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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 2025, 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 Holdings available for enrollment in 2025 to people living in Central Texas. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, you'll pay a $13 copay for preferred generic drugs at a preferred pharmacy, or 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your prescription drug costs may be reduced.
Additional Benefits
The BSW SeniorCare Advantage Select Rx (HMO-POS) plan offers a range of benefits with varying costs. It includes coverage for inpatient and outpatient services, with copays ranging from $20 to $325, and coinsurance for some services. Preventive services, primary care, and home health services are available with no copay. This plan also provides coverage for hearing, vision, and dental services, with specific copays, coinsurance, and maximum benefits. The plan provides coverage for emergency services, ambulance, and transportation, as well as services such as home infusion, dialysis, and medical equipment.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-6 and $325 for days 7-60, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you will pay a $318 copay for days 1-5 and $318 for days 6-60, and no copay for days 6-90. Additional days, and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $325 copay and 20% coinsurance, observation services with 20% coinsurance, ambulatory surgical center services with a $250 copay, and outpatient substance abuse services with a $45 copay for both individual and group sessions. Outpatient blood services are covered with 20% coinsurance and a waived deductible for three pints.
Partial Hospitalization See details
Partial Hospitalization is covered with a $40 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a $300 copay, and transportation services to plan-approved health-related locations with 24 one-way trips per year, but transportation services to any health-related location is not covered. There is no coinsurance for any of these services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay, and Urgently Needed Services have a $50 copay; both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
The BSW SeniorCare Advantage Select Rx (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $35 copay, physician specialist services with a $30 copay, and mental health specialty services with a $30 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits, and opioid treatment program services with a minimum $45 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The BSW SeniorCare Advantage Select Rx (HMO-POS) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services, with no copay or coinsurance. The plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services. The plan also covers kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit, all with no copay or coinsurance.
Hearing Services See details
Hearing services include routine hearing exams with a $40 copay, and fitting/evaluation for hearing aids, both of which are limited to one visit per year. Prescription hearing aids are covered up to a maximum of $1500 every three years, but inner ear, outer ear, and over the ear prescription hearing aids, along with OTC hearing aids, are not covered.
Vision Services See details
The BSW SeniorCare Advantage Select Rx (HMO-POS) plan covers vision services, including eye exams with a $40 copay. Eyewear is covered with a combined maximum benefit of $150 every year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are also covered. Upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Select Rx (HMO-POS) plan covers a range of dental services with a maximum benefit of $3,500 per year. Oral exams, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered with a 50% coinsurance. Fluoride treatment and maxillofacial prosthetics are not covered, and orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered by the BSW SeniorCare Advantage Select Rx (HMO-POS) plan. This plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, although Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of up to $300.00, and Therapeutic Radiological Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Select Rx (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but not in practice. Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the BSW SeniorCare Advantage Select Rx (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100, but additional days beyond Medicare-covered, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for over-the-counter items with a maximum benefit of $50 every three months, and a meal benefit for a chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several other services are not covered.
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