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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:
  • Not offered
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)

Medical and Hospital

Monthly Premium

  • $0
  • Your Part B premium is reduced by $123 per month

Special Features

  • You save $123 per month on your Part B Premium

Preventive Care Screenings

$0 Copay

Primary Care Physician Visits

$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.

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

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

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:

  • Not offered

Special Supplemental Benefits for People with Diabetes

Not covered for BayCarePlus Rewards members.

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

Not Applicable

Expanded Podiatry Benefit***

Not Applicable

Extra Nutrition Counseling***

Not Applicable

Diabetic Eye Exams***

Not Applicable

Insulin Coverage

Standard Retail Cost-Sharing

Tier 2 Select Insulins

Not covered

Tier 3 Select Insulins

Not covered

Mail-Order Pharmacy

Tier 2 Select Insulins

Not covered

Tier 3 Select Insulins

Not covered

Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits.

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

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.

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

Fitness Benefit

  • Silver&Fit® Membership Included
  • Included at no additional cost

Transportation Assistance

Rides to and from your doctor

No Coverage

Over-the-Counter Benefit

For items like toothpaste, vitamins, blood pressure cuffs, band-aids and more

No Coverage

Post-Hospitalization Meals

No Coverage

View Rewards Plan Details

***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.

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

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Get your questions answered in a virtual or in-person appointment with a BayCarePlus advisor.

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Call (877) 549-1741 (TTY: 711)*