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BayCarePlus Premier (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BayCarePlus Premier (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BayCarePlus Premier (HMO) in 2026, please refer to our full plan details page.
BayCarePlus Premier (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 Premier (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 Premier (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 Premier (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $49.00. 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 $2900.00 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 Premier (HMO) prescription drug plan features a low $90 annual drug deductible. Under this plan, Tier 1 preferred generic drugs have no copay for one, two, or three-month supplies at standard pharmacies. 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 Tier 3 preferred brand drugs, members pay a $47 copay for a one-month supply at standard pharmacies or a reduced $121 copay for a three-month 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 Premier (HMO) plan offers robust healthcare coverage featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. Specialist visits and physical therapy require a low $25 copay, while inpatient hospital stays feature a $175 daily copay for the first six days and no copay for additional days. Emergency care and ambulance services are also covered with flat copays of $125 and $200 respectively, with no coinsurance. In addition to medical care, members enjoy comprehensive dental coverage up to a $3,000 annual limit with no copay for most preventive and comprehensive services. The plan also features no copay for up to $300 in annual eyewear, a $150 quarterly allowance for over-the-counter items, and 24 free one-way taxi trips to health-related locations. Prescription hearing aids are also covered with affordable copays ranging from $599 to $899 per device.
Inpatient Hospital See details
Inpatient hospital services are partially covered by BayCarePlus Premier (HMO) with no coinsurance, featuring a $175 daily copay for days 1 through 6 and no copay for days 7 and beyond for acute and psychiatric stays. Prior authorization is required, and non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient services are covered by BayCarePlus Premier (HMO) with no coinsurance, featuring copays of $0 to $95 for outpatient hospital services, $95 per stay for observation services, and $50 for ambulatory surgical center services. Outpatient substance abuse services require a $20 to $25 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
BayCarePlus Premier (HMO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization may be required for these covered services.
Ambulance and Transportation Services See details
BayCarePlus Premier (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance. Transportation services are partially covered, offering up to 24 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 Premier (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 services are partially covered with a $125 copay and no coinsurance for emergency and urgent care, while worldwide emergency transportation is not covered.
Primary Care See details
BayCarePlus Premier (HMO) provides primary care physician services with no copay and no coinsurance, while specialist visits, physical therapy, and occupational therapy require a $25 copay and no coinsurance. Mental health, psychiatric, and telehealth services have copays ranging from $0 to $25 with no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
BayCarePlus Premier (HMO) covers preventive services, including annual physical exams, kidney disease education, and a fitness benefit, with no copay and no coinsurance. Additional preventive services are only partially covered, with excluded services including health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy.
Hearing Services See details
BayCarePlus Premier (HMO) covers hearing services, offering one annual routine hearing exam with a $25 copay, no deductible, and no coinsurance, alongside unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay of $599 to $899 for up to two devices per year, while OTC hearing aids and inner ear, outer ear, and over-the-ear prescription models are not covered.
Vision Services See details
BayCarePlus Premier (HMO) vision services are partially covered, featuring routine eye exams for a $25 copay and no coinsurance, though other eye exam services, individual eyeglass lenses, and individual eyeglass frames are not covered. Eyewear, including contact lenses and complete eyeglasses, is available with no copay or coinsurance up to a $300 annual maximum.
Dental Services See details
BayCarePlus Premier (HMO) partially covers dental services up to a $3,000 annual limit, offering most preventive and comprehensive services with no copay and no coinsurance, while restorative and prosthodontic services have no copay and 0% to 50% coinsurance. Medicare-covered dental services require a $25 to $175 copay with no coinsurance. Other diagnostic, other preventive, adjunctive general, maxillofacial prosthetics, implant, and orthodontic services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BayCarePlus Premier (HMO) with no copay, though prior authorization is required. Associated Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance to 20%, with Part B insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis Services are covered under the BayCarePlus Premier (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BayCarePlus Premier (HMO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes and inserts. Prior authorization is required for these covered benefits, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by BayCarePlus Premier (HMO), as diagnostic procedures, lab services, and outpatient X-rays are not covered. Covered diagnostic and diagnostic radiological services feature no copay and no coinsurance, whereas therapeutic radiological services require a copayment and 20% coinsurance.
Home Health Services See details
Home health services are covered by BayCarePlus Premier (HMO) with no copay and no coinsurance, though a referral is required.
Cardiac Rehabilitation Services See details
BayCarePlus Premier (HMO) partially covers Cardiac Rehabilitation Services with no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered and carry a $25 copay.
Skilled Nursing Facility (SNF) See details
BayCarePlus Premier (HMO) 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, followed by a $175 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BayCarePlus Premier (HMO) partially covers other services, offering meal benefits for chronic illnesses and up to $150 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture is not covered under this plan.
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