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BSW SeniorCare Advantage Preferred (HMO)

H8142 - 005 - 0

(5 / 5)

BSW SeniorCare Advantage Preferred (HMO) is a Medicare Advantage Plan by Baylor Scott & White Health Plan.

This page features plan details for 2023 BSW SeniorCare Advantage Preferred (HMO) H8142 – 005 – 0.

IMPORTANT: This page features the 2023 version of this plan. See the 2025 version using the link below:

No 2025 version found. You can use the location links below to find 2025 plans in your area.

Locations

BSW SeniorCare Advantage Preferred (HMO) is offered in the following locations.

Bastrop County, Texas

Bell County, Texas

Blanco County, Texas

Click to see more locations

Plan Overview

BSW SeniorCare Advantage Preferred (HMO) offers the following coverage and cost-sharing.

Insurer:	Baylor Scott & White Health Plan
Health Plan Deductible:	$0.00
MOOP:	$4,500 In-network
Drugs Covered:	No

Ready to sign up for BSW SeniorCare Advantage Preferred (HMO) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Medicare Part B Give Back Benefit

The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.

BSW SeniorCare Advantage Preferred (HMO) qualifies for a monthly Medicare Give Back Benefit of $50.00.

Premium Reduction:

$50.00

Premium Breakdown

BSW SeniorCare Advantage Preferred (HMO) has a monthly premium of $83.00. This amount includes your Part C premium but does not include your Part B premium.

Part B	Part C	Part B Give Back	Total
$164.90	$83.00	$50.00	$

Please Note:

Your Part B premium may differ based on factors including late enrollment, income, and disability status.

Additional Benefits

BSW SeniorCare Advantage Preferred (HMO) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

In-Network: No

Dental (comprehensive)

Diagnostic services:	$0 copay (limits may apply) (authorization not required) (referral not required)
Endodontics:	50% coinsurance (limits may apply) (authorization not required) (referral not required)
Extractions:	50% coinsurance (limits may apply) (authorization not required) (referral not required)
Non-routine services:	Not covered (no limits)
Periodontics:	50% coinsurance (limits may apply) (authorization not required) (referral not required)
Prosthodontics, other oral/maxillofacial surgery, other services:	50% coinsurance (limits may apply) (authorization not required) (referral not required)
Restorative services:	50% coinsurance (limits may apply) (authorization not required) (referral not required)

Dental (preventive)

Cleaning:	$0 copay (limits may apply) (authorization not required) (referral not required)
Dental x-ray(s):	$0 copay (limits may apply) (authorization not required) (referral not required)
Fluoride treatment:	Not covered (no limits)
Oral exam:	$0 copay (limits may apply) (authorization not required) (referral not required)

Diagnostic procedures/lab services/imaging

Diagnostic radiology services (e.g., MRI):	$0-15 copay (authorization required) (referral not required)
Diagnostic tests and procedures:	$0 copay (authorization required) (referral not required)
Lab services:	$0 copay (authorization required) (referral not required)
Outpatient x-rays:	$0 copay (authorization required) (referral not required)

Doctor visits

Primary:	$0 copay
Specialist:	$25 copay per visit (authorization not required) (referral not required)

Emergency care/Urgent care

Emergency:	$90 copay per visit (always covered)
Urgent care:	$40 copay per visit (always covered)

Foot care (podiatry services)

Foot exams and treatment:	$15 copay (authorization not required) (referral not required)
Routine foot care:	Not covered

Ground ambulance

$75 copay

Health plan deductible

$0.00

Health plan deductibles (other)

In-Network: No

Hearing

Fitting/evaluation:	$0 copay (limits may apply) (authorization not required) (referral not required)
Hearing aids:	$0 copay (limits may apply) (authorization not required) (referral not required)
Hearing exam:	$15 copay (authorization not required) (referral not required)

Hospital coverage (inpatient)

$700 per stay (authorization required) (referral not required)

Hospital coverage (outpatient)

$15 copay per visit (authorization required) (referral not required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

$4,500 In-network

Medical equipment/supplies

Diabetes supplies:	$0 copay (authorization required)
Durable medical equipment (e.g., wheelchairs, oxygen):	20% coinsurance per item (authorization required)
Prosthetics (e.g., braces, artificial limbs):	20% coinsurance per item (authorization required)

Medicare Part B drugs

Chemotherapy:	20% coinsurance (authorization required)
Other Part B drugs:	20% coinsurance (authorization required)

Mental health services

Inpatient hospital – psychiatric:	$700 per stay (authorization required) (referral not required)
Outpatient group therapy visit:	$15 copay (authorization not required) (referral not required)
Outpatient group therapy visit with a psychiatrist:	$15 copay (authorization not required) (referral not required)
Outpatient individual therapy visit:	$15 copay (authorization not required) (referral not required)
Outpatient individual therapy visit with a psychiatrist:	$15 copay (authorization not required) (referral not required)

Optional supplemental benefits

Preventive care

$0 copay (authorization not required) (referral not required)

Rehabilitation services

Occupational therapy visit:	$25 copay (authorization not required) (referral not required)
Physical therapy and speech and language therapy visit:	$25 copay (authorization required) (referral not required)

Skilled Nursing Facility

$0 per day for days 1 through 20
$50 per day for days 21 through 100 (authorization required) (referral not required)

Transportation

$0 copay (limits may apply) (authorization not required) (referral not required)

Vision

Contact lenses:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass frames:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglass lenses:	$0 copay (limits may apply) (authorization not required) (referral not required)
Eyeglasses (frames and lenses):	$0 copay (limits may apply) (authorization not required) (referral not required)
Other:	Not covered (no limits)
Routine eye exam:	$0 copay (limits may apply) (authorization not required) (referral not required)
Upgrades:	Not covered

Wellness programs (e.g., fitness, nursing hotline)

Covered (authorization not required) (referral not required)