2021 BSW SeniorCare Advantage Premium (HMO) H8142-006 By Scott and White Health Plan.

Summary of Benefits for
2021 BSW SeniorCare Advantage Premium (HMO)


BSW SeniorCare Advantage Premium (HMO) H8142-006 is a 2021 Medicare Advantage Plan or Medicare Part-C plan by Scott and White Health Plan available to residents in Texas. This plan does not provide additional Medicare prescription drug (Part-D) coverage. The BSW SeniorCare Advantage Premium (HMO) has a monthly premium of $199.00 and has an in-network Maximum Out-of-Pocket limit of $4,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,500 out of pocket. This can be a extremely nice safety net.

BSW SeniorCare Advantage Premium (HMO) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered by the plan.

Scott and White Health Plan works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BSW SeniorCare Advantage Premium (HMO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Scott and White Health Plan and not Original Medicare. With Medicare Advantage Plans you are always covered for urgently needed and emergency care. Plus you receive all of the benefits of Original Medicare from Scott and White Health Plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for a Medicare Advantage Plan.




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2021 Scott and White Health Plan Medicare Advantage Plan Costs

Name:
BSW SeniorCare Advantage Premium (HMO)
Plan ID:
H8142-006
Provider:Scott and White Health Plan
Year:2021
Type: Local HMO *
Monthly Premium C+D: $199.00
Part C Premium:
MOOP: $4,500
Similar Plan: H8142-007






2021 BSW SeniorCare Advantage Premium (HMO) Summary of Benefits




Additional Benefits


No



Comprehensive Dental


Diagnostic services $0 copay
Endodontics Not covered
Extractions 50% coinsurance
Non-routine services Not covered
Periodontics Not covered
Prosthodontics, other oral/maxillofacial surgery, other services 50% coinsurance
Restorative services 50% coinsurance



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $0 copay
Diagnostic tests and procedures $0 copay
Lab services $0 copay
Outpatient x-rays $0 copay



Doctor Visits


Primary $0 copay
Specialist $0 copay



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 $0 copay
Routine foot care Not covered



Ground Ambulance


$40 copay



Hearing


Fitting/evaluation $0 copay
Hearing aids $0 copay
Hearing exam $0 copay



Inpatient Hospital Coverage


$0 copay



Medical Equipment/Supplies


Diabetes supplies $0 copay
Durable medical equipment (e.g., wheelchairs, oxygen) $0 copay
Prosthetics (e.g., braces, artificial limbs) $0 copay



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $0 copay
Outpatient group therapy visit $0 copay
Outpatient group therapy visit with a psychiatrist $0 copay
Outpatient individual therapy visit $0 copay
Outpatient individual therapy visit with a psychiatrist $0 copay



MOOP


$4,500 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


$0 copay



Preventive Care


$0 copay



Preventive Dental


Cleaning $0 copay
Dental x-ray(s) $0 copay
Fluoride treatment Not covered
Oral exam $0 copay



Rehabilitation Services


Occupational therapy visit $0 copay
Physical therapy and speech and language therapy visit $0 copay



Skilled Nursing Facility


$0 per day for days 1 through 20
$15 per day for days 21 through 100



Transportation


$0 copay



Vision


Contact lenses $0 copay
Eyeglass frames $0 copay
Eyeglass lenses $0 copay
Eyeglasses (frames and lenses) $0 copay
Other Not covered
Routine eye exam $0 copay
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




Reviews for BSW SeniorCare Advantage Premium (HMO) H8142



2019 Overall Rating
Part C Summary Rating
Part D Summary 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


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Improving Physical
Improving Mental Health
Monitoring Physical Activity
Adult BMI Assessment


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Pain Screening
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in BSW SeniorCare Advantage Premium (HMO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement
Timely Decisions About Appeals


Health Plan Customer Service Rating for BSW SeniorCare Advantage Premium (HMO)

Total Customer Service Rating
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


BSW SeniorCare Advantage Premium (HMO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language
Appeals Auto
Appeals Upheld


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Sat 8am-11pm EST
Sun 9am-6pm EST




Coverage Area for BSW SeniorCare Advantage Premium (HMO)

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Source: CMS.
Data as of September 9, 2020.
Notes: Data are subject to change as contracts are finalized. For 2021, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part D benefit. Includes 2021 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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