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BSW SeniorCare Advantage Select Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Select Rx (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BSW SeniorCare Advantage Select Rx (HMO-POS) in 2026, please refer to our full plan details page.
BSW SeniorCare Advantage Select Rx (HMO-POS) is a HMO-POS plan offered by Baylor Scott & White Health available for enrollment in 2025 to people living in Central Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BSW SeniorCare Advantage Select Rx (HMO-POS) 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 BSW SeniorCare Advantage Select Rx (HMO-POS).
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 BSW SeniorCare Advantage Select Rx (HMO-POS), 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 a $250.00 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 $5800.00 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 BSW SeniorCare Advantage Select Rx (HMO-POS) Medicare plan features a $250 annual drug deductible and offers significant savings on prescription medications. For Tier 1 preferred generics, you will pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a $10 copay for a one-month supply. Tier 2 generics are also highly affordable, featuring no copay for standard mail order and a low $13 copay for a one-month supply at preferred pharmacies. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at both preferred and standard pharmacies, as well as through standard mail order. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 35% coinsurance across all pharmacy options. Specialty drugs in Tier 5 carry a 30% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
BSW SeniorCare Advantage Select Rx (HMO-POS) offers comprehensive core medical coverage, featuring primary care and preventive services with no copay and no coinsurance. Specialist visits require a $30 copay, and emergency room visits carry a $130 copay, both with no coinsurance. Inpatient hospital stays require a daily copay of $325 for the first six days of an acute stay, with no coinsurance or copays for the remaining covered days. The plan also includes valuable supplemental benefits, such as dental coverage up to $3,500 annually with no copay and routine vision and hearing exams for a $40 copay. Members also benefit from up to 24 free one-way transportation trips per year to approved locations and an $80 quarterly over-the-counter item allowance. Additionally, home health services are fully covered with no copay and no coinsurance.
Inpatient Hospital See details
BSW SeniorCare Advantage Select Rx (HMO-POS) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute stays require a $325 daily copay for days 1 through 6 (with no copay for days 7 through 90), while psychiatric stays require a $318 daily copay for days 1 through 5 (with no copay for days 6 through 90); upgrades, additional days, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers outpatient hospital services with a $325 copay and 20% coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse sessions carry a $45 copay and no coinsurance, while outpatient blood services feature no copay and 20% coinsurance with no deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by BSW SeniorCare Advantage Select Rx (HMO-POS) with a $40 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. Transportation services are partially covered, providing up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to any other health-related location is not covered.
Emergency Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $5,000 maximum with no copay and no coinsurance.
Primary Care See details
BSW SeniorCare Advantage Select Rx (HMO-POS) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $30 copay and therapy services require a $35 copay, both with no coinsurance. Mental health, psychiatric, and opioid treatment services are covered with copays ranging from $30 to $45 and no coinsurance; however, podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive services are covered by BSW SeniorCare Advantage Select Rx (HMO-POS) with no copay and no coinsurance, including annual physical exams, kidney disease education, and other preventive screenings. Additional preventive services are partially covered, offering physical and memory fitness benefits with no copay and no coinsurance, while health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home and bathroom safety modifications, and counseling services are not covered.
Hearing Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers routine hearing exams and fittings for a $40 copay and no coinsurance. Prescription and OTC hearing aids are partially covered with no copay and no coinsurance up to a $1,600 maximum every three years, though inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) partially covers vision services, featuring one routine eye exam per year with a $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $185 annual maximum for contact lenses or one pair of eyeglasses, but upgrades are not covered.
Dental Services See details
Dental services are partially covered by BSW SeniorCare Advantage Select Rx (HMO-POS) up to an annual maximum of $3,500, offering no copay for all covered services and coinsurance ranging from no coinsurance up to 50%. Fluoride treatment, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BSW SeniorCare Advantage Select Rx (HMO-POS) with no copay, subject to prior authorization. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the BSW SeniorCare Advantage Select Rx (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) partially covers Diagnostic and Radiological Services with prior authorization required, offering diagnostic services with no copay and no coinsurance, and diagnostic radiological services with no copay. Therapeutic radiological services require a copay and a 20% minimum coinsurance, while diagnostic procedures, tests, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home Health Services are covered by BSW SeniorCare Advantage Select Rx (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the BSW SeniorCare Advantage Select Rx (HMO-POS) plan, as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are all excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by BSW SeniorCare Advantage Select Rx (HMO-POS) with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) partially covers other services, offering over-the-counter (OTC) items and a chronic illness meal benefit with no copay and no coinsurance. The OTC benefit provides up to $80 of coverage every three months, though acupuncture is not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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