A non-government entity
BSW SeniorCare Advantage Preferred (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Preferred (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 (HMO-POS) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Preferred (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 (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 Preferred (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 (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 $4500.00 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:
Sign up for BSW SeniorCare Advantage Preferred (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by BSW SeniorCare Advantage Preferred (HMO-POS).
Additional Benefits
The BSW SeniorCare Advantage Preferred (HMO-POS) plan offers a range of benefits including inpatient hospital stays with a $700 copay per admission, and outpatient services with copays ranging from $15 to $100. The plan also covers emergency services with a $120 copay, along with primary care, preventive, hearing, vision, and dental services, each with their own specific copays and coverage limits. Additionally, it covers home infusion, dialysis, medical equipment, and diagnostic services with varying coinsurance or copays. This plan provides additional benefits such as ambulance services with a $75 copay, and transportation services with limitations. Other covered services include skilled nursing facility stays with a copay after day 20, and home health services with no copay. Over-the-counter items are covered up to $30 every three months, and meals for chronic illness are also included. However, the plan does not cover some services such as cardiac rehabilitation, acupuncture, and certain types of therapies.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Medicare-covered stays, there is a $700 copay per admission or stay. Additional days for Inpatient Hospital-Acute are covered 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
Outpatient Services are covered by the BSW SeniorCare Advantage Preferred (HMO-POS) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. For outpatient hospital and observation services, there is a $15 copay, while ambulatory surgical center services have a $100 copay. Individual and group sessions for outpatient substance abuse also have a $15 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BSW SeniorCare Advantage Preferred (HMO-POS) plan, with a $15 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BSW SeniorCare Advantage Preferred (HMO-POS) plan, including both ground and air ambulance services with a $75 copay. Transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year, with rides up to 50 miles and various transportation options. 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 and no coinsurance, while Urgently Needed Services have a $40 copay and no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $5,000.
Primary Care See details
The BSW SeniorCare Advantage Preferred (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $25 copay, physician specialist services with a $30 copay, mental health specialty services with a $15 copay for individual and group sessions, physical therapy and speech-language pathology services with a $25 copay, and opioid treatment program services with a $15 copay. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The BSW SeniorCare Advantage Preferred (HMO-POS) plan covers preventive services, including Medicare-covered services, annual physical exams, kidney disease education services, and other preventive services. The plan also covers fitness benefits, including physical fitness and memory fitness. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a $15 copay, and fitting/evaluation for hearing aids, with a limit of one visit per year. Prescription hearing aids are covered up to $1000 every three years, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $15 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, are covered, with a combined maximum benefit of $125 per year. Upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Preferred (HMO-POS) plan covers a variety of dental services, with a maximum benefit of $3,000 per year. Oral exams are covered once every six months, dental x-rays are covered with limitations, and other services like fillings, dentures, and oral surgery are covered with a 50% coinsurance. Fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BSW SeniorCare Advantage Preferred (HMO-POS), including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, and Prosthetics/Medical Supplies with 20% coinsurance and no copay, but Durable Medical Equipment for use outside the home and Diabetic Supplies/Therapeutic Shoes/Inserts are not covered. Diabetic Equipment is covered, but limited to specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests, and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $15, and Therapeutic Radiological Services have a copay of at most $15. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered under the BSW SeniorCare Advantage Preferred (HMO-POS) plan with no copay or coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BSW SeniorCare Advantage Preferred (HMO-POS) plan. Specifically, Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BSW SeniorCare Advantage Preferred (HMO-POS) plan, but require prior authorization. You will have no copay for days 1-20, and a $50 copay for days 21-100.
Other Services See details
The BSW SeniorCare Advantage Preferred (HMO-POS) plan 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. Over-the-counter (OTC) items are covered with a maximum benefit of $30 every three months, and the plan covers meals for a chronic illness.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved