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BSW SeniorCare Advantage Premium Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Premium 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 Premium Rx (HMO-POS) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Premium 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 Premium 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 Premium 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 Premium Rx (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $243.00. 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 $4800.00 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 Premium Rx (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $5 copay at a preferred pharmacy and a $0 copay via standard mail order. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. This plan is an enhanced alternative drug plan.
Additional Benefits
The BSW SeniorCare Advantage Premium Rx (HMO-POS) plan offers a range of benefits with varying cost structures. Inpatient hospital stays have a $100 copay per admission, while emergency services have a $90 copay. Primary care visits have a $10 copay for physical and occupational therapy, and preventive services have no copay. This plan includes additional benefits such as coverage for hearing and vision services, with a $1000 maximum benefit for hearing aids every three years, and a combined $125 annual benefit for vision eyewear. Dental services are also included, with a $3,500 maximum benefit per year, and home health and medical equipment services are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $100 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services, are covered by the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan. Outpatient substance abuse services are partially covered; individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization required. There is no information about the cost of services.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including ground and air ambulance services, are covered with a $40 copay. Transportation Services to a plan-approved health-related location are covered for 24 one-way trips per year.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered under the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan. Emergency Services have a $90 copay and no coinsurance, while Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Occupational Therapy Services, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services are partially covered, with Routine Chiropractic Care not covered, and Mental Health and Psychiatric Services are also partially covered with individual and group sessions not covered. Occupational Therapy and Physical Therapy and Speech-Language Pathology Services have a $10 copay.
Preventive Services See details
The BSW SeniorCare Advantage Premium Rx (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional services. Additional preventive services such as health education, in-home safety assessments, and personal emergency response systems are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams once per year, and prescription hearing aids (all types) with a maximum plan benefit of $1000 every three years; fitting/evaluation for hearing aids, inner ear hearing aids, outer ear hearing aids, over the ear hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with one exam covered per year, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Eyewear has a combined maximum benefit of $125 per year, and upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Premium Rx (HMO-POS) plan covers dental services, including oral exams, dental X-rays, and other diagnostic services, with a maximum benefit of $3,500 per year. Restorative, adjunctive general, endodontics, periodontics, prosthodontics, and oral surgery services are covered with 50% coinsurance, and fluoride treatment and orthodontics are 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 a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. There is no copay or coinsurance for DME and Prosthetics/Medical Supplies, but Durable Medical Equipment for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Premium 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.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but none of the sub-services, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are covered under the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, and a $15 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $30 every three months and meal benefits for a chronic illness, but does not cover 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, or Self-Directed Personal Assistance Services.
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