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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 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Premium (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 (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 a range of benefits with varying costs. Inpatient hospital stays have a $100 copay per admission, and emergency services have a $90 copay. The plan includes coverage for outpatient services, ambulance, and transportation services, as well as hearing, vision, and dental care. This plan covers primary care with a $10 copay for some services, and also includes home health services, medical equipment, and skilled nursing facility stays with no copay for the first 20 days. Preventative services are covered, as well as over-the-counter items and meal benefits. However, some services such as some dental procedures, and cardiac rehabilitation services may have coinsurance costs.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, each with 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 are covered, including outpatient hospital services, observation services, ambulatory surgical center services, and outpatient blood services. Outpatient substance abuse services are partially covered, as individual and group sessions for outpatient substance abuse are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services, including services not usually covered by Medicare plans, are covered. Ground and air ambulance services have a $40 copay, while transportation services to plan-approved health-related locations are covered for up to 24 one-way trips per year and include various transportation modes.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by BSW SeniorCare Advantage Premium (HMO-POS). Emergency Services have a $90 copay, and Urgently Needed Services have a $40 copay, but both have no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
The BSW SeniorCare Advantage Premium (HMO-POS) plan covers Primary Care Physician Services, Occupational Therapy Services with a $10 copay, Physician Specialist Services, Other Health Care Professional, Physical Therapy and Speech-Language Pathology Services with a $10 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services, Mental Health Specialty Services, and Psychiatric Services are only partially covered, with routine chiropractic care, individual sessions for mental health specialty services, group sessions for mental health specialty services, individual sessions for psychiatric services, and group sessions for psychiatric services not covered. Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services, annual physical exams, and other preventive services. Fitness benefits are covered, including physical and memory fitness. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services are covered, including routine hearing exams and fitting/evaluation for hearing aids, with no copay. Prescription hearing aids (all types) are covered, with a maximum benefit of $1,000 every three years. However, prescription hearing aids for the inner ear, outer ear, and over-the-ear are not covered, nor are OTC hearing aids.
Vision Services See details
The BSW SeniorCare Advantage Premium (HMO-POS) plan covers vision services, including routine eye exams with no copay for one exam per year. Eyewear is covered with a combined maximum benefit of $125 per year, and includes coverage for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. Upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Premium (HMO-POS) plan covers a range of dental services, including oral exams, dental X-rays, other diagnostic dental services, prophylaxis (cleaning), other preventive dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery. This plan has a maximum benefit of $3000 per year, and services like restorative, adjunctive general, endodontics, periodontics, prosthodontics, implant services, and oral and maxillofacial surgery have a 50% coinsurance. The plan does not cover fluoride treatments or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. 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 by the BSW SeniorCare Advantage Premium (HMO-POS) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the BSW SeniorCare Advantage Premium (HMO-POS) plan. Durable Medical Equipment (DME) and Prosthetics/Medical Supplies - Non-Medicare benefits are covered with no copay or coinsurance, but Durable Medical Equipment for use outside the home, Prosthetic Devices, and Medical Supplies are not covered. Diabetic Equipment is also covered, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
The BSW SeniorCare Advantage Premium (HMO-POS) plan covers diagnostic and radiological services, but does not cover diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, or outpatient X-ray services. There is no copay for the covered services.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Premium (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 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BSW SeniorCare Advantage Premium (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 for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BSW SeniorCare Advantage Premium (HMO-POS) plan's "Other Services" benefit covers over-the-counter (OTC) items with a maximum benefit of $30 every three months, and meal benefits for chronic illnesses. Acupuncture, Dual Eligible SNPs, 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 are not covered.
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