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BSW SeniorCare Advantage™ HMO and PPO and Covenant Advantage HMO plans

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Award-Winning Medicare Advantage Plans

Baylor Scott & White Health Plan offers HMO and PPO Medicare Advantage plans Texans trust. Our top priority is your health, that's why our BSW SeniorCare Advantage™ plans are designed to coordinate your doctors, simplify your experience and eliminate unnecessary expenses. Plans are available with or without prescription drug coverage and start as low as $0/month.

As a patient of Baylor Scott & White Health and a member of a BSW SeniorCare Advantage™ plan, you can access healthcare and insurance information in one secure portal through the MyBSWHealth app or website — schedule appointments, message a provider, visit test results and review and pay bills.

  • $0 to low monthly premium and $0 in-network deductible
  • $0 primary care visits
  • $0 virtual care
  • $0 dental premium on most plans
  • $0 copays on many mail-order prescriptions
  • $0 routine vision and hearing coverage, with eyewear and hearing aid allowances
  • $0 fitness membership
  • $0 over-the-counter card ($30-$50 per quarter)
  • $0 routine transportation and in-home meals
  • And more!

Members with multiple chronic conditions may also be eligible for in-home medical visits by doctors and other providers, including routine house calls, urgent house calls and 24/7 phone support for needs such as prescribing medications, labs, behavioral health, nutrition and social work support.

MetLife Dental

Dental Benefits

855.676.9337
MetLife.com

Silver&Fit

Fitness Benefits

877.427.4788
SilverandFit.com

ModivCare

Routine Transportation Benefits for HMO Plans

866.428.0212
ModivCare.com

Cricket Health

Kidney Health Program

888.780.0253
CricketHealth.com

Landmark Health

In-home Acute Care Program

877.260.9992
LandmarkHealth.org

InComm

Over-the-counter Benefits for HMO Plans

866.334.3141
MyOTCCard.com

More details are available on our Member Resources page.

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2023 Medicare Star Ratings

HMO
full starfull starfull starfull starfull star
Overall 5 out of 5 stars

PPO
full starfull starfull starfull starhalf star
Overall 4.5 out of 5 stars

Every year, Medicare evaluates plans based on a 5-star rating system.

Medicare Basics

Medicare is a national social insurance program administered by the US federal government. It guarantees access to health insurance for Americans ages 65 years old and older, people with disabilities and people with End-Stage Renal Disease (ESRD).

Overview of Medicare parts

Medicare has four parts: A, B, C and D. Each is designed to cover specific services based on different healthcare needs and budgets.

  • Partial coverage for inpatient hospital
  • Partial coverage for skilled nursing facility
  • Partial coverage for home healthcare
  • Partial coverage for primary care physician visits
  • Partial coverage for outpatient surgery
  • Partial coverage for lab services
  • Partial coverage for durable medical equipment

Similar to and takes the place of Part A and B with predictable out-of-pocket costs and more coverage. Including:

  • Hearing benefits
  • Vision benefits
  • Dental benefits
  • Gym membership
  • Coverage for prescription drugs beyond what is covered by Original Medicare.
  • Our plans are available with or without Part D coverage.

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What to Consider

Your Medicare Healthcare plan should meet your needs

There are a number of factors to consider when choosing a Medicare plan for the first time or changing your Medicare plan.

If you have current health or prescription drug coverage, get a clear understanding of how it works with Medicare. If you're covered through your employer, Indian Health or Tribal Health Program, talk to your benefits administrator or insurer before making any changes in your plan.

When you're ready to enroll in a new Medicare coverage plan, you can do so during designated enrollment periods.

  • Are you in good health?
  • How often do you see your doctor?
  • Do you take prescription drugs?
  • How much can you afford each month?
  • Are you willing to change doctors if it means lower healthcare costs?

Medical Costs

  • How much are your premiums, deductibles and other costs?
  • How much do you pay for services like hospital stays or doctor visits?
  • Is there a yearly limit on what you could pay out of pocket for medical services?

Prescription Costs

  • Do you currently have prescription drug coverage?
  • Will you pay a penalty if you join a drug plan later?
  • What will your prescription drugs cost under each plan?
  • Are your drugs covered under the plan's formulary?
  • Are there any coverage rules that apply to your prescriptions?
  • Is your pharmacy in the plan's network?

Medical Care

  • Do your doctors accept the coverage?
  • Are the doctors you want to see accepting new patients?
  • Do you have to choose your hospital and healthcare providers from a network?
  • Do you need to get referrals?
  • Are you satisfied with your medical care?

Low Income Subsidies

If you have limited resources and income, you may be eligible for a low income subsidy (also called Extra Help), which helps pay your Medicare prescription coverage (lowers your premium payment amount), and in some cases, can help lower copay costs of prescriptions. This could add up to about $4,000 per year. How much lower your premiums may be depends on what percentage of the costs Medicare will cover for you.

You must receive all routine care from plan providers.

To see if you qualify for Extra Help:

Best Evidence Available for Low Income Subsidy (LIS) Beneficiaries

In accordance with the statutory requirement to provide a cost-sharing subsidy to Part D-eligible individuals who are full-benefit dual-eligible individuals or recipients of supplemental security income (SSI), Baylor Scott & White Health Plan (BSWHP) must provide access to Part D drugs at the correct LIS cost-sharing level when presented with evidence of LIS eligibility, even if the sponsor's systems and CMS's systems do not yet reflect that eligibility.

We also must update our own systems to reflect the LIS status indicated by the best available evidence and, if necessary, must submit a request to CMS so that, for the deemed population, the agency's systems can be updated as well. These requirements apply to all beneficiaries who are "deemed" subsidy-eligible including full benefit Medicare/Medicaid eligibles, partial dual-eligibles and people receiving SSI) as well as those who must apply and are awarded LIS by the Social Security Administration (SSA).

For more information, and to see what forms of documentation are needed for evidence of low-income status:

Part D Full Subsidy — Non Full Benefit Dual

Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources below 9,900 (individuals in 2022) or $15,600 (couples, 2022)

Eligible for QMB/SLMB/QI, SSI or applied and income at or below 135% FPL and resources below 9,470 (individuals in 2021) or $14,960 (couples, 2021)

Eligible Full Subsidy Parameters: 2022 2021
Deductible $0 $0
Maximum Copayments up to Out-of-Pocket Threshold
Generic / Preferred Multi-Source Drug $3.95 $3.70
Other Drugs $9.85 $9.20
Maximum Copay above Out-of-Pocket Threshold $0 $0

Partial Subsidy Parameters

Applied and income below 150% FPL and resources below $15,510 (individual, 2022) or $30,950 couples, 2022)

Applied and income below 150% FPL and resources below $14,790 (individual, 2021) or $29,520 couples, 2021)

Partial Subsidy Parameters: 2022 2021
Deductible $99 $92
Coinsurance up to Out-of-Pocket Threshold 15% 15%
Maximum Copayments up to Out-of-Pocket Threshold
Generic / Preferred Multi-Source Drug $3.95 $3.70
Other Drugs $9.85 $9.20

Texas-Sized Customer Service

Have questions, or want a little extra assistance? Give us a call at 866.334.3141 (TTY: 711)

Oct. 1-March 31: 7 AM to 8 PM daily (closed major holidays)
April 1-Sept. 30: 7 AM to 8 PM weekdays (closed major holidays)

Baylor Scott & White Health Plan
1206 W. Campus Drive
Temple, TX 76502

customer service

Marketing Complaints

We take marketing misrepresentation allegations seriously and encourage you to contact us to report marketing complaints or concerns. So that we may complete an effective investigation, please provide the name of your sales agent or broker when submitting a complaint. You may also file a complaint with CMS at 800.MEDICARE.

Baylor Scott & White Health Plan offers BSW SeniorCare AdvantageTM HMO plans as a Medicare Advantage (MA) organization through a contract with Medicare. Baylor Scott & White Care Plan offers Covenant Health Advantage HMO plans as an MA organization through a contract with Medicare. Baylor Scott & White Insurance Company offers BSW SeniorCare AdvantageTM PPO plans as an MA organization through a contract with Medicare. Enrollment in one of these plans depends on the health plan's contract renewal with Medicare.

Y0058_BSWHPWEBSITE2024_C CMS 10/1/2023 | Last updated: 9/20/23

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