BSW SeniorCare Advantage Select Rx (HMO-POS)
Medicare Advantage Plan H8142-001 • 2026 • Limestone County, TX
BSW SeniorCare Advantage Select Rx (HMO-POS) Medicare Advantage Plan H8142-001 • 2026 • Limestone County, TX
CMS Plan ID H8142-001 identifies the Medicare Advantage plan BSW SeniorCare Advantage Select Rx, a HMO-POS Part C plan offered by Baylor Scott & White Health Plan for the 2026 plan year. This plan uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with Part D prescription drug coverage.
BSW SeniorCare Advantage Select Rx Overview
Plan Overview for H8142-001-0 |
|
|---|---|
| CMS Plan ID: | H8142-001-0 |
| Plan Type: | HMO-POS |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $5800.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Enhanced, $250.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Limestone County, TX |
| Enrollment (Nationwide) | 16,314 beneficiaries |
| Enrollment (CMS – Local) | 316 beneficiaries in Limestone County |
| Provided By: | Baylor Scott & White Health Plan |
Plan Details for BSW SeniorCare Advantage Select Rx
This Medicare Advantage Prescription Drug (MAPD) HMO-POS plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $0.00, and the plan provides coverage through a network of participating providers, with limited access to out-of-network services in certain situations. The annual Part D deductible is $250.00.
Primary care visits have a $0 copay, specialist visits come with a $30 copay, urgent care services carry a $50 copay, and ambulance transportation is $300 copay. These costs apply toward the maximum out-of-pocket (MOOP) limit of $5800.00. Once this limit is reached, in-network services are fully covered for the remainder of the year.
This plan is listed by CMS under Plan ID {title_plan_id}. Cost-sharing details are provided below.
Cost Sharing Expenses
BSW SeniorCare Advantage Select Rx has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H8142-001.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay |
| Specialist: | In-network: $30 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay |
| Health transportation (non-emergency): | In-network: $0 copay |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $0-$300 copay |
| Lab services: | In-network: $0 copay |
| Outpatient x-rays: | In-network: $0 copay |
| Diagnostic tests and procedures: | In-network: $0 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $130 copay |
| Worldwide emergency care: | $0 copay |
| Urgent care: | $50 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $325 per day for days 1-6 | $0 per day for days 7-90 | $325 Lifetime Reserve Days for days 1-6 | $325 Lifetime Reserve Days for days 7-60 | $0 per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-100 |
| Ground ambulance: | In-network: $300 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $30 copay |
| Outpatient group therapy: | In-network: $30 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $325 per day for days 1-6 | $0 per day for days 7-90 | $325 Lifetime Reserve Days for days 1-6 | $325 Lifetime Reserve Days for days 7-60 | $0 per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $35 copay |
| Occupational therapy: | In-network: $35 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay |
| Durable medical equipment: | In-network: 20% coinsurance |
| Prosthetics: | In-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: 0%-50% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: 0%-50% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: 0%-50% coinsurance |
| Periodontics: | In-network: 50% coinsurance | Out-of-network: 0%-50% coinsurance |
| Endodontics: | In-network: 50% coinsurance | Out-of-network: 0%-50% coinsurance |
| Restorative services: | In-network: 0%-50% coinsurance | Out-of-network: 0%-50% coinsurance |
| Implant services: | In-network: 50% coinsurance | Out-of-network: 0%-50% coinsurance |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: 50% coinsurance | Out-of-network: 0%-50% coinsurance |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| OTC hearing aids: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by BSW SeniorCare Advantage Select Rx as a Part B benefit.
Prescription Drug Coverage
BSW SeniorCare Advantage Select Rx includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Advantage coverage.
| Basic Part D Premium: | $-12.30 |
|---|---|
| Supplemental Part D Premium: | $12.30 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $4.82 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program.
Prescription Drug Plan Deductible
This plan has a $250.00 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 Select 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 copay | Coming soon |
| Generic | $13.00 copay | Coming soon |
| Preferred Brand | $47.00 copay | Coming soon |
| Non-Preferred Drug | 35% coinsurance | Coming soon |
| Specialty Tier | 30% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS Star Ratings
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
Is there a monthly premium for this plan in 2026?
For 2026, the monthly premium is $0.00. Medicare Part B premiums apply in addition to this amount.
What is the annual out-of-pocket maximum (MOOP) for this plan?
For 2026, the in-network maximum out-of-pocket is $5800.00. The plan pays 100% of covered in-network services beyond this amount.
What is the star rating for plan H8142-001 in 2026?
CMS rates this plan at ★4.0 out of 5 stars for 2026.
What is the current enrollment for BSW SeniorCare Advantage Select Rx?
CMS reports 16,314 beneficiaries enrolled in this plan.
What is the prescription drug deductible for 2026?
The Part D deductible is $250.00.
Contact Information for Baylor Scott & White Health Plan
| Contact Type | Details |
|---|---|
| Website: | Baylor Scott & White Health Plan Plan Page |
| New Members: | 1-866-334-3141 |
| Existing Members: | 1-866-334-3141 |
| Plan Address: | 1206 West Campus Drive | Temple, TX 76502 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- Baylor Scott & White Health Plan (official source), http://BSWHealthPlan.com/Medicare — Last accessed October 13, 2025
- CMS.gov, "Medicare Advantage Plan Fact Sheet" — Last accessed 25 May, 2025
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
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