All of the BayCarePlus (HMO) plans bundle your hospital, medical and prescription drug benefits into one plan and include money-saving extra benefits like dental and vision coverage and free health club memberships. Below is an overview of each plan so that you may quickly and easily compare your options.
BayCarePlus
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BayCarePlus
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BayCarePlus
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Medical and Hospital |
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Monthly Premium |
$0 | $0
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$34 | ||||||||||||||||
Special Features |
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Preventive Care/Screenings |
$0 Copay | $0 Copay | $0 Copay | ||||||||||||||||
Primary Care Physician Visits |
$0 Copay | $0 Copay | $0 Copay | ||||||||||||||||
Specialist Doctor VisitsA referral from your PCP may be required to see a specialist. |
$15 Copay A referral is required for specialist visits except for visits with an obstetrician/gynecologist, chiropractor, podiatrist or dermatologist. |
$35 Copay A referral is required for specialist visits except for visits with an obstetrician/gynecologist, chiropractor, podiatrist or dermatologist. |
$10 Copay A referral is not required to see specialists on this plan, except for home health, occupational therapy, physical therapy and speech therapy. |
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Annual Out-of-Pocket MaximumThis is the most you’d pay in a year for covered medical services. Once you reach it, your plan pays all the costs. |
$3,500 per calendar year | $4,500 per calendar year | $2,800 per calendar year | ||||||||||||||||
Virtual/Telehealth Visits |
All plans
Telehealth visits are available with select primary care and specialist physicians as well as for therapy (occupational, physical, speech), mental health, psychiatry and substance abuse services. Members pay the same copay as if the services were provided at an in-person visit. Prior authorization is required for mental health, psychiatry and substance abuse services. For urgent care needs: BayCareAnywhere® virtual visits—$20 copay, limited to four visits per calendar year. A referral is required for therapy (occupational, physical, speech). |
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Part D Drug Coverage |
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Annual Pharmacy Deductible |
$0 | $0 | $0 | ||||||||||||||||
30-Day Retail Pharmacy SupplyIf you get Extra Help from Medicare, your costs may be lower |
Tier 1 – Preferred Generics:
Tier 2 – Generics:
Tier 3 – Preferred Brands:
Tier 4 – Non-Preferred Brands:
Tier 5 – Specialty Drugs:
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Tier 1 – Preferred Generics:
Tier 2 – Generics:
Tier 3 – Preferred Brands:
Tier 4 – Non-Preferred Brands:
Tier 5 – Specialty Drugs:
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Tier 1 – Preferred Generics:
Tier 2 – Generics:
Tier 3 – Preferred Brands:
Tier 4 – Non-Preferred Brands:
Tier 5 – Specialty Drugs:
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90-Day Mail Order SupplyIf you get Extra Help from Medicare, your costs may be lower. |
Tier 1 – Preferred Generics:
Tier 2 – Generics:
Tier 3 – Preferred Brands:
Tier 4 – Non-Preferred Brands:
Tier 5 – Specialty Drugs:
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Tier 1 – Preferred Generics:
Tier 2 – Generics:
Tier 3 – Preferred Brands:
Tier 4 – Non-Preferred Brands:
Tier 5 – Specialty Drugs:
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Tier 1 – Preferred Generics:
Tier 2 – Generics:
Tier 3 – Preferred Brands:
Tier 4 – Non-Preferred Brands:
Tier 5 – Specialty Drugs:
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New for 2022! Special Supplemental Benefits for People with DiabetesAt 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. |
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Select Insulins |
$4-$35 Copay per month (remains through the coverage gap) (30-day supply) |
Not Applicable++ |
$0-$35 Copay per month (remains through the coverage gap) (30-day supply) |
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Diabetes Supplies | $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider | Not Applicable++ | $0 Copay when using a network pharmacy or contracted durable medical equipment (DME) provider | ||||||||||||||||
Additional Over-the-Counter (OTC) Dollars | +$25/Quarter | Not Applicable++ | +$50/Quarter | ||||||||||||||||
Expanded Dental Benefit | Up to three routine cleanings and one deep cleaning every 12 months | Not Applicable++ | 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 | Not Applicable++ | $0 Copay for up to six routine visits/calendar year, which include nail trimmings | ||||||||||||||||
Extra Nutrition Counseling | $0 Copay for four additional hours/calendar year | Not Applicable++ | $0 Copay for six additional hours/calendar year | ||||||||||||||||
Insulin Savings ProgramAs a member of the BayCarePlus Complete or Premier plan, you’ll have low, predictable copays on Select Insulins† through our Insulin Savings Program. Standard Retail Cost-Sharing
Mail-Order Pharmacy
†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. ††The Insulin Savings Program isn’t available if you’re a BayCarePlus Rewards member. If you’re a member of the Rewards plan, insulins on this tier are covered at the regular tier cost-share. Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits. |
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View the drugs covered by this plan (Updated 03/22/2022) |
View the drugs covered by this plan (Updated 03/22/2022) |
View the drugs covered by this plan (Updated 03/22/2022) |
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Search Our Prescription Drug Formulary | |||||||||||||||||||
Extra Benefits |
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Preventive DentalExams, horizontal bitewing x-rays & cleanings |
$0 Copay
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$0 Copay
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$0 Copay
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Comprehensive Dental |
Optional supplemental dental coverage is available for an additional monthly premium. Learn more about our comprehensive dental benefits |
Optional supplemental dental coverage is available for an additional monthly premium. Learn more about our comprehensive dental benefits |
Optional supplemental dental coverage is available for an additional monthly premium. Learn more about our comprehensive dental benefits |
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Vision Care |
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Fitness Benefit |
Silver&Fit® Membership Included | Silver&Fit® Membership Included | Silver&Fit® Membership Included | ||||||||||||||||
Transportation AssistanceRides to and from your doctor |
$0 Copay (16 one-way trips to approved locations per calendar year) | No Coverage | $0 Copay (24 one-way trips to approved locations per calendar year) | ||||||||||||||||
Over-the-Counter BenefitFor items like toothpaste, vitamins, blood pressure cuffs, band-aids and more |
$65 Per Quarter | No Coverage | $100 Per Quarter | ||||||||||||||||
Post-Hospitalization Meals |
Up to 56 home-delivered, post-discharge meals per calendar year | No Coverage | Up to 56 home-delivered, post-discharge meals per calendar year | ||||||||||||||||
Therapeutic Massage |
No Coverage | No Coverage | $20 Copay for up to 30 combined total visits between acupuncture and therapeutic massage, per calendar year | ||||||||||||||||
Acupuncture |
$20 Copay for up to 20 visits | $20 Copay for up to 20 visits | $20 Copay for up to 30 combined total visits between acupuncture and therapeutic massage, per calendar year | ||||||||||||||||
View Complete Plan Details | View Rewards Plan Details | View Premier Plan Details |
Tap one of the buttons/plan names below to select a plan and scroll to view included benefits. Tap on a different button at anytime to view other BayCarePlus plans.
Medical and Hospital |
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Monthly Premium |
$0 | $0 And your Part B premium is reduced by $114 |
$34 | ||
Special Features |
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Preventive Care Screenings |
$0 Copay | $0 Copay | $0 Copay | ||
Primary Care Physician Visits |
$0 Copay | $0 Copay | $0 Copay | ||
Specialist VisitsA referral from your PCP may be required to see a specialist. |
$15 Copay A referral is required for specialist visits except for visits with an obstetrician/ gynecologist, chiropractor, podiatrist or dermatologist. |
$35 Copay A referral is required for specialist visits except for visits with an obstetrician/ gynecologist, chiropractor, podiatrist or dermatologist. |
$10 Copay A referral is not required to see specialists on this plan, except for home health, occupational therapy, physical therapy and speech therapy. |
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Annual Out-of-Pocket MaximumThis is the most you’d pay in a year for covered medical services. Once you reach it, your plan pays all the costs. |
$3,500 per calendar year | $4,500 per calendar year | $2,800 per calendar year | ||
Virtual/Telehealth Visits |
All plans
Telehealth visits are available with select primary care and specialist physicians as well as for therapy (occupational, physical, speech), mental health, psychiatry and substance abuse services. Members pay the same copay as if the services were provided at an in-person visit. For urgent care needs: BayCareAnywhere® virtual visits—$20 copay, limited to four visits per calendar year Prior authorization is required for mental health, psychiatry and substance abuse services. A referral is required for therapy (occupational, physical, speech). |
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Part D Drug Coverage |
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Annual Pharmacy Deductible |
$0 | $0 | $0 | ||
30-Day Retail Pharmacy SupplyIf you get Extra Help from Medicare, your costs may be even lower |
Preferred Generics:
Generics:
Preferred Brands:
Non-Preferred Brands:
Specialty Drugs:
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90-Day Mail Order SupplyIf you get Extra Help from Medicare, your costs may be lower. |
Preferred Generics:
Generics:
Preferred Brands:
Non-Preferred Brands:
Specialty Drugs:
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New for 2022! Diabetic Benefits |
Includes $0 copay for diabetic supplies, enhanced dental, over-the-counter, podiatry and more. See a full list of benefits here. |
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View the drugs covered by this plan (Updated 03/22/2022) |
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Extra Benefits |
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Preventive DentalExams, horizontal bitewing x-rays & cleanings |
$0 Copay
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$0 Copay
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$0 Copay
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Comprehensive Dental |
Optional supplemental dental coverage is available for an additional monthly premium. Learn more about our comprehensive dental benefits |
Optional supplemental dental coverage is available for an additional monthly premium. Learn more about our comprehensive dental benefits |
Optional supplemental dental coverage is available for an additional monthly premium. Learn more about our comprehensive dental benefits |
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Vision Care |
$0 Copay for routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts ($100 max benefit/calendar year) |
$0 Copay for routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts ($100 max benefit/calendar year) |
$0 Copay for routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts ($200 max benefit/calendar year) |
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Fitness Benefit |
Silver&Fit® Membership Included | Silver&Fit® Membership Included | Silver&Fit® Membership Included | ||
Transportation AssistanceRides to and from your doctor |
$0 Copay (16 one-way trips to approved locations per calendar year) | No Coverage | $0 Copay (24 one-way trips to approved locations per calendar year) | ||
Over-the-Counter BenefitFor items like toothpaste, vitamins, blood pressure cuffs, band-aids and more |
$65 Per Quarter | No Coverage | $100 Per Quarter | ||
Post-Hospitalization Meals |
Up to 56 home-delivered, post-discharge meals per calendar year | No Coverage | Up to 56 home-delivered, post-discharge meals per calendar year | ||
Therapeutic Massage |
No Coverage | No Coverage | $20 Copay for up to 30 combined total visits between acupuncture and therapeutic massage, per calendar year | ||
Acupuncture |
$20 Copay for up to 20 visits | $20 Copay for up to 20 visits | $20 Copay for up to 30 combined total visits between acupuncture and therapeutic massage, per calendar year | ||
View Complete Plan Details | View Rewards Plan Details | View Premier Plan Details |
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