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BSW SeniorCare Advantage Select (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Select (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 (HMO-POS) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Select (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 (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BSW SeniorCare Advantage Select (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 (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. Additionally, this plan comes with a Part B Premium reduction of $50.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5900.00 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
Prescription drugs are not covered by BSW SeniorCare Advantage Select (HMO-POS).
Additional Benefits
The BSW SeniorCare Advantage Select (HMO-POS) plan offers a variety of benefits with varying costs. Hospital stays have a copay for the first few days, while outpatient services often involve copays or coinsurance. The plan also covers primary care, preventive services, hearing, vision, and dental, with specific copays, annual maximums, or coinsurance. Additional benefits include ambulance and transportation services, emergency services, and home health services with no copay. The plan also provides coverage for medical equipment, skilled nursing facilities, and home infusion services. However, the plan has limitations, such as not covering certain services like acupuncture, orthodontics, and specific types of hearing aids.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both acute and psychiatric care, with a copay of $325 per day for days 1-6 of acute care, and no copay for days 7-90. Psychiatric care has a copay of $318 per day for days 1-5, and no copay for days 6-90. Additional days, non-Medicare covered stays, and upgrades 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 individual and group sessions, and outpatient blood services with 20% coinsurance. Outpatient blood services include an enhanced benefit where the three (3) pint deductible is waived.
Partial Hospitalization See details
BSW SeniorCare Advantage Select (HMO-POS) covers partial hospitalization with a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both Ground and Air Ambulance Services, each with a $265 copay. Transportation Services to plan-approved health-related locations are covered for up to 24 one-way trips per year, using various modes of transportation for rides up to 50 miles. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay with no coinsurance, and Urgently Needed Services have a $50 copay with no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
The BSW SeniorCare Advantage Select (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, mental health and psychiatric services with a $30 copay, physical therapy and speech-language pathology services with a $35 copay, and opioid treatment program services with a $45 copay. Routine chiropractic care is not covered, and podiatry services are not covered.
Preventive Services See details
The BSW SeniorCare Advantage Select (HMO-POS) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services, such as fitness benefits, are covered, while services like health education and home-based palliative care are not covered. Other preventive services include glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams are covered once per year, and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered up to $1,000 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 Select (HMO-POS) plan covers routine eye exams with a $40 copay, and also covers eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. The plan offers a combined maximum benefit of $125 annually for all eyewear, and covers contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames once per year. Upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Select (HMO-POS) plan covers dental services with a maximum benefit of $3,000 per year. Oral exams and cleanings are covered, as well as dental x-rays and other diagnostic services, while 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 and require prior authorization, with coinsurance depending on the specific drug. 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 Select (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment for use outside the home, 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 Select (HMO-POS) plan, however, Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay of up to $300, and Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Select (HMO-POS) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically 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 under the BSW SeniorCare Advantage Select (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefit, 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, and Self-Directed Personal Assistance Services. The OTC benefit provides a maximum of $30 every three months.
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