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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 2026, 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 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 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 $255.00. 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 features a $0 drug deductible, meaning your prescription coverage begins immediately. Under this plan, you will pay no copay for Tier 1 preferred generic drugs filled at a preferred pharmacy or through standard mail order. Tier 2 generic drugs are also highly affordable, starting at no copay for standard mail order and just a $5 copay for a one-month supply at a preferred pharmacy. For Tier 3 preferred brand drugs, you can expect a $45 copay for a one-month supply at both preferred and standard pharmacies. Higher-tier prescriptions require coinsurance rather than flat copays, with Tier 4 non-preferred drugs costing 35% coinsurance and Tier 5 specialty drugs carrying a 33% coinsurance for a one-month supply. Utilizing preferred pharmacies and standard mail order services generally offers the lowest out-of-pocket costs for this plan's members.
Additional Benefits
The BSW SeniorCare Advantage Premium Rx (HMO-POS) plan offers robust medical coverage with many essential services available at no cost. Members enjoy no copays and no coinsurance for primary care visits, specialist consultations, outpatient hospital services, and preventive care. For more intensive medical needs, inpatient hospital stays require a $100 copay per stay with no coinsurance, and emergency room visits feature a $90 copay. This plan also includes generous dental, vision, hearing, and everyday wellness benefits to support your health. Routine vision and hearing exams are covered with no copay, alongside allowances of up to $125 annually for eyewear and $1,000 every three years for hearing aids. Dental care is covered up to a $3,000 annual maximum, featuring no copay for preventive services and a 50% coinsurance for comprehensive treatments.
Inpatient Hospital See details
Inpatient hospital services are partially covered by BSW SeniorCare Advantage Premium Rx (HMO-POS) with a $100 copayment per stay and no coinsurance, subject to prior authorization. While unlimited additional days are covered for acute care, upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by BSW SeniorCare Advantage Premium Rx (HMO-POS) with no copay and no coinsurance for outpatient hospital, ambulatory surgical center, and blood services. Some outpatient substance abuse services are covered with no copay and no coinsurance, but individual and group sessions are not covered.
Partial Hospitalization See details
BSW SeniorCare Advantage Premium Rx (HMO-POS) covers partial hospitalization services with no copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan, with Medicare-covered ground and air ambulance services requiring a $40 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
BSW SeniorCare Advantage Premium Rx (HMO-POS) covers emergency services with a $90 copay and no coinsurance, and urgently needed services with a $40 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $5,000 maximum benefit limit with no copay and no coinsurance.
Primary Care See details
Primary care services are covered by BSW SeniorCare Advantage Premium Rx (HMO-POS) with no copay and no coinsurance for primary care, specialists, and telehealth, while physical and occupational therapy require a $10 copay and no coinsurance. Podiatry is not covered, and while some chiropractic, mental health, and psychiatric services are covered with no copay and no coinsurance, routine chiropractic care along with individual and group sessions are not covered.
Preventive Services See details
Preventive services are covered by BSW SeniorCare Advantage Premium Rx (HMO-POS) with no copay and no coinsurance, including annual physical exams, kidney disease education, glaucoma screenings, and diabetes self-management training. Additional preventive services are partially covered with no copay and no coinsurance to offer physical and memory fitness benefits. However, sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, enhanced disease management, telemonitoring, remote access, home modifications, and counseling are not covered.
Hearing Services See details
BSW SeniorCare Advantage Premium Rx (HMO-POS) covers hearing services with no copay, no coinsurance, and no deductible, including one routine exam and fitting evaluation per year. Hearing aids are partially covered with a $1,000 maximum benefit every three years and no copay or coinsurance, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
BSW SeniorCare Advantage Premium Rx (HMO-POS) covers vision services with no copay, no coinsurance, and no deductible, including one routine eye exam and up to $125 for eyewear annually. This benefit is partially covered, as other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental Services are partially covered by BSW SeniorCare Advantage Premium Rx (HMO-POS) up to a $3,000 annual maximum, featuring no copay and no coinsurance for preventive services, and no copay with 50% coinsurance for comprehensive services. Fluoride treatments, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled services are covered by BSW SeniorCare Advantage Premium Rx (HMO-POS) with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy and other drugs require no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by BSW SeniorCare Advantage Premium Rx (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
BSW SeniorCare Advantage Premium Rx (HMO-POS) covers Durable Medical Equipment with no copay and no coinsurance, subject to prior authorization. Other medical equipment benefits are not covered in practice, as prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered by the plan.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are not covered under the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan, as all sub-services, including lab services, diagnostic procedures, radiological services, and outpatient X-rays, are excluded from coverage.
Home Health Services See details
Home Health Services are covered under the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services, including intensive cardiac, pulmonary, and SET for PAD services, are not covered under the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan.
Skilled Nursing Facility (SNF) See details
BSW SeniorCare Advantage Premium Rx (HMO-POS) covers skilled nursing facility (SNF) care with no coinsurance and does not require a prior three-day hospital stay. There is no copay for days 1 through 20 and a $50 daily copay for days 21 through 100, though prior authorization is required and additional days beyond the standard Medicare limit are not covered.
Other Services See details
Other Services are partially covered under the BSW SeniorCare Advantage Premium Rx (HMO-POS) plan, with acupuncture excluded from coverage. Covered benefits include over-the-counter (OTC) items up to $30 every three months and chronic illness meal benefits, both of which feature no copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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