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BSW SeniorCare Advantage Essentials (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BSW SeniorCare Advantage Essentials (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 Essentials (HMO-POS) in 2026, please refer to our full plan details page.
BSW SeniorCare Advantage Essentials (HMO-POS) is a HMO-POS plan offered by Baylor Scott & White Health available for enrollment in 2025 to people living in Central Texas. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BSW SeniorCare Advantage Essentials (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 Essentials (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 Essentials (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $4.80. 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 $615.00 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 Essentials (HMO-POS) Medicare plan features an annual prescription drug deductible of $615. This deductible is the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share of your prescription costs. Specific drug coverage tier details, including individual copayments and coinsurance rates, are currently unavailable for this plan. To determine your exact out-of-pocket expenses, you should verify how your specific prescription medications are covered under this plan's formulary.
Additional Benefits
The BSW SeniorCare Advantage Essentials (HMO-POS) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth services, and routine preventive care. For specialized medical needs, specialist visits require copays between $25 and $45, while inpatient hospital stays incur daily copays for the first several days before transitioning to no copay. Emergency services are available with a $130 copay, which is waived if you are admitted to the hospital within 24 hours. This plan also includes valuable supplemental benefits, such as dental care covered up to $3,000 annually with no copay for preventive services and a 50% coinsurance for comprehensive care. Additionally, members benefit from routine vision and hearing exams for a $40 copay, alongside allowances for eyewear, hearing aids, and up to $50 every three months for over-the-counter items with no copay. To assist with healthcare access, the plan also provides up to 24 one-way trips per year to approved medical locations with no copay.
Inpatient Hospital See details
Inpatient hospital benefits under BSW SeniorCare Advantage Essentials (HMO-POS) are partially covered and require prior authorization, featuring no coinsurance for all covered stays. Acute hospital stays require a $325 daily copay for days 1 through 6 and no copay for days 7 through 90, while psychiatric stays require a $318 daily copay for days 1 through 5 and no copay for days 6 through 90. Additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers outpatient hospital services with a $325 copay and 20% coinsurance, and ambulatory surgical center services with a $250 copay and no coinsurance. Outpatient substance abuse sessions require a $45 copay and no coinsurance, while outpatient blood services have no copay and a 20% coinsurance.
Partial Hospitalization See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers partial hospitalization services with a $40.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers Medicare-approved ground and air ambulance services with a $300 copay and no coinsurance, subject to prior authorization. The plan also provides up to 24 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, though transportation to other health-related locations is not covered.
Emergency Services See details
BSW SeniorCare Advantage Essentials (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 with no copay and no coinsurance, up to a maximum plan benefit of $5,000.
Primary Care See details
Primary care and telehealth services are covered under BSW SeniorCare Advantage Essentials (HMO-POS) with no copay and no coinsurance. Specialist visits, mental health sessions, and therapy services require copays ranging from $25 to $45 with no coinsurance, while podiatry is not covered, and chiropractic care only has some services covered as routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services under BSW SeniorCare Advantage Essentials (HMO-POS) are covered with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive benefits are partially covered with no copay and no coinsurance, offering physical and memory fitness programs but excluding health education, in-home safety assessments, personal emergency response systems, and nutritional counseling.
Hearing Services See details
Hearing services are covered by BSW SeniorCare Advantage Essentials (HMO-POS) with no deductible, featuring a $40 copay and no coinsurance for routine exams and fittings. Prescription and OTC hearing aids are covered with no copay and no coinsurance up to a $1,000 maximum every three years, though prescription hearing aids are only partially covered since inner ear, outer ear, and over the ear types are not covered.
Vision Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) partially covers vision services with no deductibles, excluding upgrades and other non-routine eye exams. Routine eye exams are covered with a $40 copay and no coinsurance for one yearly visit, and eligible eyewear is covered with no copay and no coinsurance up to a $150 annual maximum.
Dental Services See details
Dental services are partially covered by BSW SeniorCare Advantage Essentials (HMO-POS) up to an annual limit of $3,000, offering preventive care with no copay and no coinsurance, and comprehensive services with no copay and a 50% coinsurance. However, fluoride treatment, maxillofacial prosthetics, and orthodontics are not covered under this plan.
Home Infusion bundled Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B insulin drugs have a $35 copay and no coinsurance, while Part B chemotherapy, radiation, and other drugs require a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BSW SeniorCare Advantage Essentials (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment is partially covered with no copay and no coinsurance, but diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) diagnostic and radiological services require prior authorization and are partially covered, as diagnostic procedures, lab services, and outpatient X-rays are not covered. Covered diagnostic and diagnostic radiological services feature no copay and no coinsurance, while therapeutic radiological services require a copay and a minimum 20% coinsurance.
Home Health Services See details
Home Health Services are covered by BSW SeniorCare Advantage Essentials (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) offers Cardiac Rehabilitation Services with no copay and no coinsurance, meaning some services are covered. However, 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 Essentials (HMO-POS) with no coinsurance and do not require a prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) provides partial coverage for Other Services, featuring meal benefits for chronic illnesses and over-the-counter (OTC) items with no copay and no coinsurance. OTC items are covered up to $50 every three months, while acupuncture and nicotine replacement therapy are not covered.
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