BSW SeniorCare Advantage Preferred Rx (HMO-POS) 2025 Plan Details for Burnet County, Texas Residents
BSW SeniorCare Advantage Preferred Rx (HMO-POS) 2025 Plan Details for Burnet County, Texas Residents
Navigating your Medicare Advantage options in Burnet County for 2025 can be overwhelming, but we're here to help. With BSW SeniorCare Advantage Preferred Rx (HMO-POS) included in your plan options, you can evaluate it alongside other plans to make an informed decision. Enroll online quickly, or consult with a licensed agent if you need assistance.
Based on May, 2025 CMS enrollment data, an estimated 5,919 Medicare beneficiaries are enrolled in this plan, with 168 members in Burnet County, TX.
BSW SeniorCare Advantage Preferred Rx Overview
| Plan ID H8142-002-0 Overview | |
|---|---|
| Health Plan ID: | H8142-002-0 |
| Medicare Advantage Plan Type: | HMO-POS |
| Plan Year: | 2025 |
| Monthly Premium: | $135.00 Plus your Medicare Part B premium. |
| Health Plan Deductible: | $0.00 |
| Annual Out-of-Pocket Maximum: | $4,600.00 (In-Network) |
| Part B Give Back: | $0.00/mo |
| Part D Drug Plan Benefit: | Enhanced, $0.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Availability: | Burnet County, TX |
| Insured By: | Baylor Scott & White Health Plan |
Why Consider BSW SeniorCare Advantage Preferred Rx ?
BSW SeniorCare Advantage Preferred Rx is a Medicare Advantage Prescription Drug (MAPD) Health Maintenance Organization - Point of Service (HMO-POS) plan that offers comprehensive healthcare coverage with added flexibility. With a monthly premium of $135.00, this plan provides the core services of Medicare Part A and Part B, along with additional benefits like prescription drug coverage. There is no annual deductible. Cost sharing begins with your first prescription. As an HMO-POS plan, you can seek care both in and out of the network, but in-network services will generally cost less.
A key benefit of BSW SeniorCare Advantage Preferred Rx is its financial protection through an annual maximum out-of-pocket (MOOP) limit of $4,600.00 . Once you reach this limit, the plan covers 100% of your in-network healthcare costs for the rest of the year. This makes BSW SeniorCare Advantage Preferred Rx a dependable choice for those who want the structure of an HMO with the flexibility to access care outside the network when needed.
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Out-of-Pocket Expenses
With BSW SeniorCare Advantage Preferred Rx , you'll have cost-sharing expenses, which are the out-of-pocket costs for approved healthcare services. The table below provides a summary of the typical in-network out-of-pocket costs associated with plan H8142-002-0.
Find out the costs for visiting your primary care doctor and specialists, as well as coverage for wellness and preventive programs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Primary: | Not Covered |
| Specialist: | $30 Copay |
Review the costs for emergency services, urgent care, ambulance services, inpatient hospital stays, and skilled nursing facility care.
| Service | Enrollee Cost |
|---|---|
| Emergency room care: | $120 Copay |
| Urgent care: | $40 Copay |
| Ground ambulance: | $75 Copay |
| Inpatient hospital care: | $700.00 per stay |
| Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $50.00 per day for days 21 and beyond |
This section covers Medicare-approved foot care services, including exams and routine foot care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Foot Exams and Treatments (Medicare-covered): | $15 Copay |
| Routine Foot Care: | Not Covered |
Understand the coverage for Medicare-approved chiropractic services and routine chiropractic care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Medicare-covered chiropractic: | $15 Copay |
| Routine chiropractic: | Not Covered |
This section explains the costs for mental health services, including individual and group therapy, and inpatient care.
| Service | Enrollee Cost (in-network) |
|---|---|
| Outpatient individual therapy: | $15 Copay |
| Outpatient group therapy: | $15 Copay |
| Inpatient psychiatric hospital care: | $700.00 per stay |
See the cost details for rehabilitation services, including physical therapy, speech therapy, and occupational therapy.
| Service | Enrollee Cost (in-network) |
|---|---|
| Physical therapy and speech and language therapy: | $25 Copay |
| Occupational therapy: | $25 Copay |
Learn about the costs associated with medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diabetes supplies: | Not Covered |
| Durable medical equipment: | 20% Coinsurance Prior Authorization Required |
| Prosthetics: | 20% Coinsurance |
This section outlines the costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Service | Enrollee Cost (in-network) |
|---|---|
| Diagnostic radiology services: | $15 Copay Prior Authorization Required |
| Lab services: | Not Covered |
| Outpatient x-rays: | Not Covered |
| Diagnostic tests and procedures: | Not Covered |
Review the cost-sharing details for chemotherapy and other Medicare Part B-covered drugs.
| Service | Enrollee Cost (in-network) |
|---|---|
| Chemotherapy: | 20% Coinsurance |
| Other Part B drugs (Medicare-covered): | 20% Coinsurance |
This section details the dental services covered under your plan including, Medicare-covered preventive dental, oral exams, x-rays, dental cleanings, and comprehensive dental.
| Service | Member Cost (in-network) |
|---|---|
| Medicare Covered Preventive Dental | Not Covered |
| Oral exam | $0 |
| Dental x-rays | $0 |
| Cleaning | $0 |
| Periodontics | Not Covered |
| Endodontics | Not Covered |
| Restorative Services | Not Covered |
This section outlines the coverage for hearing-related services, including exams, fittings, and hearing aids.
| Service | Member Cost (in-network) |
|---|---|
| Fitting/evaluation | Covered Limits may apply |
| Hearing aids | Covered Limits may apply |
| Hearing exam | Covered Limits may apply |
Learn about the costs for vision-related services, including eye exams, eyeglasses, and contact lenses.
| Service | Member Cost (in-network) |
|---|---|
| Medicare-covered eye exam (in-network) | $15 Copay |
| Routine eye exam (in-network) | Covered Limits may apply |
| Eyewear benefits | Eyeglasses: Yes Contact Lenses: Yes Eyeglass Lenses: Yes Eyeglass Frames: Yes Eyewear Upgrades: Yes |
Maximum eyewear benefit: | $150.00 Every year |
Certain preventive services are covered 100% by BSW SeniorCare Advantage Preferred Rx as a Part B benefit.
Part D Prescription Drug Costs & Benefits
BSW SeniorCare Advantage Preferred Rx includes an enhanced benefit Medicare Part D plan (PDP), which offers greater coverage than basic plans. An enhanced benefit plan has a higher actuarial value, meaning it covers a larger percentage of your healthcare costs.
Part D Plan Premium
The Part D prescription drug plan premium is included in your overall Medicare Advantage plan cost. However, additional expenses or subsidies may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help. LIS, provided by Social Security, helps those with limited income and resources to lower or eliminate Part D costs. LIS benefits are not part of Medicare Advantage coverage.
| Basic Part D Premium: | $9.50 |
|---|---|
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $9.50 |
| Low-Income Premium Subsidy: | ${part_d_lips_amount} |
| Low-Income Premium Subsidy Paid by CMS: | $9.50 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $0.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Baylor Scott & White Health Plan starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, BSW SeniorCare Advantage Preferred Rx may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 | $0.00 |
| Generic | $8.00 | $0.00 |
| Preferred Brand | $45.00 | $45.00 |
| Non-Preferred Drug | $95.00 | $95.00 |
| Specialty Tier | 33.00% | 33.00% |
| *Deductible does not apply. | ||
How CMS Star Ratings Guide Your Choice
Each year, the Centers for Medicare & Medicaid Services (CMS) evaluates health and drug plans using a comprehensive 5-star rating system. These ratings offer valuable insights into the quality of care, member satisfaction, and overall plan performance.
When selecting a Medicare Advantage plan, looking at the star ratings can help you gauge how well a plan might meet your healthcare needs, making it easier to choose a plan with confidence.
| CMS Measure | Star Rating |
|---|---|
| 2025 Overall 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 |
If you are new to Medicare or Medicare Advantage plans, the following information will help you understand the enrollment process and restrictions.
Eligibility Requirements for BSW SeniorCare Advantage Preferred Rx
You are eligible to enroll in BSW SeniorCare Advantage Preferred Rx if you meet the following conditions:
- You qualify for Medicare Part A and Part B.
- You live in the plan’s service area.
If these criteria describe your situation, you’re eligible to sign up for BSW SeniorCare Advantage Preferred Rx and take advantage of its full range of benefits.
When Can I Enroll in BSW SeniorCare Advantage Preferred Rx ?
Knowing when you can enroll in BSW SeniorCare Advantage Preferred Rx is essential. Here are the main enrollment periods:
- Initial Enrollment Period (IEP): Your IEP starts three months before your 65th birthday and ends three months after, giving you a seven-month window to enroll in Medicare.
- Annual Enrollment Period (AEP): The AEP, from October 15 to December 7, allows you to make changes to your Medicare Advantage plan if you are currently enrolled in a Medicare Advantage plan.
- Medicare Advantage Open Enrollment Period (MA OEP): Running from January 1 to March 31, the MA OEP lets you switch plans or return to Original Medicare if you are currently enrolled in a Medicare Advantage plan.
- Special Enrollment Periods (SEPs): Life events such as moving or losing coverage may qualify you for a SEP, enabling you to enroll or make changes outside the usual periods.
If you're uncertain about the right time to enroll, Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711) for guidance from a licensed insurance agent.
Steps to Enroll in BSW SeniorCare Advantage Preferred Rx
Enrolling in BSW SeniorCare Advantage Preferred Rx is easy. Choose the option that works best for you:
- Online through MedicareEnrollment.com: Visit the enrollment page and complete your enrollment through their Secure Online Enrollment Form.
- By Phone: Call HealthCompare (our trusted enrollment partner) at 1-833-748-3201 (TTY 711). A licensed insurance agent can assist you with the enrollment process and provide answers to any questions.
- Through Medicare.gov: Go to Medicare.gov, log in or create an account, and follow the instructions to join BSW SeniorCare Advantage Preferred Rx through the official Medicare website.
- Directly with BSW SeniorCare Advantage Preferred Rx : You can also enroll directly with the plan. The necessary contact details are provided below in the "Contact" section.
Remember to enroll during the correct enrollment period to ensure your coverage starts on time.
Contact Baylor Scott & White Health Plan
| Website: | Baylor Scott & White Health Plan Plan Page |
|---|---|
| Providers: | Baylor Scott & White Health Plan Providers Page |
| Formulary: | Baylor Scott & White Health Plan Formulary Page |
| Pharmacy: | Baylor Scott & White Health Plan Pharmacy Page |
| New Member Health Plan Help: | (866)334-3141 |
| New Member Health Plan TTY: | 711 |
| New Member Part D Help: | (866)334-3141 |
| New Member Part D TTY Users: | 711 |
If you're eligible for Medicare but haven't enrolled or need to verify your enrollment status, visit the Social Security Administration website. For more information about Medicare Advantage, visit medicare.gov.
- Baylor Scott & White Health Plan, http://BSWHealthPlan.com/Medicare, Last Accessed June 1, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You", Last Accessed 25 May, 2025
- , "", Last Accessed
- CMS.gov, Landscape Source Files, Last Accessed October 15, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed October 15, 2024
- CMS.gov, Plan Benefits Package, Last Accessed October 15, 2024
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County, Last Accessed June 6, 2025
Medicare Advantage and Part D plans and benefits offered by: Aetna Medicare, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.