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BSW SeniorCare Advantage Select Rx (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Select 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 Select Rx (HMO-POS) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Select Rx (HMO-POS) is a HMO-POS plan offered by Baylor Scott & White Holdings available for enrollment in 2025 to people living in North 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 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 Select 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 Select Rx (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.
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 $5000.00 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 Select Rx (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $13 copay at preferred pharmacies, while standard mail order generic drugs have no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The BSW SeniorCare Advantage Select Rx (HMO-POS) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays and coinsurance. It also covers a range of services such as primary care, preventive services, hearing, vision, and dental, each with specific copays, coinsurance, or annual maximums. Emergency, ambulance, and home health services are covered. The plan also provides additional benefits such as coverage for home infusion, dialysis, medical equipment, and skilled nursing facility stays. There is coverage for over-the-counter items and a meal benefit for chronic illnesses. However, certain services like acupuncture, private duty nursing, and some rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. For Inpatient Hospital-Acute, there is a $200 copay for days 1-5, and no copay for days 6-90, and a service-specific out-of-pocket maximum of $1000. For Inpatient Hospital Psychiatric, the copay is $318 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and neither are Non-Medicare-covered Stay for Inpatient Hospital-Acute or Inpatient Hospital Psychiatric, or Upgrades for Inpatient Hospital-Acute.
Outpatient Services See details
Outpatient services, including outpatient hospital services and observation services, are covered. Outpatient hospital services have a $275 copay and 20% coinsurance, while observation services have 20% coinsurance. Ambulatory surgical center services have a $250 copay, and outpatient substance abuse services have a $45 copay for both individual and group sessions. Outpatient blood services are covered with 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the BSW SeniorCare Advantage Select Rx (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for ambulance services. Ground and air ambulance services have a $300 copay, while transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year. 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 under the BSW SeniorCare Advantage Select Rx (HMO-POS) plan. Emergency Services have a $120 copay, and Urgently Needed Services have a $50 copay, while both have no coinsurance. Worldwide Emergency Services are covered up to a maximum of $5,000.
Primary Care See details
The BSW SeniorCare Advantage Select Rx (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits and opioid treatment program services. Chiropractic services have a $20 copay, physician specialist services have a $25 copay, occupational therapy services have a $35 copay, physical therapy and speech-language pathology services have a $35 copay, and other health care professional services have a $45 copay. Individual and group sessions for mental health and psychiatric services have a $30 copay. Opioid treatment program services have a $45 copay. Routine chiropractic care is not covered, and 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. 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 include hearing exams with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids, each covered once per year. Prescription hearing aids (all types) are covered, with a maximum benefit of $1,200 every three years; however, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, nor are OTC hearing aids.
Vision Services See details
Vision services include eye exams with a $40 copay, as well as coverage for eyewear including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses. Eyewear has a combined maximum plan benefit coverage of $200 every year, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a maximum benefit of $3,500 per year. Oral exams, dental x-rays, other diagnostic dental services, cleaning, other preventive dental services, restorative services, prosthodontics, removable, prosthodontics, fixed, oral and maxillofacial surgery, and implant services are covered with varying coinsurance of 0% to 50%, while fluoride treatment, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. 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 Rx (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 and no copay, Prosthetics/Medical Supplies with 20% coinsurance and no copay, 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 Rx (HMO-POS) plan, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a maximum copay of $200, and Therapeutic Radiological Services have a maximum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Select Rx (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally 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, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The BSW SeniorCare Advantage Select Rx (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, or Self-Directed Personal Assistance Services. Over-the-Counter (OTC) Items are covered up to $100 every three months, and the plan offers a meal benefit for chronic illnesses.
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