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 |
BayCarePlus |
BayCarePlus |
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Medical and Hospital |
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Monthly Premium |
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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. |
$40 Copay A referral is required for specialist visits except for visits with an obstetrician/gynecologist, chiropractor, podiatrist or dermatologist. |
$15 Copay A referral is required for specialist visits except for visits with an obstetrician/gynecologist, chiropractor, podiatrist or dermatologist. |
$15 Copay A referral is not required to see specialists on this plan, except for home health, occupational therapy, physical therapy and speech therapy. |
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:
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Tier 1 - Preferred Generics:
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Tier 1 - Preferred Generics:
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90-Day Retail Pharmacy SupplyIf you get Extra Help from Medicare, your costs may be lower |
Tier 1 - Preferred Generics:
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Tier 1 - Preferred Generics:
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Tier 1 - Preferred Generics:
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Special Supplemental Benefits for People with Diabetes |
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Additional Over-the-Counter (OTC) Dollars*** |
Not Applicable | +$25/Quarter | +$50/Quarter |
Expanded Podiatry Benefit*** |
Not Applicable | $0 Copay for up to four routine visits/calendar year, which include nail trimmings | $0 Copay for up to six routine visits/calendar year, which include nail trimmings |
Extra Nutrition Counseling*** |
Not Applicable | $0 Copay for four additional hours/calendar year | $0 Copay for six additional hours/calendar year |
Diabetic Eye Exams*** |
Not Applicable | $0 Copay | $0 Copay |
Insulin Coverage |
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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 your plan choice, 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. |
As a member of the BayCarePlus Complete or Premier plan, you’ll have low, predictable copays on Select Insulins through our 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 your plan choice, 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. |
As a member of the BayCarePlus Complete or Premier plan, you’ll have low, predictable copays on Select Insulins through our 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 your plan choice, 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. |
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Standard Retail Cost-Sharing |
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Tier 2 Select Insulins |
N/A |
30-Day Supply: $3 copay 60-Day Supply: $6 copay 90-Day Supply: $9 copay |
30-Day Supply: $0 copay 60-Day Supply: $0 copay 90-Day Supply: $0 copay |
Tier 3 Select Insulins |
N/A |
30-Day Supply: $35 copay 60-Day Supply: $70 copay 90-Day Supply: $105 copay |
30-Day Supply: $30 copay 60-Day Supply: $60 copay 90-Day Supply: $90 copay |
Mail-Order Pharmacy |
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Tier 2 Select Insulins |
N/A |
30-Day Supply: Not Offered 60-Day Supply: Not Offered 90-Day Supply: $0 copay |
30-Day Supply: Not Offered 60-Day Supply: Not Offered 90-Day Supply: $0 copay |
Tier 3 Select Insulins |
N/A |
30-Day Supply: Not Offered 60-Day Supply: Not Offered 90-Day Supply: $95 copay |
30-Day Supply: Not Offered 60-Day Supply: Not Offered 90-Day Supply: $80 copay |
Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits. |
†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. |
†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. |
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Search Our Prescription Drug Formulary |
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Extra Benefits |
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Preventive DentalExams, horizontal bitewing x-rays & cleanings |
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Comprehensive Dental |
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. |
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. |
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. |
Vision Care |
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Fitness Benefit |
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Transportation AssistanceRides to and from your doctor |
No Coverage |
$0 Copay (16 one-way trips to approved locations per calendar year) |
$0 Copay (24 one-way trips to approved locations per calendar year) |
Over-the-Counter AllowanceFor items like toothpaste, vitamins, blood pressure cuffs, band-aids and more |
No Coverage |
$85 Per Quarter |
$115 Per Quarter |
Post-Hospitalization Meals |
No Coverage |
Up to 56 home-delivered, post-discharge meals per calendar year |
Up to 56 home-delivered, post-discharge meals per calendar year |
Medical and Hospital |
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Monthly Premium |
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Special Features |
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Preventive Care Screenings |
$0 Copay |
$0 Copay |
$0 Copay |
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Primary Care Physician Visits |
$0 Copay |
$0 Copay |
$0 Copay |
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Specialist VisitsA referral from your PCP may be required to see a specialist. |
$40 Copay |
$15 Copay |
$15 Copay |
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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 |
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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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Special Supplemental Benefits for People with Diabetes |
Not covered for BayCarePlus Rewards members. |
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Select Insulins (as part of the Insulin Savings Program)* |
Select Insulins (as part of the Insulin Savings Program)* |
Additional Over-the-Counter (OTC) Dollars*** |
Not Applicable |
+$25/Quarter |
+$50/Quarter |
Expanded Podiatry Benefit*** |
Not Applicable |
$0 Copay for up to four routine visits/calendar year, which include nail trimmings |
$0 Copay for up to six routine visits/calendar year, which include nail trimmings |
Extra Nutrition Counseling*** |
Not Applicable |
$0 Copay for four additional hours/calendar year |
$0 Copay for six additional hours/calendar year |
Diabetic Eye Exams*** |
Not Applicable |
$0 Copay |
$0 Copay |
Insulin Coverage |
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Standard Retail Cost-Sharing |
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Tier 2 Select Insulins |
Not covered |
30-Day Supply: $3 copay |
30-Day Supply: $0 copay |
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Tier 3 Select Insulins |
Not covered |
30-Day Supply: $35 copay |
30-Day Supply: $30 copay |
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Mail-Order Pharmacy |
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Tier 2 Select Insulins |
Not covered |
30-Day Supply: Not Offered |
30-Day Supply: Not Offered |
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Tier 3 Select Insulins |
Not covered |
30-Day Supply: Not Offered |
30-Day Supply: Not Offered |
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Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits. |
†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. |
†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. |
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Search Our Prescription Drug Formulary |
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Extra Benefits |
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Preventive DentalExams, horizontal bitewing x-rays & cleanings |
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Comprehensive Dental |
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. |
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. |
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. |
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Vision Care |
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Fitness Benefit |
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Transportation AssistanceRides to and from your doctor |
No Coverage |
$0 Copay (16 one-way trips to approved locations per calendar year) |
$0 Copay (24 one-way trips to approved locations per calendar year) |
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Over-the-Counter BenefitFor items like toothpaste, vitamins, blood pressure cuffs, band-aids and more |
No Coverage |
$85 Per Quarter |
$115 Per Quarter |
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Post-Hospitalization Meals |
No Coverage |
Up to 56 home-delivered, post-discharge meals per calendar year |
Up to 56 home-delivered, post-discharge meals per calendar year |
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***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.
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