids are available with fixed copayments and no coinsurance, and members receive a $35 quarterly allowance for over-the-counter items. Skilled nursing facility care is also covered, offering no copay for the first 20 days of a stay.
Inpatient Hospital See details
BayCarePlus Rewards (HMO) covers inpatient acute and psychiatric hospital stays with no coinsurance and a copay of $200 per day for days 1 through 5, followed by no copay for days 6 and beyond. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
BayCarePlus Rewards (HMO) covers outpatient services with no coinsurance, featuring outpatient hospital services with no copay to a $225 copay and observation services with a $225 copay per stay. Ambulatory surgical center services require a $125 copay with no coinsurance, while outpatient substance abuse sessions have a $20 to $25 copay with no coinsurance, and outpatient blood services feature no copay and no coinsurance.
Partial Hospitalization See details
BayCarePlus Rewards (HMO) covers partial hospitalization with a $55 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
BayCarePlus Rewards (HMO) covers ground and air ambulance services with a $250 copay and no coinsurance, subject to prior authorization. Some transportation services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
BayCarePlus Rewards (HMO) covers emergency services with a $125 copay (waived if admitted within 24 hours) and urgently needed services with a $20 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered with a $125 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BayCarePlus Rewards (HMO) provides primary care physician services with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $25 copay and no coinsurance. Mental health, psychiatric, and telehealth services carry copays ranging from $0 to $25 with no coinsurance, whereas podiatry is not covered, and chiropractic care is only partially covered with a $20 copay and no coinsurance.
Preventive Services See details
Preventive services are covered by BayCarePlus Rewards (HMO) with no copay and no coinsurance, though additional preventive benefits are only partially covered. Covered services include annual physicals and a fitness benefit, while health education, in-home safety assessments, PERS, medical nutrition therapy, and weight management programs are not covered.
Hearing Services See details
Hearing services are partially covered by BayCarePlus Rewards (HMO) with no deductible, offering routine hearing exams and evaluations for a $25 to $30 copay and no coinsurance. While up to two prescription hearing aids are covered annually with a $599 to $899 copay and no coinsurance, over-the-counter (OTC) hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
BayCarePlus Rewards (HMO) partially covers vision services, offering one routine eye exam per year with a $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 annual maximum for contact lenses or eyeglasses, although individual eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
BayCarePlus Rewards (HMO) partially covers dental services, providing preventive care up to a $2,000 annual maximum with no copay and no coinsurance, while Medicare-covered dental has a $25 to $200 copay and no coinsurance. Covered comprehensive options like endodontics and oral surgery require no copay and no coinsurance, whereas restorative and prosthodontic services require no copay and 0% to 50% coinsurance. Other diagnostic and preventive dental, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BayCarePlus Rewards (HMO) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered by BayCarePlus Rewards (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by BayCarePlus Rewards (HMO) with no copays, though prior authorization is required. Durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts are subject to a 20% coinsurance, while diabetic supplies carry a 10% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by BayCarePlus Rewards (HMO), with prior authorization required for covered services. Diagnostic radiological services have no copay or coinsurance, while therapeutic radiological services require both a copay and a minimum 20% coinsurance; however, diagnostic procedures, tests, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered under the BayCarePlus Rewards (HMO) plan with no copay and no coinsurance, although a referral is required to receive care.
Cardiac Rehabilitation Services See details
BayCarePlus Rewards (HMO) covers cardiac rehabilitation services with no coinsurance and a referral requirement, though only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered and require a $25 copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by BayCarePlus Rewards (HMO) with no coinsurance, featuring no copay for days 1 through 20 and a $172 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not necessary, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BayCarePlus Rewards (HMO) partially covers other services, offering a $35 allowance every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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