Here are details for PPO Platinum

If you’d like help choosing a Medicare Advantage plan from Baylor Scott & White Health Plan, please call 833.975.0841833.975.0841 (TTY: 711) to speak to a licensed insurance agent.

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Below are plan details for 2027.

BSW SeniorCare Advantage PPO Platinum (Central Texas)

Best for members who want greater freedom to choose their care through a PPO network and prefer a higher monthly premium paired with lower out-of-pocket costs for covered services.

Monthly Premium $145

Deductible $0

Out-of-Pocket Maximum $6,600

Annual Physical Exam $0 copay

Primary Care Physician (PCP) Office Visit $0 copay

Specialty Care Physician (SCP) Office Visit $20 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) $200 copay

Physical/Occupational/Speech Therapy(per visit) $25 copay

Inpatient Hospital Day 1-6: $275/day per stay
Day 7-90: $0/day per stay

Inpatient Mental Health Day 1-5: $250/day per stay
Day 6-90: $0/day per stay

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

Outpatient Surgery(facility) $100 copay

Ambulatory Surgical Center(facility) $75 copay

Ambulance(ground and air) $75 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 $250 (Applies to Tiers 3-5)

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

Tier 2 – Generic Drugs (30-day supply) $5 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) 30% 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 $30.05

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) $1,500 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 833.975.0841833.975.0841 (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 833.412.3320833.412.3320.

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