BSW SeniorCare Advantage Premium (HMO-POS) H8142-006-0 Plan Details
BSW SeniorCare Advantage Premium (HMO-POS) H8142-006-0 Plan Details
When selecting a Medicare Advantage plan for 2025, it's important to compare all your options. BSW SeniorCare Advantage Premium (HMO-POS) is among the plans you can review side-by-side with others, ensuring you find the coverage that suits your needs. You can easily enroll online or reach out to a licensed agent for personalized guidance.
BSW SeniorCare Advantage Premium Overview
Plan ID H8142-006-0 Overview | |
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Health Plan ID: | H8142-006-0 |
Medicare Advantage Plan Type: | Local HMO |
Plan Year: | 2024 |
Monthly Premium: | $199.00 Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Annual Out-of-Pocket Maximum: | $4,500 |
Part B Give Back: | $50.00/mo |
Part D Drug Plan Benefit: | Not Included |
Part D Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | See List |
Insured By: | Baylor Scott & White Health Plan |
Explore BSW SeniorCare Advantage Premium Benefits
BSW SeniorCare Advantage Premium is a Medicare Advantage Health Maintenance Organization - Point of Service (HMO-POS) plan that provides comprehensive coverage with the added flexibility of out-of-network care. With a monthly premium of $199.00, this plan covers all the essential benefits of Medicare Part A and Part B, giving you access to vital healthcare services. As an HMO-POS plan, BSW SeniorCare Advantage Premium allows you to choose providers both within and outside the network, although in-network services generally cost less.
Keep in mind that BSW SeniorCare Advantage Premium does not include a Medicare prescription drug plan. If you require drug coverage, you can explore standalone Part D plans. BSW SeniorCare Advantage Premium also offers financial protection through its annual maximum out-of-pocket (MOOP) limit of $4,500. Once you reach this limit, your in-network healthcare costs are fully covered for the remainder of the year. This feature makes BSW SeniorCare Advantage Premium a solid option for those who value both flexibility and comprehensive coverage.
We're Here to Help You Enroll |
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Out-of-Pocket Costs
BSW SeniorCare Advantage Premium includes cost-sharing, which refers to the out-of-pocket expenses you'll incur when accessing approved healthcare services. The table below outlines the most common in-network out-of-pocket costs for plan H8142-006-0.
Service | Enrollee Cost |
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Doctor's Office Visit (In-Network) | |
Primary: | $0 |
Specialist: | $0 |
Wellness & Preventive Programs: | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot Exams and Treatments (Medicare-covered): | $0 |
Routine Foot Care: | Not Covered |
Chiropractic Treatment (In-Network) | |
Medicare-covered chiropractic: | $0 |
Routine chiropractic: | Not Covered |
Emergency and Urgent Care | |
Emergency room care: | $90 Copay |
Urgent care: | $40 Copay |
Ground ambulance: | $40 Copay |
Inpatient hospital care: | $100.00 per stay |
Outpatient hospital care: | $0 |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $15.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy: | $0 |
Outpatient group therapy: | $0 |
Inpatient psychiatric hospital care: | $100.00 per stay |
Outpatient group therapy: | $0 |
Outpatient individual therapy: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy: | $10 Copay Prior Authorization Required |
Occupational therapy: | $10 Copay |
Medical Equipment and Supplies (In-Network) | |
Diabetes supplies: | $0 |
Durable medical equipment: | $0 |
Prosthetics: | $0 |
Diagnostics, Lab Services, and Imaging (In-Network) | |
Diagnostic radiology services: | $0 |
Lab services: | $0 |
Outpatient x-rays: | $0 |
Diagnostic tests and procedures: | $0 |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Most preventive services are covered 100% by BSW SeniorCare Advantage Premium as a Part B benefit.
Supplemental Benefits
Here’s an overview of the additional benefits that Baylor Scott & White Health Plan offers with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | Covered Limits may apply |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | Covered Limits may apply |
Vision | Maximum vision benefit: | $125.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | Covered Limits may apply |
Routine eye exam (In-Network) | Covered Limits may apply |
Contact lenses (In-Network) | Covered Limits may apply |
Additional Benefits
None specified.
Part D Prescription Drug Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Overview
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Plan Availability
BSW SeniorCare Advantage Premium (H8142-006-0) is available in the following locations (click to open):
Who Can Enroll in BSW SeniorCare Advantage Premium?
To qualify for enrollment in BSW SeniorCare Advantage Premium, you must:
- Be entitled to Medicare Part A and enrolled in Medicare Part B.
- Live within the plan’s designated service area.
- Not have End-Stage Renal Disease (ESRD), except under certain conditions.
If you fulfill these criteria, you can enroll in BSW SeniorCare Advantage Premium and enjoy the extensive healthcare benefits it offers.
When Can I Enroll in BSW SeniorCare Advantage Premium?
Understanding the right time to enroll in BSW SeniorCare Advantage Premium is crucial. Here are the key enrollment periods:
- Initial Enrollment Period (IEP): Your first opportunity to enroll in Medicare starts three months before your 65th birthday and lasts until three months after your birthday month.
- Annual Enrollment Period (AEP): Occurring annually from October 15 to December 7, the AEP allows you to enroll in, switch, or drop a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): From January 1 to March 31 each year, the MA OEP gives you the chance to switch Medicare Advantage plans or return to Original Medicare.
- Special Enrollment Periods (SEPs): Certain life changes, like moving or losing other coverage, may make you eligible for a SEP, allowing you to adjust your plan outside the usual periods.
Not sure when to enroll? Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711) to speak with a licensed insurance agent who can guide you through your options.
Steps to Enroll in BSW SeniorCare Advantage Premium
Enrolling in BSW SeniorCare Advantage Premium is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-877-388-0596 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join BSW SeniorCare Advantage Premium through the official Medicare website.
- Directly with BSW SeniorCare Advantage Premium: You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Contact Baylor Scott & White Health Plan
Website: | http://BSWHealthPlan.com/Medicare |
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Formulary: | http://BSWHealthPlan.com/Medicare |
Pharmacy: | Baylor Scott & White Health Plan Pharmacy Page |
New Members: | (866)334-3141 |
TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, you can do so on the Social Security Administration website. For more information about the Medicare Part C program, visit the official Medicare website or call 1-800-MEDICARE.
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, GlobalHealth, Health Care Service Corporation, Cigna Healthcare, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Scott and White Health Plan now part of Baylor Scott & White Health, UnitedHealthcare(R), and Wellcare.
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