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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 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 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 $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 Essentials (HMO-POS) prescription drug plan features an annual drug deductible of $615. You will need to pay this deductible amount out-of-pocket for your covered medications before the plan begins to cover its share of your prescription costs. Understanding this upfront cost is an important step in evaluating your overall Medicare drug coverage options. Specific drug tier details, including copays and coinsurance rates for specific prescription drugs, are currently unavailable for this plan. To determine how your personal medications are categorized and what they will cost after meeting the deductible, it is best to consult the plan's formulary directly.
Additional Benefits
The BSW SeniorCare Advantage Essentials (HMO-POS) plan offers robust medical coverage featuring no copay for primary care visits, telehealth services, and routine preventive care. Specialist visits require a $20 copay, while inpatient hospital stays incur a daily copay of $225 for the first six days with no coinsurance. Outpatient hospital services carry a $275 copay and 20% coinsurance, and emergency room care is available with a $130 copay that is waived if you are admitted. Additional perks include comprehensive dental services with no copay for preventive care and 50% coinsurance for other services up to a $3,000 annual limit. Routine vision and hearing exams are covered with a $40 copay, alongside allowances of up to $130 annually for eyewear and $1,000 every three years for hearing aids. Members also receive no-copay transportation for up to 24 one-way trips to approved locations and a $100 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $225 daily copay for days 1 to 6 of an acute stay and a $318 daily copay for days 1 to 5 of a psychiatric stay, with no copay for subsequent days up to day 90. Prior authorization is required, and 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 $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 per session with no coinsurance, and outpatient blood services are covered with 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 services.
Ambulance and Transportation Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers ground and air ambulance services with a $300 copay and no coinsurance. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers emergency services with a $130 copay and urgently needed services with a $50 copay, both featuring no coinsurance and waived copays if 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 benefit of $5,000.
Primary Care See details
BSW SeniorCare Advantage Essentials (HMO-POS) provides primary care physician visits and telehealth services with no copay and no coinsurance, while specialist visits require a $20 copay and no coinsurance. Other covered benefits, including physical therapy and mental health sessions, have copays ranging from $30 to $45 with no coinsurance, but podiatry and routine chiropractic services are not covered.
Preventive Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers preventive services, including annual physicals, kidney disease education, and fitness benefits, with no copay and no coinsurance. However, additional preventive services are only partially covered, excluding health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs for chemotherapy hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation counseling, enhanced disease management, telemonitoring, remote access technologies, home safety modifications, and counseling.
Hearing Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers routine hearing exams and fitting evaluations for a $40 copay and no coinsurance. 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 partially covered because inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) offers partially covered vision services, including one annual routine eye exam 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 $130 annual maximum, though upgrades are excluded.
Dental Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) partially covers dental services up to a $3,000 annual maximum, offering preventive care with no copay and no coinsurance. Comprehensive dental benefits, such as restorative services and implants, are covered with no copay and a 50% coinsurance, though fluoride treatments, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BSW SeniorCare Advantage Essentials (HMO-POS) with no copay, though prior authorization is required. Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by BSW SeniorCare Advantage Essentials (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers medical equipment with no copay, requiring a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by BSW SeniorCare Advantage Essentials (HMO-POS) with prior authorization required, though lab services, diagnostic procedures or tests, and outpatient X-rays are not covered. Covered diagnostic services and diagnostic radiological services have no copay and no coinsurance, while therapeutic radiological services require both a copay and 20% coinsurance.
Home Health Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under BSW SeniorCare Advantage Essentials (HMO-POS) with no copay and no coinsurance. Although some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
BSW SeniorCare Advantage Essentials (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, and a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
BSW SeniorCare Advantage Essentials (HMO-POS) partially covers other services, providing meals for chronic illness and over-the-counter (OTC) items up to $100 every three months with no copay and no coinsurance. Acupuncture and nicotine replacement therapy are not covered under these benefits.
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