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BSW SeniorCare Advantage Select (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Select (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 (HMO-POS) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Select (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 (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 Select (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 (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 $5550.00 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 Select (HMO-POS).
Additional Benefits
The BSW SeniorCare Advantage Select (HMO-POS) plan offers a range of benefits, including inpatient hospital stays, outpatient services, and emergency care. The plan includes copays for many services, such as $200 for inpatient hospital stays (days 1-5), $275 for outpatient hospital services, and $120 for emergency services. This plan also covers preventive services with no copay, hearing exams, vision exams, and dental services with a $3,000 annual maximum.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for both acute and psychiatric services. For Inpatient Hospital-Acute, you pay a $200 copay for days 1-5, and a $0 copay for days 6-90; for Inpatient Hospital Psychiatric, you pay a $318 copay for days 1-5, and a $0 copay for days 6-90.
Outpatient Services See details
Outpatient services, including outpatient hospital services, observation services, and outpatient substance abuse 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 individual and group sessions have a $45 copay. Outpatient blood services have 20% coinsurance, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the BSW SeniorCare Advantage Select (HMO-POS) plan, but requires prior authorization. You will have a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, and transportation services to plan-approved health-related locations. Ground and air ambulance services have a copay of $265.00, and transportation services to any health-related location offers 24 one-way trips per year for up to 50 miles. 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 with no coinsurance, Urgently Needed Services have a $50 copay with no coinsurance, and Worldwide Emergency Services has a maximum benefit coverage of $5,000.
Primary Care See details
Primary Care benefits cover primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional, psychiatric services, physical therapy and 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, individual and group sessions for mental health specialty services, individual and group sessions for psychiatric services, and opioid treatment program services have a $30-$45 copay. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The BSW SeniorCare Advantage Select (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay. The plan also offers an annual physical exam, kidney disease education services, and other preventive services, while some additional preventive services such as Health Education and In-Home Safety Assessments are not covered. The plan also offers a fitness benefit.
Hearing Services See details
Hearing services include hearing exams with a $40 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a maximum benefit of $1000 every three years. Prescription hearing aids - inner ear, outer ear, and over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $40 copay, and eyewear benefits including contact lenses, eyeglasses, and eyeglass lenses and frames. This plan offers a combined maximum of $125 for eyewear every year, and contact lenses, eyeglasses, and eyeglass lenses and frames are each limited to one per year. Upgrades are not covered.
Dental Services See details
The BSW SeniorCare Advantage Select (HMO-POS) plan covers dental services with a maximum benefit of $3,000 per year. This plan covers 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 with a 50% coinsurance. Fluoride treatment and maxillofacial prosthetics are not covered, and orthodontics is not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BSW SeniorCare Advantage Select (HMO-POS) plan, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required for these services.
Dialysis Services See details
Dialysis Services are covered under the BSW SeniorCare Advantage Select (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance for Medicare-covered items, though Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment is covered, but the plan limits supplies and services to those from specified manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BSW SeniorCare Advantage Select (HMO-POS) plan, but diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered. Diagnostic Radiological Services have a copay of up to $200, while Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Select (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 technically covered by the BSW SeniorCare Advantage Select (HMO-POS) plan, but 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 Select (HMO-POS) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit of $30 every three months, and meal benefits for a chronic illness. 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 are not covered.
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