BSW SeniorCare Advantage Select (HMO)

Medicare Plan Details (2022 Plan)


Monthly Premium

 

by Baylor Scott & White Health Plan
Additional Coverage
HearingVisionDental
Overall Government Star Rating
 4.5
out of 5 stars

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Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$0
$0
$0
$0
$5,900 In-network
No
Yes
Yes
Yes

Doctor Services

$0 copay
$25 copay per visit

Tests, labs, & imaging

$0 copay
$0 copay
$75-300 copay
$0 copay
$90 copay per visit (always covered)
$50 copay per visit (always covered)

Hospital Services

$325 per day for days 1 through 6
$0 per day for days 7 through 90
$350 copay or 20% coinsurance per visit

Skilled nursing facility

$0 per day for days 1 through 20
$188 per day for days 21 through 100

Preventive services

$0 copay

Ambulance

$265 copay

Therapy services

$35 copay
$35 copay

Mental health services

$40 copay
$40 copay
$40 copay
$40 copay

Opioid treatment services

Covered

Other services

20% coinsurance per item
20% coinsurance per item
$0 copay

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

20% coinsurance
20% coinsurance

Hearing

$40 copay
$0 copay
$0 copay

Preventive Dental

$0 copay
$0 copay
Not covered
$0 copay

Comprehensive dental

Not covered
$0 copay
50% coinsurance
Not covered
Not covered
50% coinsurance
50% coinsurance

Vision

$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
Not covered

Other benefits

Limited coverage
Limited coverage
Limited coverage
Not covered
Limited coverage
Limited coverage
Limited coverage
 5
 4
 4
 5
 4
 4

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