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BSW SeniorCare Advantage (PPO)

H2032 - 004 - 0
3.5 out of 5 stars (3.5 / 5)

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

This page features plan details for 2025 BSW SeniorCare Advantage (PPO) H2032 – 004 – 0 available in West Texas.

Locations

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

Crosby County, Texas
Floyd County, Texas
Garza County, Texas

Click to see more locations

Plan Overview

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

Insurer:Baylor Scott & White Health Plan
Health Plan Deductible:$0
MOOP:$10,000 In and Out-of-network
$6,400 In-network
$10,000 Out-of-network
Drugs Covered:Yes

Ready to sign up for BSW SeniorCare Advantage (PPO) ?

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 (PPO) qualifies for a monthly Medicare Give Back Benefit of $5.00.

Premium Reduction:$5.00

Premium Breakdown

BSW SeniorCare Advantage (PPO) has a monthly premium of $0.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $0.00 $5.00 $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

BSW SeniorCare Advantage (PPO) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $300.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Enhanced Alternative

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$0.00$0.00

Initial Coverage Phase

After you pay your $300.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. Please note, that this plan has a Enhanced Alternative benefit type.

Additional Benefits

BSW SeniorCare Advantage (PPO) also provides the following benefits.

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

    • In-Network: No

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 0-50% Coins – No Copay
  • Endodontics
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 0-50% Coins – No Copay
  • Implant Services
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 0-50% Coins – No Copay
  • Oral and Maxillofacial Surgery
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 0-50% Coins – No Copay
  • Periodontics
    • In-Network: 50 Coins – No Co pay
    • Out-of-Network: 0-50% Coins – No Copay
  • Prosthodontics, fixed
    • In-Network: 0-50 Coins – No Co pay
    • Out-of-Network: 0-50% Coins – No Copay
  • Prosthodontics, removable
    • In-Network: 0-50 Coins – No Co pay
    • Out-of-Network: 0-50% Coins – No Copay
  • Restorative Services
    • In-Network: 0-50 Coins – No Co pay
    • Out-of-Network: 0-50% Coins – No Copay

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
    • Out-of-Network: 0-50% Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
    • Out-of-Network: 0-50% Coins – No Copay
  • Other Diagnostic Dental Services
    • In-Network: No Coins – No Copay
    • Out-of-Network: 0-50% Coins – No Copay
  • Other Preventive Dental Services
    • In-Network: No Coins – No Copay
    • Out-of-Network: 0-50% Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay
    • Out-of-Network: 0-50% Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $0-300 copay (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 35% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • Out-of-Network: 35% coinsurance (Authorization Required)
  • Lab services
    • Out-of-Network: 35% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • Out-of-Network: 35% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
    • Out-of-Network: 35% coinsurance per visit
  • Specialist
    • In-Network: $35 copay per visit
    • Out-of-Network: 35% coinsurance per visit

Emergency care/Urgent care

  • Emergency
    • $120 copay per visit (always covered)
  • Urgent care
    • $50 copay per visit (always covered)

Foot care (podiatry services)

  • Foot exams and treatment
    • In-Network: $45 copay
    • Out-of-Network: 35% coinsurance
  • Routine foot care
    • Not covered

Ground ambulance

    • In-Network: $325 copay
    • Out-of-Network: 35% coinsurance

Health plan deductible

    • $0

Hearing

  • Medicare-Covered Hearing Exam
    • In-Network: $40 copay
  • Fitting/evaluation
    • Out-of-Network: 35% coinsurance (Limits Apply)
  • Hearing aids
    • Out-of-Network: 35% coinsurance (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Hearing aids
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: 35% coinsurance

Inpatient hospital coverage

    • In-Network: $325 per day for days 1 through 6
      $0 per day for days 7 through 90 (Authorization Required)
    • Out-of-Network: 35% per day for days 1 through 6
      35% per day for days 7 through 90 (Authorization Required)

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

    • $10,000 In and Out-of-network
      $6,400 In-network
      $10,000 Out-of-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 35% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • Out-of-Network: 35% coinsurance per item (Authorization Required)
  • Diabetes supplies
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 35% coinsurance per item (Authorization Required)
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 35% coinsurance (Authorization Required)
  • Other Part B drugs
    • In-Network: 0-20% coinsurance (Authorization Required)
    • Out-of-Network: 35% coinsurance (Authorization Required)

Mental health services

  • Outpatient group therapy visit
    • In-Network: $40 copay
  • Outpatient individual therapy visit
    • Out-of-Network: 35% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $40 copay
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $40 copay
    • Out-of-Network: 35% coinsurance
  • Outpatient group therapy visit
    • Out-of-Network: 35% coinsurance
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 35% coinsurance
  • Inpatient hospital – psychiatric
    • In-Network: $318 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 35% per day for days 1 through 5
      35% per day for days 6 through 90 (Authorization Required)
  • Outpatient individual therapy visit
    • In-Network: $40 copay

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • In-Network: $350 copay or 20% coinsurance per visit (Authorization Required)
    • Out-of-Network: 35% coinsurance per visit (Authorization Required)

Preventive care

    • Out-of-Network: 35% coinsurance
    • In-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • Out-of-Network: 35% coinsurance
  • Physical therapy and speech and language therapy visit
    • In-Network: $35 copay
  • Occupational therapy visit
    • In-Network: $35 copay
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 35% coinsurance

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 100 (Authorization Required)
    • Out-of-Network: 35% per stay
      35% per day for days 1 through 20
      35% per day for days 21 through 100 (Authorization Required)

Transportation

    • Not covered

Vision

  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 35% coinsurance (Limits Apply)
  • Eyeglass lenses
    • Out-of-Network: 35% coinsurance (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
    • Out-of-Network: 35% coinsurance (Limits Apply)
  • Contact lenses
    • Out-of-Network: 35% coinsurance (Limits Apply)
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered
  • Upgrades
    • Not covered
  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglasses (frames and lenses)
    • Out-of-Network: 35% coinsurance (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)

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

    • Covered

Ready to sign up for BSW SeniorCare Advantage (PPO) ?

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

Need more information on BSW SeniorCare Advantage (PPO)? See 2025 BSW SeniorCare Advantage (PPO) at MedicareAdvantageRX.com.

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Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

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All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

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