2022 BSW SeniorCare Advantage Platinum (PPO)

BSW SeniorCare Advantage Platinum (PPO) H2032-003 is a 2022 Medicare Advantage Plan or Part-C by Baylor Scott and White Health Plan available to residents in Texas. This plan includes additional prescription drug (Part-D) coverage. The BSW SeniorCare Advantage Platinum (PPO) has a monthly premium of $140.00 and has an in-network maximum out-of-pocket limit of $4,700 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,700 out-of-pocket. This can be a extremely nice safety net.

BSW SeniorCare Advantage Platinum (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Baylor 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 Platinum (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Baylor Scott and White Health Plan and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Baylor Scott and White Health Plan except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Baylor Scott and White Health Plan Medicare Advantage Plan Costs

BSW SeniorCare Advantage Platinum (PPO) Part-C Premium

Baylor Scott and White Health Plan charges a $80.80 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H2032-003 Part-D Deductible and Premium

BSW SeniorCare Advantage Platinum (PPO) has a monthly drug premium of $59.20 and a $50.00 drug deductible. This Baylor Scott and White Health Plan plan offers a $59.20 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Baylor Scott and White Health Plan above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $59.20 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Baylor Scott and White Health Plan Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Baylor Scott and White Health Plan plan does not offer additional coverage through the gap.

Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The BSW SeniorCare Advantage Platinum (PPO) medicare insurance offers a $34.10 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $40.40 for 75% low income subsidy $46.60 for 50% and $52.90 for 25%.

H2032-003 Formulary or Drug Coverage

BSW SeniorCare Advantage Platinum (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 BSW SeniorCare Advantage Platinum (PPO) H2032-003 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$2
Tier 2	NA	$12
Tier 3	NA	$45
Tier 4	NA	$95
Tier 5	NA	32%

*Initial Coverage Phase and 30 day supply

2021 BSW SeniorCare Advantage Platinum (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

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

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	25% coinsurance (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$20-200 copay
Diagnostic tests and procedures	$0 copay
Diagnostic tests and procedures	25% coinsurance (Out-of-Network)
Lab services	$0 copay
Lab services	25% coinsurance (Out-of-Network)
Outpatient x-rays	25% coinsurance (Out-of-Network)
Outpatient x-rays	$0 copay

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Doctor Visits

Primary	$0 copay
Primary	25% coinsurance per visit (Out-of-Network)
Specialist	25% coinsurance per visit (Out-of-Network)
Specialist	$20 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$50 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	25% coinsurance (Out-of-Network)
Foot exams and treatment	$45 copay
Routine foot care	Not covered

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Ground Ambulance

$75 copay
25% coinsurance (Out-of-Network)

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Hearing

Fitting/evaluation	25% coinsurance (Out-of-Network)
Fitting/evaluation	$0 copay
Hearing aids	25% coinsurance (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	25% coinsurance (Out-of-Network)
Hearing exam	$20 copay

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Inpatient Hospital Coverage

$200 per day for days 1 through 4 $0 per day for days 5 through 90
25% per day for days 1 through 5 25% per day for days 6 through 90 (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	25% coinsurance per item (Out-of-Network)
Diabetes supplies	$0 copay
Durable medical equipment (e.g., wheelchairs, oxygen)	25% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	25% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	20% coinsurance
Chemotherapy	25% coinsurance (Out-of-Network)
Other Part B drugs	25% coinsurance (Out-of-Network)
Other Part B drugs	20% coinsurance

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Mental Health Services

Inpatient hospital - psychiatric	25% per day for days 1 through 5 25% per day for days 6 through 90 (Out-of-Network)
Inpatient hospital - psychiatric	$200 per day for days 1 through 5 $0 per day for days 6 through 90
Outpatient group therapy visit	$20 copay
Outpatient group therapy visit	25% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	25% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$20 copay
Outpatient individual therapy visit	$20 copay
Outpatient individual therapy visit	25% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	25% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$20 copay

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MOOP

$10,000 In and Out-of-network $4,700 In-network $10,000 Out-of-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

25% coinsurance per visit (Out-of-Network)
$100 copay or 20% coinsurance per visit

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Preventive Care

$0 copay
25% coinsurance (Out-of-Network)

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Preventive Dental

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

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Rehabilitation Services

Occupational therapy visit	$25 copay
Occupational therapy visit	25% coinsurance (Out-of-Network)
Physical therapy and speech and language therapy visit	$25 copay
Physical therapy and speech and language therapy visit	25% coinsurance (Out-of-Network)

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Skilled Nursing Facility

25% per stay 25% per day for days 1 through 20 25% per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $50 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	25% coinsurance (Out-of-Network)
Contact lenses	$0 copay
Eyeglass frames	$0 copay
Eyeglass frames	25% coinsurance (Out-of-Network)
Eyeglass lenses	25% coinsurance (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	25% coinsurance (Out-of-Network)
Eyeglasses (frames and lenses)	$0 copay
Other	Not covered
Routine eye exam	25% coinsurance (Out-of-Network)
Routine eye exam	$0 copay
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for BSW SeniorCare Advantage Platinum (PPO) H2032

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in BSW SeniorCare Advantage Platinum (PPO) Plans Performance

Health Plan Customer Service Rating for BSW SeniorCare Advantage Platinum (PPO)

BSW SeniorCare Advantage Platinum (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for BSW SeniorCare Advantage Platinum (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, 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 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.