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BSW SeniorCare Advantage Select Rx Assist (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Select Rx Assist (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 Assist (HMO-POS) in 2025, please refer to our full plan details page.
BSW SeniorCare Advantage Select Rx Assist (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 Select Rx Assist (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 Assist (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 Assist (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $18.30. 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 $590.00 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 $5800.00 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 Assist (HMO-POS) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on their tier and the pharmacy you use. Once your total drug costs reach $2000, you will enter the next coverage phase. If you qualify for the low-income subsidy, you may have a reduced premium. After your yearly out-of-pocket drug costs reach $2000, you will pay nothing for covered Part D drugs.
Additional Benefits
The BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays and coinsurance. The plan also covers primary care visits, preventive services, and dental, hearing, and vision services, with specific copays and maximum benefits. Additionally, the plan includes coverage for ambulance, emergency, and home health services, along with other services such as medical equipment and home infusion. In terms of cost, the plan has copays for various services like primary care, specialist visits, and emergency services, as well as coinsurance for services like outpatient services and medical equipment. The plan also provides coverage for prescription hearing aids, dental services, and vision services with set maximums. It is important to note that prior authorization is required for some services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For Inpatient Hospital-Acute, you pay a $325 copay for days 1-6, and no copay for days 7-90, with a service-specific out-of-pocket maximum of $1950. For Inpatient Hospital Psychiatric, you pay a $318 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute, Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a $325 copay and 20% coinsurance, while observation services have 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a $250 copay, and individual and group sessions for outpatient substance abuse have a $45 copay. Outpatient blood services have 20% coinsurance.
Partial Hospitalization See details
Partial Hospitalization is covered under the BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan, requiring prior authorization. The copay for this benefit is $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan, with a $300 copay for both ground and air ambulance services, and no coinsurance. The plan also covers transportation services to plan-approved health-related locations, with 24 one-way trips per year, but does not cover transportation services to any health-related location.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $120 copay and no coinsurance, while Urgently Needed Services have a $50 copay and no coinsurance. Worldwide Emergency Services have a maximum plan benefit coverage of $5,000.
Primary Care See details
Primary Care benefits include coverage for 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, while Occupational Therapy Services have a $35 copay, and Physician Specialist Services have a $25 copay. Individual and Group Sessions for Mental Health and Psychiatric Services have a $30 copay, Physical Therapy and Speech-Language Pathology Services have a $35 copay, and Other Health Care Professional and Opioid Treatment Program Services have a $45 copay. Routine Chiropractic Care is not covered.
Preventive Services See details
The BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan covers preventive services, including Medicare-covered preventive services, annual physical exams, and other preventive services. Additionally, the plan covers fitness benefits, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. However, health education, in-home safety assessments, and various other services are not covered.
Hearing Services See details
Hearing exams are covered with a $40 copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered, with a maximum plan benefit of $1500 every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. 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 (lenses and frames), eyeglass lenses, and eyeglass frames. The plan covers one pair of contact lenses, one pair of eyeglasses (lenses and frames), one pair of eyeglass lenses, and one eyeglass frame per year, with a combined maximum benefit of $170.
Dental Services See details
The BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan covers dental services with a maximum benefit of $3,000 per year. 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), and oral and maxillofacial surgery are covered with a 50% coinsurance. Fluoride treatments, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have 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 by the BSW SeniorCare Advantage Select Rx Assist (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, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with 20% coinsurance and no copay. 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, but Diagnostic Procedures/Tests, Lab Services, and Outpatient X-Ray Services are not covered. Diagnostic Radiological Services have a copay up to $300, and Therapeutic Radiological Services have 20% coinsurance.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Select Rx Assist (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 not covered by the BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan. Specifically, 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 BSW SeniorCare Advantage Select Rx Assist (HMO-POS) with prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
The BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan covers Over-the-Counter (OTC) Items, up to $50 every three months, and meal benefits for chronic illnesses; however, acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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