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 also receive acupuncture benefits, post-hospitalization meals and 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.

	Hospital and Medical Coverage
Monthly Premium	$0
Part B Premium Reduction	$0 Per Month
Maximum Out-of-Pocket Limit	$3,500 Per Calendar Year
Annual Deductible	$0
Preventive Care/Screenings	$0 Copay
Primary Care Physician Visits	$0 Copay
Specialist Doctor Visits	$15 Copay
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.

Part D Drug Coverage

Annual Deductible

Tier 1 – Preferred Generics

$0 Copay (30 day retail supply)

Tier 2 – Generics

$4 Copay (30 day retail supply)

Tier 3 – Preferred Brands

$35 Copay (30 day retail supply)

Tier 4 – Non-Preferred Brands

$85 Copay (30 day retail supply)

Tier 5 – Specialty Drugs

33% Co-insurance (30 day retail supply)

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

$4,430

New for 2022! Special Supplemental Benefits for People with Diabetes

At BayCarePlus Medicare Advantage, we believe our members should be able to have affordable, easy access to benefits that’ll help them effectively manage their diabetes and avoid serious illness.

Any BayCarePlus Complete or Premier plan member who’s been diagnosed with diabetes will receive these new benefits. This includes the Insulin Savings Program. Members will have a predictable, stable copay for Select Insulins during the Initial Coverage and Coverage Gap phases. You aren’t eligible for the Insulin Savings Program if you receive Extra Help from the government or are a member of the BayCarePlus Rewards plan. If you’re a member of the Rewards plan, insulins are covered at the regular tier cost-share.

Select Insulins

$4-$35 Copay per month
(remains through the coverage gap)
(30-day supply)

Diabetes Supplies

$0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider

Additional Over-the-Counter (OTC) Dollars

+$25/Quarter

Expanded Dental Benefit

Up to three routine cleanings and one deep cleaning every 12 months

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

Insulin Savings Program

As a member of the BayCarePlus Complete or Premier plan, you’ll have low, predictable copays on Select Insulins^† through our Insulin Savings Program.
Costs for Select Insulins will remain the same during the Initial Coverage and Coverage Gap phases of your prescription drug benefit. The program doesn’t apply during the Catastrophic Coverage stage.
Note that this program isn’t available if you receive Extra Help from the government.

Standard Retail Cost-Sharing

Tier 2 Select Insulins	30-Day Supply: $4 copay 60-Day Supply: $8 copay 90-Day Supply: $12 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

^†Select Insulins are those that are part of the Insulin Savings Program and therefore will incur low, consistent copays through the coverage gap. For information regarding which insulins are Select Insulins under the plan’s benefit, refer to the plan’s Prescription Drug Formulary. See the Evidence of Coverage for more information regarding Select Insulins, including full cost-sharing information.

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.

	Extra Benefits
Vision Care	$0 Copay: routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts ($100 max benefit/calendar year)
Preventive Dental Care	$0 Copay Includes exams, horizontal bitewing x-rays & cleanings
Comprehensive Dental Care (Optional Supplemental Benefit only)	Additional monthly premium $25 $0 Copays No annual deductible No maximum benefit amount per year Crowns Root canals Complete or partial dentures with unlimited extractions Some limitations apply. See Evidence of Coverage for complete details. Services must be received from an Argus dental provider. Learn more about our comprehensive dental benefits.
Over-the-Counter (OTC) Items	$65 Per Quarter
Hearing	Up to two hearing aids every two calendar years (one per ear), $699 or $999 copay per hearing aid
Transportation Assistance	$0 Copay for 16 one-way trips to approved locations per calendar year
Fitness Club Membership	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
Therapeutic Massage	No Coverage
Acupuncture	$20 Copay for up to 20 visits