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BSW SeniorCare Advantage Premium (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Premium (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 (HMO-POS) in 2026, please refer to our full plan details page.
BSW SeniorCare Advantage Premium (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 (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 Premium (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 (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:
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Drug Coverage
Prescription drugs are not covered by BSW SeniorCare Advantage Premium (HMO-POS).
Additional Benefits
The BSW SeniorCare Advantage Premium (HMO-POS) plan offers comprehensive coverage with no copay and no coinsurance for many essential services, including primary care, specialist visits, preventive care, and outpatient hospital services. Patients also benefit from no copay on routine eye and hearing exams, home health care, and medical equipment. For other medical needs, the plan keeps out-of-pocket costs predictable with a low $100 copay per inpatient hospital stay, a $90 copay for emergency room visits, and a $40 copay for urgent care and ambulance services. Additional perks include a $125 annual vision allowance for eyewear, up to $1,000 every three years for hearing aids, and a $30 quarterly allowance for over-the-counter items with no copay. Dental care is also highly accessible, featuring no copay for preventive services and a $3,000 annual maximum for comprehensive care with a 50% coinsurance. Furthermore, the plan covers up to 24 one-way transportation trips per year and skilled nursing facility stays with no copay for the first 20 days.
Inpatient Hospital See details
BSW SeniorCare Advantage Premium (HMO-POS) partially covers inpatient hospital services with a $100 copayment per stay and no coinsurance, subject to prior authorization. While acute stays include unlimited additional days, this benefit does not cover hospital upgrades, non-Medicare-covered stays, or additional days for psychiatric stays.
Outpatient Services See details
BSW SeniorCare Advantage Premium (HMO-POS) covers outpatient hospital, ambulatory surgical center, and outpatient blood services with no copay and no coinsurance. Some outpatient substance abuse services are covered with no copay or coinsurance, though individual and group sessions are not covered.
Partial Hospitalization See details
BSW SeniorCare Advantage Premium (HMO-POS) covers partial hospitalization services with no copay and no coinsurance. Some of these covered services may require prior authorization.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the BSW SeniorCare Advantage Premium (HMO-POS) plan, with a $40 copay and no coinsurance for both ground and air ambulance services. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
BSW SeniorCare Advantage Premium (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 admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered with no copay or coinsurance up to a $5,000 maximum benefit limit.
Primary Care See details
BSW SeniorCare Advantage Premium (HMO-POS) covers primary care, specialist, telehealth, and opioid treatment services with no copay and no coinsurance, while occupational, physical, and speech therapies require a $10 copay and no coinsurance. Podiatry is not covered, and chiropractic, mental health, and psychiatric services are not covered in practice due to routine, individual, and group session exclusions.
Preventive Services See details
BSW SeniorCare Advantage Premium (HMO-POS) covers preventive services, including annual physical exams, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered, offering physical and memory fitness programs with no copay and no coinsurance, while services such as health education, weight management, and personal emergency response systems are not covered.
Hearing Services See details
BSW SeniorCare Advantage Premium (HMO-POS) covers routine hearing exams and OTC hearing aids with no copay and no coinsurance, providing a $1,000 maximum benefit for OTC devices every three years. Prescription hearing aids are partially covered with no copay and no coinsurance up to a $1,000 limit every three years, but inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
BSW SeniorCare Advantage Premium (HMO-POS) provides partially covered vision services with no copay, no coinsurance, and no deductible, including one routine eye exam and up to a $125 annual allowance for contacts or eyeglasses. Other eye exam services and eyewear upgrades are not covered.
Dental Services See details
BSW SeniorCare Advantage Premium (HMO-POS) partially covers dental services up to a $3,000 annual maximum, offering preventive care with no copay and no coinsurance. Covered comprehensive services require no copay and a 50% coinsurance, but fluoride treatments, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
BSW SeniorCare Advantage Premium (HMO-POS) covers home infusion bundled services with no copay, subject to prior authorization. Under this plan, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require a 0% to 20% coinsurance and no copay.
Dialysis Services See details
Dialysis Services are covered under the BSW SeniorCare Advantage Premium (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BSW SeniorCare Advantage Premium (HMO-POS) provides medical equipment coverage with no copay and no coinsurance, though prior authorization is required. This benefit is partially covered because prosthetic devices, medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by BSW SeniorCare Advantage Premium (HMO-POS) with no copay and no coinsurance, though prior authorization is required and only some services are covered. Diagnostic procedures and tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient x-ray services are not covered.
Home Health Services See details
Home Health Services are covered by BSW SeniorCare Advantage Premium (HMO-POS) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
BSW SeniorCare Advantage Premium (HMO-POS) indicates that some services are covered for Cardiac Rehabilitation Services with no copay and no coinsurance, though 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 partially covered by BSW SeniorCare Advantage Premium (HMO-POS) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $50 copay for days 21 through 100, while additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BSW SeniorCare Advantage Premium (HMO-POS) partially covers other services, offering chronic illness meal benefits and up to $30 every three months for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered under this plan.
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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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