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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
Complete
(HMO)
H2235-001

BayCarePlus
Rewards
(HMO)
H2235-002

BayCarePlus
Premier
(HMO)
H2235-003

Medical and Hospital

Monthly Premium

$0 $0

  • And your Part B premium is reduced by $113
$34

Special Features

  • LOW co-pays
  • Over-the-counter supply (OTC) allowance
  • Transportation
  • Meals
  • You save $113/month on your Part B Premium
  • No referrals required*
  • LOWER co-pays
  • LOWER maximum out-of-pocket limit
  • BIGGER OTC supply allowance
  • Meals
  • Transportation

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.

$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.

Annual Out-of-Pocket Maximum

This 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).

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:

  • $4 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:

  • $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:

  • $0 Copay

Tier 3 – Preferred Brands:

  • $35 Copay

Tier 4 – Non-Preferred Brands:

  • $85 Copay

Tier 5 – Specialty Drugs:

  • 33% Co-insurance

90-Day Mail Order 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:

  • $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:

  • $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

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 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.

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)
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 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: $4 copay
60-Day Supply: $8 copay
90-Day Supply: $12 copay
30-Day Supply: Not Applicable††
60-Day Supply: Not Applicable††
90-Day Supply: Not Applicable††
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
30-Day Supply: Not Applicable††
60-Day Supply: Not Applicable††
90-Day Supply: Not Applicable††
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
30-Day Supply: Not Offered
60-Day Supply: Not Offered
90-Day Supply: Not Applicable††
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
30-Day Supply: Not Offered
60-Day Supply: Not Offered
90-Day Supply: Not Applicable††
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.

††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.

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

  • Includes two routine cleanings per year, one deep cleaning every three years and one filling per year
$0 Copay

  • Includes two routine cleanings per year, one deep cleaning every three years and one filling per year
$0 Copay

  • Includes two routine cleanings per year, one deep cleaning every three years, 2 fillings and 2 extractions

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

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)

Fitness Benefit

Silver&Fit® Membership Included Silver&Fit® Membership Included Silver&Fit® Membership Included

Transportation Assistance

Rides 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 Benefit

For 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.

BayCarePlus Complete (HMO)

Medical and Hospital

Monthly Premium

$0

Special Features

  • LOW co-pays
  • Over-the-counter supply (OTC) allowance
  • Transportation
  • Meals

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.

$15 Copay
A referral is required for specialist visits except for visits with an obstetrician/ gynecologist, chiropractor, podiatrist or dermatologist.

Annual Out-of-Pocket Maximum

This 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

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).

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:

  • $4 Copay

Preferred Brands:

  • $35 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:

  • $95 Copay

Non-Preferred Brands:

  • $245 Copay

Specialty Drugs:

  • No Coverage

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.

View the drugs covered by this plan

Extra Benefits

Preventive Dental

Exams, horizontal bitewing x-rays & cleanings

$0 Copay

  • Includes two routine cleanings per year, one deep cleaning every three years and one filling per year

Comprehensive Dental

Optional supplemental dental coverage is available for an additional monthly premium.
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/calendar year)

Fitness Benefit

Silver&Fit® Membership Included

Transportation Assistance

Rides to and from your doctor

$0 Copay (16 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

$65 Per Quarter

Post-Hospitalization Meals

Up to 56 home-delivered, post-discharge meals per calendar year

Therapeutic Massage

No Coverage

Acupuncture

$20 Copay for up to 20 visits
View Complete Plan Details

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