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BSW SeniorCare Advantage Preferred Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Preferred 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 Preferred Rx (HMO-POS) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Preferred 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 Preferred 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 Preferred 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 Preferred Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $135.00. 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 $4600.00 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 Preferred Rx (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for your prescriptions. For example, Preferred Generic drugs have an $8 copay at a preferred pharmacy, and $0 copay with standard mail. Once your total drug costs reach $2000, you enter the Catastrophic Coverage phase where you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan offers a range of benefits with varying costs. Hospital stays have a $700 copay, while outpatient services range from no copay to a $100 copay. Emergency services have a $120 copay, and primary care visits cost between $15 and $30. This plan also includes coverage for hearing, vision, and dental services. Hearing exams have a $15 copay, and routine eye exams also have a $15 copay. The plan offers dental coverage with a $3,000 annual maximum, and many other benefits, such as home health, skilled nursing, and ambulance services, are covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For each admission or stay, you will pay a $700 copay, while additional days for Inpatient Hospital-Acute are unlimited with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan covers outpatient services including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and observation services have a $15 copay, while ambulatory surgical center services have a $100 copay. Individual and group sessions for outpatient substance abuse have a copay between $15.00 and $15.00.
Partial Hospitalization See details
Partial Hospitalization is covered by the BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan, but requires prior authorization. You will pay a $15 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services. Ground and air ambulance services have a $75 copay, and the plan covers 24 one-way trips per year to a plan-approved health-related location using transportation services such as taxi, rideshare, bus/subway, van, or medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan. Emergency Services have a $120 copay, and Urgently Needed Services have a $40 copay, and both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
Primary Care services include coverage for Primary Care Physician services, Chiropractic Services, Occupational Therapy, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic services have a $15 copay, while Occupational Therapy has a $25 copay. Physician Specialist Services have a $30 copay, and Physical Therapy and Speech-Language Pathology Services have a $25 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a copay between $15 and $15. Opioid Treatment Program Services have a copay between $15 and $15. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit are also covered. 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 are not covered.
Hearing Services See details
Hearing Services includes hearing exams with a $15 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered, with one visit allowed per year. Prescription hearing aids (all types) are covered, with a maximum benefit of $1100 every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan covers routine eye exams with a $15 copay and eyewear, with a combined maximum benefit of $150 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered. Upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan covers dental services with a $3,000 annual maximum. Oral exams, dental X-rays, other diagnostic services, cleaning, and other preventive services are covered, though fluoride treatment and orthodontics are not covered. Restorative services, adjunctive general services, endodontics, periodontics, removable prosthodontics, implant services, fixed prosthodontics, and oral and maxillofacial surgery are covered with a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, while Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan. Diagnostic services have no copay, but Diagnostic Procedures/Tests and Lab Services are not covered, and Radiological Services have a copay of at most $15.00 for Diagnostic and Therapeutic Radiological Services.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $50 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include Over-the-Counter (OTC) Items and Meal Benefit coverage. OTC items have a maximum benefit of $30.00 every three months, and the meal benefit covers meals for a chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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