BayCarePlus Premier (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.

Low Monthly Premium with NO Referrals and NO Deductibles Required

Our popular NO REFERRALS REQUIRED** BayCarePlus Premier (HMO) plan offers you the most comprehensive coverage for the low premium of just $34/month. There are also no annoying deductibles to meet. Your coverage begins right away.

Find out how we offer such low premiums

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

Every BayCarePlus plan comes with important extra benefits including preventive dental, vision and even free memberships to health clubs through the popular Silver&Fit^® program for no additional premium.

BayCarePlus Premier (HMO) plan members will also receive massage therapy, acupuncture and post-hospitalization meal benefits as well as access to BayCareAnywhere^®, offering 24/7 virtual doctor visits via video chat.

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	$34
Part B Premium Reduction	$0
Maximum Out-of-Pocket Limit	$2,800 Per calendar year
Annual Deductible	$0
Preventive Care/Screenings	$0 Copay
Primary Care Physician Visits	$0 Copay
Specialist Doctor Visits	$10 Copay
Urgent Care	$30 Copay
Emergency Care	$120 Copay
Lab Services	$0 Copay
Home Health Care	100% Coverage
Chiropractic Services	$10 Copay
Inpatient Hospital Care	$150 Per day, per stay; Days 1-5 $0 Per day, per stay; Day 6 and beyond
Outpatient Surgery at Hospital	$95 Copay
Outpatient Surgery at Ambulatory Surgery Center	$50 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

$0 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 Premierplan members 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

$0-$35 Copay per month
(remains through the coverage gap)

Diabetes Supplies

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

Additional Over-the-Counter (OTC) Dollars

+$50/Quarter

Expanded Dental Benefit

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

Enhanced Podiatry Benefit

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

Extra Nutrition Counseling

$0 Copay for six 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: $0 copay 60-Day Supply: $0 copay 90-Day Supply: $0 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
New for 2022! Special Supplemental Benefits for People with Diabetes	$0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider
Vision Care	$0 Copay: routine eye exam $0 Copay: eyeglasses or contacts ($200 max benefit/calendar year)
Preventive Dental Care	$0 Copay
Over-the-Counter (OTC) Items	$100 Per Quarter
Hearing	Up to two hearing aids every two calendar years (one per ear) $599 or $899 Copay per hearing aid
Transportation Assistance	$0 Copay (24 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
Post-Hospitalization Meals	56 Home-delivered, post-discharge meals per calendar year
Therapuetic Massage & Acupuncture	$20 Copay for up to 30 combined total visits between acupuncture and therapeutic massage, per calendar year

Optional Supplemental Benefits

In addition to comprehensive coverage and money-saving extra benefits that come with a BayCarePlus (HMO) plan, we also offer optional supplemental benefits which give you an opportunity to enhance your benefits for a low additional
monthly premium.

	Optional Supplemental Benefits
Comprehensive Dental Care	Add comprehensive dental care for a low additional premium of only $25 per month! $25 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.

Optional Supplemental Benefits

Comprehensive Dental Care

Add comprehensive dental care for a low additional premium of only $25 per month!

$25 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.