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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 2026, 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 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 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 $143.00. 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 features a $0 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generics, there is no copay when using a preferred pharmacy or standard mail order, while standard pharmacies charge an $8 copay for a one-month supply. Tier 2 generics also offer no copay through standard mail order, but cost an $8 copay at preferred pharmacies and a $15 copay at standard pharmacies for a one-month supply. Tier 3 preferred brand drugs require a $45 copay for a one-month supply at preferred pharmacies, standard pharmacies, and standard mail order. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring 35% coinsurance across all pharmacy options. Finally, Tier 5 specialty drugs incur a 33% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan offers comprehensive medical coverage featuring no copay for primary care visits, annual physical exams, and home health services. Specialist visits require a $30 copay, while inpatient hospital stays carry a $700 copay per stay with no coinsurance. For urgent needs, emergency room visits have a $130 copay, which is waived if admitted, and urgent care services require a $40 copay. This plan also includes valuable extra benefits, such as dental care covered up to $3,000 annually with no copay for preventive services and a 50% coinsurance for comprehensive care. Routine vision and hearing exams each require a $15 copay, with allowances of $150 annually for eyewear and $1,100 every three years for hearing aids at no copay. Additionally, skilled nursing facility stays feature no copay for the first 20 days, and durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) covers inpatient hospital services with a $700 copayment per stay and no coinsurance, subject to prior authorization. This benefit is partially covered because non-Medicare-covered stays, upgrades, and additional days for psychiatric care are not covered.
Outpatient Services See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) covers outpatient services with no coinsurance, featuring a $15 copay for outpatient hospital, observation, and substance abuse services, alongside a $100 copay for ambulatory surgical center services. Outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) covers partial hospitalization services with a $15.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) covers ambulance services with a $75 copay and no coinsurance for both ground and air transport, subject to prior authorization. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, while trips to any health-related location are not covered.
Emergency Services See details
Emergency services are covered by BSW SeniorCare Advantage Preferred Rx (HMO-POS) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are provided with no copay and no coinsurance up to a $5,000 maximum benefit limit.
Primary Care See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Therapy services have a $25 copay, mental health and psychiatric sessions require a $15 copay, all with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services are covered by BSW SeniorCare Advantage Preferred Rx (HMO-POS) with no copay and no coinsurance for annual physical exams, kidney disease education, and screenings. Additional preventive services are partially covered, offering physical and memory fitness benefits with no copay and no coinsurance, but excluding health education, personal emergency response systems (PERS), in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, and therapeutic massage. Other excluded services include adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by BSW SeniorCare Advantage Preferred Rx (HMO-POS), offering routine hearing exams for a $15 copay and no coinsurance. Prescription and OTC hearing aids feature no copay and no coinsurance up to an $1,100 maximum benefit every three years, though inner ear, outer ear, and over-the-ear prescription hearing aid types are not covered.
Vision Services See details
Vision services are partially covered by BSW SeniorCare Advantage Preferred Rx (HMO-POS), as other eye exam services and eyewear upgrades are not covered. Routine eye exams have a $15 copay and no coinsurance, while eyewear has no copay, no coinsurance, and no deductible up to a $150 annual limit.
Dental Services See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) partially covers dental services up to a $3,000 annual maximum, with preventive care requiring no copay and no coinsurance, and comprehensive care requiring no copay and a 50% coinsurance. Fluoride treatment, maxillofacial prosthetics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, although prior authorization is required. Medicare Part B insulin drugs are covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs have no copay and a coinsurance of 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the BSW SeniorCare Advantage Preferred Rx (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered under BSW SeniorCare Advantage Preferred Rx (HMO-POS) with no copay and 20% coinsurance for durable medical equipment, prosthetics, and medical supplies, with prior authorization required. While diabetic equipment is covered with no copay and no coinsurance, diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) partially covers Diagnostic and Radiological Services with no coinsurance and prior authorization required. Covered diagnostic and diagnostic radiological services have no copay, while therapeutic radiological services carry a minimum $15 copay, but diagnostic procedures, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) covers Home Health Services 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 Preferred 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
BSW SeniorCare Advantage Preferred Rx (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $100 copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BSW SeniorCare Advantage Preferred Rx (HMO-POS) partially covers other services, providing a chronic illness meal benefit and an over-the-counter (OTC) allowance of $30 every three months with no copay and no coinsurance. Acupuncture and nicotine replacement therapy are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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