BayCarePlus (HMO) Plans in Your Area

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 Rewards (HMO) H2235-002	BayCarePlus Complete (HMO) H2235-001	BayCarePlus Premier (HMO) H2235-003
Medical and Hospital
Monthly Premium	$0 Your Part B premium is reduced by $123 per month	$0	$34
Special Features	You save $123 per month on your Part B Premium	LOWER copays OTC allowance Transportation Meals BIGGER eyewear allowance Hearing aids	No referrals required** LOWER copays LOWER maximum out-of-pocket limit BIGGER OTC allowance Transportation Meals BIGGER eyewear allowance Hearing aids
Preventive Care/Screenings	$0 Copay	$0 Copay	$0 Copay
Primary Care Physician Visits	$0 Copay	$0 Copay	$0 Copay
Specialist Doctor Visits A 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).
Part D Drug Coverage
Annual Pharmacy Deductible	$0	$0	$0
30-Day Retail Pharmacy Supply If you get Extra Help from Medicare, your costs may be lower	Tier 1 - Preferred Generics: $0 Copay Tier 2 - Generics: $10 Copay Tier 3 - Preferred Brands $47 Copay Tier 4 - Non-Preferred Brands: $100 Copay Tier 5 - Specialty Drugs: 33% Co-insurance	Tier 1 - Preferred Generics: $0 Copay Tier 2 - Generics: $3 Copay Tier 3 - Preferred Brands $35 Copay Tier 4 - Non-Preferred Brands: $85 Copay Tier 5 - Specialty Drugs: 33% Co-insurance	Tier 1 - Preferred Generics: $0 Copay Tier 2 - Generics: $0 Copay Tier 3 - Preferred Brands $30 Copay Tier 4 - Non-Preferred Brands: $85 Copay Tier 5 - Specialty Drugs: 33% Co-insurance
90-Day Retail Pharmacy Supply If you get Extra Help from Medicare, your costs may be lower	Tier 1 - Preferred Generics: $0 Copay Tier 2 - Generics: $0 Copay Tier 3 - Preferred Brands $125 Copay Tier 4 - Non-Preferred Brands: $275 Copay Tier 5 - Specialty Drugs: No Coverage	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	Tier 1 - Preferred Generics: $0 Copay Tier 2 - Generics: $0 Copay Tier 3 - Preferred Brands $80 Copay Tier 4 - Non-Preferred Brands: $245 Copay Tier 5 - Specialty Drugs: No Coverage
Special Supplemental Benefits for People with Diabetes
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
	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.
Standard Retail Cost-Sharing
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
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.
	View the drugs covered by this plan	View the drugs covered by this plan	View the drugs covered by this plan
Search Our Prescription Drug Formulary
Extra Benefits
Preventive Dental Exams, horizontal bitewing x-rays & cleanings	$0 Copay $0 Copay for two cleanings per calendar year and one deep cleaning every three calendar years	$0 Copay $0 Copay for two cleanings per calendar year and one deep cleaning every three calendar years	$0 Copay $0 Copay for two cleanings, two fillings and two extractions per calendar year and one deep cleaning every three calendar years
Comprehensive Dental	Additional monthly premium $30 $0 Copays No annual deductible $1,000 maximum benefit amount per year Two crowns per calendar year Three root canals per calendar year Complete or partial dentures with unlimited extractions 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.	Additional monthly premium $30 $0 Copays No annual deductible $1,000 maximum benefit amount per year Two crowns per calendar year Three root canals per calendar year Complete or partial dentures with unlimited extractions 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.	Additional monthly premium $30 $0 Copays No annual deductible $1,000 maximum benefit amount per year Two crowns per calendar year Three root canals per calendar year Complete or partial dentures with unlimited extractions 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	$0 Copay for routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts $100 max benefit (non-Medicare covered eyewear) per calendar year	$0 Copay: routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts $150 max benefit (non-Medicare covered eyewear) per calendar year	$0 Copay for routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts $200 max benefit (non-Medicare covered eyewear) per calendar year
Fitness Benefit	Silver&Fit^® Membership Included Included at no additional cost	Silver&Fit^® Membership Included Included at no additional cost	Silver&Fit^® Membership Included Included at no additional cost
Transportation Assistance Rides 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 Allowance For 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
	View Rewards Plan Details	View Complete Plan Details	View Premier Plan Details

BayCarePlus
Rewards
(HMO)
H2235-002

BayCarePlus
Complete
(HMO)
H2235-001

BayCarePlus
Premier
(HMO)
H2235-003

BayCarePlus Rewards (HMO)

Medical and Hospital
Monthly Premium	$0 Your Part B premium is reduced by $123 per month	$0	$34
Special Features	You save $123 per month on your Part B Premium	LOWER copays OTC allowance Transportation Meals BIGGER eyewear allowance Hearing aids	No referrals required** LOWER copays LOWER maximum out-of-pocket limit BIGGER OTC allowance Transportation Meals BIGGER eyewear allowance Hearing aids
Preventive Care Screenings	$0 Copay	$0 Copay	$0 Copay
Primary Care Physician Visits	$0 Copay	$0 Copay	$0 Copay
Specialist Visits A 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).
Part D Drug Coverage
Annual Pharmacy Deductible	$0	$0	$0
30-Day Retail Pharmacy Supply If you get Extra Help from Medicare, your costs may be even lower	Preferred Generics: $0 Copay Generics: $10 Copay Preferred Brands $47 Copay Non-Preferred Brands: $100 Copay Specialty Drugs: 33% Co-insurance	Preferred Generics: $0 Copay Generics: $3 Copay Preferred Brands $35 Copay Non-Preferred Brands: $85 Copay Specialty Drugs: 33% Co-insurance	Preferred Generics: $0 Copay Generics: $0 Copay Preferred Brands $30 Copay Non-Preferred Brands: $85 Copay Specialty Drugs: 33% Co-insurance
90-Day Mail Order Supply If you get Extra Help from Medicare, your costs may be lower.	Preferred Generics: $0 Copay Generics: $0 Copay Preferred Brands $125 Copay Non-Preferred Brands: $275 Copay Specialty Drugs: No Coverage	Preferred Generics: $0 Copay Generics: $0 Copay Preferred Brands $95 Copay Non-Preferred Brands: $245 Copay Specialty Drugs: No Coverage	Preferred Generics: $0 Copay Generics: $0 Copay Preferred Brands $80 Copay Non-Preferred Brands: $245 Copay Specialty Drugs: No Coverage
Special Supplemental Benefits for People with Diabetes
Not covered for BayCarePlus Rewards members.
Select Insulins (as part of the Insulin Savings Program)* $0-$35 Copay per month (remains through coverage gap)		Select Insulins (as part of the Insulin Savings Program)* $0-$35 Copay per month (remains through coverage gap)
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
Standard Retail Cost-Sharing
Tier 2 Select Insulins	Not covered	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	Not covered	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
Tier 2 Select Insulins	Not covered	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	Not covered	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.
View the drugs covered by this plan		View the drugs covered by this plan		View the drugs covered by this plan
Search Our Prescription Drug Formulary
Extra Benefits
Preventive Dental Exams, horizontal bitewing x-rays & cleanings	$0 Copay $0 Copay for two cleanings per calendar year and one deep cleaning every three calendar years	$0 Copay $0 Copay for two cleanings per calendar year and one deep cleaning every three calendar years	$0 Copay $0 Copay for two cleanings, two fillings and two extractions per calendar year and one deep cleaning every three calendar years
Comprehensive Dental	Additional monthly premium $30 $0 Copays No annual deductible $1,000 maximum benefit amount per year Two crowns per calendar year Three root canals per calendar year Complete or partial dentures with unlimited extractions 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.	Additional monthly premium $30 $0 Copays No annual deductible $1,000 maximum benefit amount per year Two crowns per calendar year Three root canals per calendar year Complete or partial dentures with unlimited extractions 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.	Additional monthly premium $30 $0 Copays No annual deductible $1,000 maximum benefit amount per year Two crowns per calendar year Three root canals per calendar year Complete or partial dentures with unlimited extractions 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	$0 Copay for routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts $100 max benefit (non-Medicare covered eyewear) per calendar year	$0 Copay: routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts $150 max benefit (non-Medicare covered eyewear) per calendar year	$0 Copay for routine eye exam $0 Copay for a pair of eyeglasses (lenses and frames) or contacts $200 max benefit (non-Medicare covered eyewear) per calendar year
Fitness Benefit	Silver&Fit^® Membership Included Included at no additional cost	Silver&Fit^® Membership Included Included at no additional cost	Silver&Fit^® Membership Included Included at no additional cost
Transportation Assistance Rides 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 Benefit For 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
View Rewards Plan Details		View Complete Plan Details		View Premier Plan Details

BayCarePlus (HMO) Plans in Your Area

BayCarePlusRewards(HMO)

BayCarePlusComplete(HMO)

BayCarePlusPremier(HMO)

Medical and Hospital

Monthly Premium

Special Features

Preventive Care/Screenings

Primary Care Physician Visits

Specialist Doctor Visits

Virtual/Telehealth Visits

Part D Drug Coverage

Annual Pharmacy Deductible

30-Day Retail Pharmacy Supply

90-Day Retail Pharmacy Supply

Special Supplemental Benefits for People with Diabetes

Additional Over-the-Counter (OTC) Dollars***

Expanded Podiatry Benefit***

Extra Nutrition Counseling***

Diabetic Eye Exams***

Insulin Coverage

Standard Retail Cost-Sharing

Tier 2 Select Insulins

Tier 3 Select Insulins

Mail-Order Pharmacy

Tier 2 Select Insulins

Tier 3 Select Insulins

Search Our Prescription Drug Formulary

Extra Benefits

Preventive Dental

Comprehensive Dental

Vision Care

Fitness Benefit

Transportation Assistance

Over-the-Counter Allowance

Post-Hospitalization Meals

BayCarePlus Rewards (HMO)

BayCarePlus Complete (HMO)

BayCarePlus Premier (HMO)

Medical and Hospital

Monthly Premium

Special Features

Preventive Care Screenings

Primary Care Physician Visits

Specialist Visits

Virtual/Telehealth Visits

Part D Drug Coverage

Annual Pharmacy Deductible

30-Day Retail Pharmacy Supply

90-Day Mail Order Supply

Special Supplemental Benefits for People with Diabetes

Additional Over-the-Counter (OTC) Dollars***

Expanded Podiatry Benefit***

Extra Nutrition Counseling***

Diabetic Eye Exams***

Insulin Coverage

Standard Retail Cost-Sharing

Tier 2 Select Insulins

Tier 3 Select Insulins

Mail-Order Pharmacy

Tier 2 Select Insulins

Tier 3 Select Insulins

Search Our Prescription Drug Formulary

Extra Benefits

Preventive Dental

Comprehensive Dental

Vision Care

Fitness Benefit

Transportation Assistance

Over-the-Counter Benefit

Post-Hospitalization Meals

Interested in Learning More About aBayCarePlus Medicare Advantage (HMO) Plan?

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BayCarePlus
Rewards
(HMO)

BayCarePlus
Complete
(HMO)

BayCarePlus
Premier
(HMO)

Interested in Learning More About a
BayCarePlus Medicare Advantage (HMO) Plan?

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