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BayCarePlus Complete (HMO)

Complete Coverage with One Plan from One Company

BayCarePlus bundles medical, hospital and prescription drug coverage together into one convenient plan. With one insurance card and one number to call, we eliminate the hassle and cost of dealing with multiple insurance companies so you can focus on more important things.

$0 Monthly Premium and NO Deductibles

With BayCarePlus Complete, there are no additional premiums to pay. There are also no annoying deductibles to meet. Your coverage begins right away.

How can we offer $0 premiums? Find out.

Coverage When Traveling

Whether you’re making a trip out of state or out of the country, BayCarePlus has you covered. If you ever get sick or injured when away from home, you can rest easy knowing you have emergency or urgent care coverage.

Financial Security

All of our plans include out-of-pocket protection that limits your annual health care costs and protects your savings in case of an emergency or unexpected illness. This important protection isn’t offered by traditional Medicare plans.

Are you protected? Find out.

Money-Saving Extra Benefits

The BayCarePlus Complete plan also includes preventive dental coverage, transportation to and from doctor appointments, hearing aid coverage and even coverage for over-the-counter health care expenses.

BayCarePlus Complete members will have access to BayCareAnywhere® 24/7 virtual doctor visits via video chat at no additional cost.

Learn more about all the extra benefits.

Telehealth: Video Doctor Visits

Technology has changed the way we do everything, and that includes how we see doctors. If you’re too sick to leave the house or just want to practice social distancing, BayCarePlus covers telemedicine visits with your primary care doctor and specialists. You can also use the BayCareAnywhere mobile app to have an unscheduled video visit with a doctor for urgent care needs any time of day or night—even on holidays.


Benefits at a Glance

The following tables highlight some of the many benefits available to you as a valued BayCarePlus member. For more details and a complete list of benefits, please review our downloadable Summary of Benefits or Evidence of Coverage below.

Hospital and Medical Coverage

Your BayCarePlus plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments.

  BaycarePlus Medicare Advantage Complete
(HMO)

Monthly Premium

$0

Maximum Out-of-Pocket Limit

(What's this?)
$3,100 Per Calendar Year
This is the most you'd pay in a year for covered medical services. Once you reach it, your plan pays all the costs.

Annual Deductible

$0

Preventive Care/Screenings

$0 Copay

Primary Care Physician Visits

$0 Copay

Specialist Doctor Visits

$15 Copay
A referral is required for specialist visits except for visits with an obstetrician/gynecologist, chiropractor, podiatrist or dermatologist.

Urgent Care

$35 Copay

Emergency Care

$90 Copay

Lab Services

$0 Copay

Home Health Care

100% Coverage

Chiropractic Services

$20 Copay

Inpatient Hospital Care

$175 Copay per day, per stay: Days 1-5
$0 Copay per day, per stay: Days 6 and beyond

Outpatient Surgery at Hospital

$125 Copay

Outpatient Surgery at Ambulatory Surgery Center

$75 Copay

Part D Drug Coverage

This table shows the drug tiers associated with your plan, and the copayments or co-insurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.

BaycarePlus Medicare Advantage Complete
(HMO)

Annual Deductible

$0

Retail Pharmacy — 30 Day Supply

Tier 1 — Preferred Generics

  • $0 Copay

Tier 2 — Generics

  • $3 Copay

Tier 3 — Preferred Brands

  • $35 Copay

Tier 4 — Non-Preferred Brands

  • $85 Copay

Tier 5 — Specialty Drugs

  • 33% Co-insurance

Mail Order — 90 Day Supply

Tier 1 — Preferred Generics

  • $0 Copay

Tier 2 — Generics

  • $0 Copay

Tier 3 — Preferred Brands

  • $95 Copay

Tier 4 — Non-Preferred Brands

  • $245 Copay

Tier 5 — Specialty Drugs

  • No Coverage

Initial Coverage Limit

$4,660

Special Supplemental Benefits for People with Diabetes

Plan members who have been diagnosed with diabetes will receive the following extra benefits:

Additional Over-the-Counter (OTC) Dollars

+$25/Quarter

Enhanced Podiatry Benefit

$0 Copay for up to four routine visits/calendar year, which include nail trimmings

Extra Nutrition Counseling

$0 Copay for four additional hours/calendar year

Diabetic Supplies & Services

$0 Copay

Insulin Savings Program

Important—you won’t pay more than $35 for a one-month supply of each Part D insulin product covered by our plan, no matter the cost-sharing tier of the insulin product, the prescription drug coverage stage you are in (initial coverage, coverage gap or catastrophic coverage), your Extra Help status or whether the insulin product is considered a Select Insulin under the plan’s Prescription Drug Formulary.

Standard Retail Cost-Sharing

Tier 2 Select Insulins

30-Day Supply: $3 copay
60-Day Supply: $6 copay
90-Day Supply: $9 copay

Tier 3 Select Insulins

30-Day Supply: $35 copay
60-Day Supply: $70 copay
90-Day Supply: $105 copay
Mail-Order Pharmacy

Tier 2 Select Insulins

30-Day Supply: Not Offered
60-Day Supply: Not Offered
90-Day Supply: $0 copay

Tier 3 Select Insulins

30-Day Supply: Not Offered
60-Day Supply: Not Offered
90-Day Supply: $95 copay

Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits.

Extra Benefits

Your BayCarePlus plan offers many valuable extras not offered by Original Medicare or Medicare supplement plans—at no additional cost to you.

BaycarePlus Medicare Advantage Complete
(HMO)

Vision Care

  • $0 Copay: routine eye exam
  • $0 Copay for a pair of eyeglasses (lenses and frames) or contacts
  • $150 max benefit (non-Medicare covered eyewear) per calendar year

Preventive Dental Care

  • $0 Copay
  • $0 Copay for two cleanings per calendar year and one deep cleaning every three calendar years

Comprehensive Dental Care

  • Additional monthly premium $30
  • $0 Copays
  • No annual deductible
  • $1,000 maximum benefit amount per year
  • Two crowns per calendar year
  • Three root canals per calendar year
  • Complete or partial dentures with unlimited extractions

Some limitations apply. See Evidence of Coverage for complete details. Services must be received from a Delta Dental provider. Learn more about our comprehensive dental benefits.

Over-the-Counter (OTC) Allowances

$85 Per Quarter

Hearing

Up to two hearing aids every two years (one per ear per year). $699 or $999 copay per hearing aid

Transportation Assistance

$0 Copay (16 one-way trips to approved locations per calendar year)

Fitness Club Membership

  • Silver&Fit® Membership Included
  • Included at no additional cost

Travel Benefits

Emergency or urgent care coverage if you are making a trip out of state or country

Meals

Up to 56 home-delivered, post-discharge meals per calendar year


Important Plan Documents

Summary of Benefits Updated: 10/01/2022
Resumen de Beneficios Updated: 10/01/2022
Provider Directory Updated: 10/01/2022
Directorio de Proveedores Updated: 10/01/2022
Drug Formulary Updated: 10/01/2022
Evidence of Coverage Updated: 10/01/2022
Evidencia de Cobertura Updated: 10/01/2022
Star Ratings Updated: 10/01/2022
Calificaciones por Estrellas Updated: 10/01/2022
Annual Notice of Change Updated: 10/01/2022
Aviso Anual de Cambio Updated: 10/01/2022
Formulary Change Notice Updated: 10/01/2022
Low Income Subsidy Premiums Updated: 10/01/2022

***Except for Select Insulins, the benefits mentioned are part of a special supplemental program for the chronically ill. Not all members qualify. A diagnosis of diabetes isn’t required for insulin coverage.