Here are details for PPO Basic

If you’d like help choosing a Medicare Advantage plan from Baylor Scott & White Health Plan, please call 1.833.975.08411.833.975.0841 (TTY: 711) to speak to a licensed insurance agent.

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Below are plan details for 2027.

BSW SeniorCare Advantage PPO Basic (Central Texas)

Best for members who want to keep their monthly expenses low, value the flexibility of a PPO network to see providers both in and out of network, and want greater freedom when choosing their care.

Monthly Premium $32

Deductible $0

Out-of-Pocket Maximum $7,150

Annual Physical Exam $0 copay

Primary Care Physician (PCP) Office Visit $0 copay

Specialty Care Physician (SCP) Office Visit $35 copay

Telehealth Visit (PCP, SCP, urgent care, psychiatry and mental health services) $0 copay

Diagnostic Tests, X-rays, Lab Services(separate office visit copay may apply) $0 copay

Advanced Diagnostic Imaging Services (MRI, MRA, SPECT, CTA) $0-$300 copay

Physical/Occupational/Speech Therapy(per visit) $35 copay

Inpatient Hospital Day 1-6: $350/day per stay
Day 7-90: $0/day per stay

Inpatient Mental Health Day 1-5: $318/day per stay
Day 6-90: $0/day per stay

Skilled Nursing Facility (SNF) Day 1-20: $0/day
Day 21-100: $221/day

Outpatient Surgery(facility) $350 copay

Ambulatory Surgical Center(facility) $275 copay

Ambulance(ground and air) $325 copay

Emergency Care(within the U.S.; copay waived if admitted within 24 hours) $130 copay

Urgent Care(within the U.S.; copay waived if admitted within 24 hours) $50 copay

Durable Medical Equipment (DME) 20% coinsurance

Podiatry $45 copay

Chemotherapy Drugs 0%-20% coinsurance

Other Part B Drugs 0%-20% coinsurance

Heart Health Program* Not applicable

Deductible $500 (Applies to Tiers 3-5)

Tier 1 – Preferred Generic Drugs (30-day supply) $0 copay

Tier 2 – Generic Drugs (30-day supply) $10 copay

Tier 3 – Preferred Brand Drugs (30-day supply) $47 copay

Tier 4 – Non-Preferred Drugs (30-day supply) 35% coinsurance

Tier 5 – Specialty Drugs (30-day supply) 28% coinsurance

Mail Order Copays (90-day supply) Tiers 1 – 2 are $0 copay;
Tier 3 is $94 copay;
Tier 4 is 35% coinsurance

Total Out-of-Pocket You Pay Before Catastrophic Coverage $2,400

Catastrophic Coverage Amounts – You Pay $0 copay

Additional Monthly Premium $30

Deductible $0

Annual Dental Benefit Maximum $2,000

Dentures (every 5 years) 50% coinsurance

Fillings (One filling per surface, per tooth every 24 months) 50% coinsurance

Root Canals 75% coinsurance

Periodontal Maintenance (deep cleaning) 50% coinsurance

Extractions 50% coinsurance

Routine Eye Exam(one per year; must use a network provider) $0 copay

Eyewear(annually; must use network provider) $150 allowance

Routine Hearing Exam(one per year) $0 copay

Hearing Aids(every 3 years) $1,000 allowance

*Special Supplemental Benefits for the Chronically Ill (SSBCI) are available only to qualifying members with chronic heart failure. Having chronic heart failure alone does not automatically qualify you for these benefits. Eligibility also depends on meeting the Centers for Medicare & Medicaid Services’ definition of a chronically ill enrollee and the Plan’s SSBCI eligibility criteria.

Want help comparing your plans and benefits—and finding the right choice for your needs? Are you ready to enroll?

Call 1.833.975.08411.833.975.0841 (TTY: 711) to speak with a licensed insurance agent.

October 1 – March 31: 7 days a week, 8:00 AM – 8:00 PM
April 1 – September 30: Monday – Friday, 8:00 AM – 5:00 PM
Closed on major holidays.

Para hablar con un representante en español, llame a 1.833.412.33201.833.412.3320.

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