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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 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 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 $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 Assist (HMO-POS) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2,000. Once your yearly out-of-pocket drug costs reach $2,000, you pay nothing for covered drugs. If you qualify for the low-income subsidy, your monthly premium for Part D is $18.30.
Additional Benefits
The BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with copays, outpatient services with varying copays and coinsurance, and emergency services with copays. You'll also have access to primary care, preventive services, hearing, vision, and dental coverage, each with specific copays, coinsurance, and annual maximums. Additionally, the plan covers ambulance and transportation, home health, home infusion, dialysis, and medical equipment, each with its own cost-sharing structure.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a copay of $200 per day for days 1-5 and $0 for days 6-90 for acute care, and a copay of $318 per day for days 1-5 and $0 for days 6-90 for psychiatric care. Additional days, non-Medicare covered stays, and upgrades for both acute and psychiatric inpatient hospital care are not covered.
Outpatient Services See details
Outpatient services include all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a $275 copay and 20% coinsurance, and observation services have 20% coinsurance. Ambulatory Surgical Center (ASC) Services have a $250 copay. 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. This benefit has a $40 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan. Ground and air ambulance services have a $300 copay, and transportation services to a plan-approved health-related location are covered for up to 24 one-way trips per year using various modes of transportation, but transportation to any health-related location is 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, while Urgently Needed Services have a $50 copay with no coinsurance. Worldwide Emergency Services has a maximum plan benefit coverage of $5,000.
Primary Care See details
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 are covered. Chiropractic Services have a $20 copay, Occupational Therapy Services have a $35 copay, Physician Specialist Services have a $20 copay, Individual and Group Sessions for Mental Health Specialty Services have a $30 copay, Other Health Care Professional Services have a $45 copay, Individual and Group Sessions for Psychiatric Services have a $30 copay, Physical Therapy and Speech-Language Pathology Services have a $35 copay, and Opioid Treatment Program Services have a $45 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive Services are covered under the BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan, including Medicare-covered services, annual physical exams, and other preventive services. Additional preventive services are partially covered, with Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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 Benefit, 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 (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $40 copay. Prescription hearing aids are covered up to $1,000 every three years, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services includes eye exams with a $40 copay, and also covers eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum benefit of $130 per year, and contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames are each limited to one per year. Upgrades are not covered.
Dental Services See details
Dental services are covered, with a maximum benefit of $3,000 per year. Oral exams, dental x-rays, other diagnostic dental services, cleaning, other preventative dental services, restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered 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 Rx Assist (HMO-POS) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while 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 is covered by the BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan. Durable Medical Equipment (DME) has a 20% coinsurance, and Prosthetics/Medical Supplies have a 20% coinsurance with no copay, while Diabetic Equipment is 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. For Diagnostic Radiological Services, there is a copay of at most $200, and for Therapeutic Radiological Services, there is a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the BSW SeniorCare Advantage Select Rx Assist (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 not covered by the BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan. 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 by the BSW SeniorCare Advantage Select Rx Assist (HMO-POS) plan. There is no copay for days 1-20, but there is a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "BSW SeniorCare Advantage Select Rx Assist (HMO-POS)" plan's "Other Services" benefit includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $100 every three months, and a meal benefit for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and many other services are not covered.
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