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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 2026, 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 Health available for enrollment in 2025 to people living in North Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 features an annual drug deductible of $250. For Tier 1 preferred generics, you pay no copay at preferred pharmacies or through standard mail order, while standard pharmacies charge a copay starting at $10 for a one-month supply. Tier 2 generics also offer no copay through standard mail order, with copays starting at $13 at preferred pharmacies and $20 at standard pharmacies. Tier 3 preferred brand drugs require a $47 copay for a one-month supply at preferred, standard, and standard mail order pharmacies. Higher-tier medications require coinsurance instead of copays, with Tier 4 non-preferred drugs carrying a 35% coinsurance and Tier 5 specialty tier drugs requiring a 30% coinsurance for a one-month supply.
Additional Benefits
The BSW SeniorCare Advantage Select Rx (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth services, and standard preventive care. For specialist visits, members pay a $25 copay, while emergency room visits require a $130 copay, which is waived if admitted. Inpatient hospital stays require a $225 copay per day for the first six days of acute care, with no copay for subsequent days. This plan also features valuable everyday benefits, including dental care with no copay for preventive services and up to a $3,500 annual limit for comprehensive care. Vision and routine hearing exams are available with a $40 copay, alongside no-copay allowances of up to $200 annually for eyewear and $1,200 every three years for hearing aids. Additionally, members benefit from up to 24 one-way transportation trips per year with no copay and a $100 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $225 copay for days 1 through 6 of acute stays and a $318 copay for days 1 through 5 of psychiatric stays, with no copay for subsequent days up to day 90. Prior authorization is required, and the benefit is partially covered because additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers outpatient hospital services with a $275 copay and 20% coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse services require a $45 copay for individual or group sessions with no coinsurance, while outpatient blood services are covered with no copay and 20% coinsurance.
Partial Hospitalization See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers partial hospitalization services with a $40 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the BSW SeniorCare Advantage Select Rx (HMO-POS) plan, with Medicare-covered ground and air ambulance services requiring a $300 copay and no coinsurance. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved health-related locations with no copay or coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency, urgent, and transportation services are also covered up to a $5,000 maximum limit with no copay and no coinsurance.
Primary Care See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Standard therapy services cost a $35 copay with no coinsurance, mental health and psychiatric services have a $30 copay with no coinsurance, and podiatry services are not covered.
Preventive Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, offering a fitness benefit but excluding health education, in-home safety assessments, personal emergency response systems, and nutritional/dietary benefits.
Hearing Services See details
Hearing services are partially covered by BSW SeniorCare Advantage Select Rx (HMO-POS), with routine hearing exams and evaluations costing a $40 copay and no coinsurance. Prescription and OTC hearing aids are available with no copay and no coinsurance up to a $1,200 maximum every three years, although inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision services are partially covered by BSW SeniorCare Advantage Select Rx (HMO-POS), offering one routine eye exam per year for a $40 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 annual limit for contacts or eyeglasses, though upgrades are not covered.
Dental Services See details
Dental services are partially covered by BSW SeniorCare Advantage Select Rx (HMO-POS) with no copay for all covered services, no coinsurance for preventive care, and 0% to 50% coinsurance for comprehensive care up to a $3,500 annual maximum. Fluoride treatments, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B insulin drugs are covered under this benefit with a $35 copay and no coinsurance, while Part B chemotherapy and other Part B drugs have no copay and 0% to 20% coinsurance.
Dialysis Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
BSW SeniorCare Advantage Select Rx (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance. While diabetic equipment is covered with no copay and no coinsurance, this benefit is only partially covered as diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by BSW SeniorCare Advantage Select Rx (HMO-POS), requiring prior authorization for covered services. Diagnostic radiological services feature no copay and no coinsurance, while therapeutic radiological services require a copay and 20% coinsurance. Although some diagnostic services are covered, diagnostic procedures, tests, lab services, and outpatient X-ray services are not covered.
Home Health Services See details
Home health services are covered by BSW SeniorCare Advantage Select Rx (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the BSW SeniorCare Advantage Select Rx (HMO-POS) plan. None of the associated sub-services, including intensive cardiac, pulmonary, and SET for PAD rehabilitation, are covered by this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BSW SeniorCare Advantage Select Rx (HMO-POS) with no coinsurance, requiring no prior three-day hospital stay but subject to prior authorization. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BSW SeniorCare Advantage Select Rx (HMO-POS) partially covers other services, providing over-the-counter (OTC) items up to $100 every three months and chronic illness meal benefits with no copay and no coinsurance. Acupuncture and nicotine replacement therapy are not covered under this benefit.
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