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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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay varying costs based on the drug tier, with some generic drugs having no copay at standard pharmacies. For preferred brand drugs, you pay 31% coinsurance at standard pharmacies, while non-preferred drugs have a 33% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BayCarePlus Premier (HMO) plan offers a range of benefits, including inpatient and outpatient hospital services with varying copays. You'll have access to emergency and urgent care services, both locally and worldwide, with copays ranging from $20 to $125. This plan also covers primary care and specialist visits, with copays ranging from $0 to $25 depending on the service. Additional benefits include hearing and vision services, with copays for exams and coverage for hearing aids, eyeglasses, and contact lenses. Dental services are covered up to a $3,000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you'll pay a $175 copay for days 1-6, and no copay for days 7-90; Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services includes coverage for Outpatient Hospital Services with a $95 copay, Observation Services with a $95 copay, Ambulatory Surgical Center (ASC) Services with a $50 copay, Outpatient Substance Abuse Services with a copay between $20 and $25 depending on the session, and Outpatient Blood Services.
Partial Hospitalization See details
Partial Hospitalization is covered by the BayCarePlus Premier (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a $200 copay. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way taxi trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the BayCarePlus Premier (HMO) plan. For emergency services, the copay is $125, and there is no coinsurance. Urgently needed services have a $20 copay with no coinsurance. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $125 copay with no coinsurance, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The BayCarePlus Premier (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $25 copay. The plan also covers mental health specialty services, psychiatric services, and opioid treatment program services, all with varying copays. Physical therapy and speech-language pathology services have a $25 copay, and additional telehealth benefits range from no copay to a $25 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The BayCarePlus Premier (HMO) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, kidney disease education services, and other preventive services. Fitness Benefit and Telemonitoring Services are also covered. However, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and many other services are not covered.
Hearing Services See details
Hearing services under the BayCarePlus Premier (HMO) plan include hearing exams with a $25 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $599 and $899. Prescription hearing aids are not covered for inner ear, outer ear, or over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
The BayCarePlus Premier (HMO) plan covers vision services, including routine eye exams with a $25 copay. The plan also covers eyewear, including contact lenses (1 pair per year, up to $350), eyeglasses with lenses and frames (1 pair per year, up to $300), and upgrades (up to $300). Eyeglass lenses and eyeglass frames are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $3,000 per year. Medicare Dental Services have a copay between $30 and $175, while Restorative Services and Prosthodontics (fixed and removable) have 0% to 50% coinsurance. Oral exams, dental x-rays, cleaning, and fluoride treatments are covered, but limited to a certain number of visits per year. 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 the BayCarePlus Premier (HMO) plan, which includes coverage for Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the BayCarePlus Premier (HMO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment benefits are covered by the BayCarePlus Premier (HMO) plan. Durable Medical Equipment (DME) and Prosthetic Devices have a 20% coinsurance with no copay, while Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
The BayCarePlus Premier (HMO) plan covers diagnostic and radiological services, but does not cover diagnostic procedures/tests, lab services, and outpatient X-ray services. Diagnostic radiological services have a copay of up to $90.00, while therapeutic radiological services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the BayCarePlus Premier (HMO) plan with no copay or coinsurance, but a referral is required; however, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BayCarePlus Premier (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $175. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $175 every three months, and Meal Benefits for chronic illnesses. However, 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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