BSW SeniorCare Advantage Premium (HMO-POS)

SCOTT AND WHITE HEALTH PLAN · 2027 plan year

Plan ID H8142-006-000

HMOPOS★ 4.5 CMS Stars
MOOP (in-network)
$4,500
MOOP (combined)
—
Monthly premium
$170/mo
Prescription drugs
Not included

This plan in 2026

Plan information

Contract / Plan / Segment
H8142-006-000
Medical deductible
$0 — no deductible
Also owed
Your Medicare Part B premium, paid separately

More SCOTT AND WHITE HEALTH PLAN plans in TX

Benefits & cost sharing

Hospital

BenefitIn-network
Inpatient Hospital — Acute$100 per stay
Inpatient Hospital — Additional Days (Acute)No charge
Inpatient Hospital — Psychiatric$100 per stay

Pharmacy

BenefitIn-network
Part B DrugsSee plan details
Chemotherapy & Radiation Drugs (Part B)0%-20% coinsurance
Other Part B Drugs0%-20% coinsurance

Mental Health

BenefitIn-network
Mental Health Specialty ServicesSee plan details
Mental Health — Individual SessionsNo charge
Mental Health — Group SessionsNo charge

Other

BenefitIn-network
Intensive Cardiac Rehabilitation — Additional SessionsNo charge
Pulmonary Rehabilitation — Additional SessionsNo charge
Supervised Exercise Therapy (SET)No charge
Skilled Nursing Facility (SNF)$0/day for days 1–20, $75/day for days 21–100
Cardiac & Pulmonary RehabilitationSee plan details
Cardiac Rehabilitation — Additional SessionsNo charge
Emergency Services$90
Urgently Needed Services$40
Partial Hospitalization ProgramNo charge
Intensive Outpatient Program (IOP)No charge
Home Health ServicesNo charge
Primary Care Physician ServicesNo charge
Chiropractic ServicesNo charge
Occupational Therapy Services$10
Physician Specialist ServicesNo charge
Podiatry ServicesNo charge
Other Health Care Professional ServicesNo charge
Psychiatric ServicesSee plan details
Psychiatric Services — Individual SessionsNo charge
Psychiatric Services — Group SessionsNo charge
Physical Therapy & Speech-Language Pathology$10
Additional Telehealth Services (Part B)No charge
Opioid Treatment Program ServicesNo charge
Diagnostic Tests & Lab ServicesSee plan details
Diagnostic Procedures & TestsNo charge
Laboratory ServicesNo charge
Radiological ServicesSee plan details
Diagnostic RadiologyNo charge
Therapeutic RadiologyNo charge
X-Ray ServicesNo charge
Outpatient Hospital ServicesNo charge
Hospital Observation ServicesNo charge
Ambulatory Surgical Center (ASC)No charge
Outpatient Substance Abuse ServicesSee plan details
Substance Abuse — Individual SessionsNo charge
Substance Abuse — Group SessionsNo charge
Outpatient Blood ServicesNo charge
Ambulance ServicesSee plan details
Ground Ambulance$40
Air Ambulance$40
Non-Emergency Transportation — Health FacilityNo charge
Durable Medical Equipment (DME)No charge
Prosthetics & OrthoticsSee plan details
Prosthetic DevicesNo charge
Medical SuppliesNo charge
Diabetic Supplies & ServicesSee plan details
Diabetic SuppliesNo charge
Diabetic Therapeutic Shoes & InsertsNo charge
Diabetic MonitorsNo charge
Dialysis Services20% coinsurance
Meal BenefitNo charge
Annual Physical ExamNo charge
Kidney Disease Education ServicesNo charge
Glaucoma ScreeningNo charge
Diabetes Self-Management TrainingNo charge
Digital Rectal ExamsNo charge
Welcome to Medicare EKGNo charge
Insulin (Part B)$35
Dental — Medicare-Covered ServicesNo charge
Dental — PreventiveSee plan details
Dental — Oral ExamsNo charge
Dental — X-RaysNo charge
Dental — Diagnostic ServicesNo charge
Dental — Prophylaxis (Cleaning)No charge
Hearing — Hearing Aids (All Types)No charge
Dental — Other Preventive ServicesNo charge
Vision — Eye ExamsNo charge
Vision — Eye ExamsSee plan details
Vision — Routine Eye ExamsNo charge
Vision — EyewearNo charge
Vision — EyewearSee plan details
Vision — Contact LensesNo charge
Vision — Eyeglasses (Lenses & Frames)No charge
Vision — Eyeglass LensesNo charge
Vision — Eyeglass FramesNo charge
Hearing — ExamsNo charge
Hearing — ExamsSee plan details
Hearing — Routine ExamsNo charge
Hearing — Fitting & Evaluation for Hearing AidNo charge
Hearing — Prescription Hearing AidsSee plan details
Hearing — OTC Hearing AidsNo charge
Medicare-Covered Preventive ServicesSee plan details

Service area

  • TX: 34 counties

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