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.
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.
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.
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 |
$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
Tier 2 — Generics
Tier 3 — Preferred Brands
Tier 4 — Non-Preferred Brands
Tier 5 — Specialty Drugs
|
Mail Order — 90 Day Supply |
Tier 1 — Preferred Generics
Tier 2 — Generics
Tier 3 — Preferred Brands
Tier 4 — Non-Preferred Brands
Tier 5 — Specialty Drugs
|
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 |
|
Preventive Dental Care |
|
Comprehensive Dental Care |
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 |
|
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 |
