BayCarePlus Premier (HMO)
Complete Coverage with One Plan from One Company
BayCarePlus bundles medical, hospital and prescription drug coverage together into one convenient plan. With one insurance card and one number to call, we eliminate the hassle and cost of dealing with multiple insurance companies so you can focus on more important things.
Low Monthly Premium with NO Referrals and NO Deductibles Required
Our popular NO REFERRALS REQUIRED** BayCarePlus Premier (HMO) plan offers you the most comprehensive coverage for the low premium of just $34 per month. There are also no annoying deductibles to meet. Your coverage begins right away.
Coverage When Traveling
Whether you’re making a trip out of state or out of the country, BayCarePlus has you covered. If you ever get sick or injured when away from home, you can rest easy knowing you have emergency or urgent care coverage.
Financial Security
All of our plans include out-of-pocket protection that limits your annual health care costs and protects your savings in case of an emergency or unexpected illness. This important protection isn’t offered by traditional Medicare plans.
Money-Saving Extra Benefits
Every BayCarePlus plan comes with important extra benefits including preventive dental, vision and even free memberships to health clubs through the popular Silver&Fit® program for no additional premium.
BayCarePlus Premier (HMO) plan members will also have access to BayCareAnywhere®, offering 24/7 virtual doctor visits via video chat.
Telehealth: Video Doctor Visits
Technology has changed the way we do everything, and that includes how we see doctors. If you’re too sick to leave the house or just want to practice social distancing, BayCarePlus covers telemedicine visits with your primary care doctor and specialists. You can also use the BayCareAnywhere mobile app to have an unscheduled video visit with a doctor for urgent care needs any time of day or night—even on holidays.
Technology has changed the way we do everything, and that includes how we see doctors. If you’re too sick to leave the house or just want to practice social distancing, BayCarePlus covers telemedicine visits with your primary care doctor and specialists. You can also use the BayCareAnywhere mobile app to have an unscheduled video visit with a doctor for urgent care needs any time of day or night—even on holidays.
Hospital and Medical Coverage
Your BayCarePlus plan provides comprehensive medical and hospital coverage with no annual deductible and low copayments.
| BaycarePlus Medicare Advantage Premier (HMO) |
|
|---|---|
Monthly Premium | $34 |
Maximum Out-of-Pocket Limit |
$2,500 Per Calendar Year This is the most you'd pay in a year for covered medical services. Once you reach it, your plan pays all the costs. |
Annual Deductible |
$0 |
Preventive Care/Screenings |
$0 Copay |
Primary Care Physician Visists |
$0 Copay |
Specialist Doctor Visits |
$15 Copay A referral is not required to see specialists on this plan, except for home health, occupational therapy, physical therapy and speech therapy. |
Urgent Care |
$30 Copay |
Emergency Care |
$120 Copay |
Lab Services |
$0 Copay |
Home Health Care |
100% Coverage |
Chiropractic Services |
$10 Copay |
Inpatient Hospital Care |
$150 Per day, per stay; Days 1-5 $0 Per day, per stay; Day 6 and beyond |
Outpatient Surgery at Hospital |
$95 Copay |
Outpatient Surgery at Ambulatory Surgery Center |
$50 Copay |
Part D Drug Coverage
This table shows the drug tiers associated with your plan, and the copayments or co-insurance that you will pay in each tier. A drug formulary provides a list of drugs that are covered by our plan.
| BaycarePlus Medicare Advantage Premier (HMO) |
|
|---|---|
Annual Deductible |
$0 |
Retail Pharmacy — 30 Day Supply |
Tier 1 — Preferred Generics
Tier 2 — Generics
Tier 3 — Preferred Brands
Tier 4 — Non-Preferred Brands
Tier 5 — Specialty Drugs
|
Mail Order — 90 Day Supply |
Tier 1 — Preferred Generics
Tier 2 — Generics
Tier 3 — Preferred Brands
Tier 4 — Non-Preferred Brands
Tier 5 — Specialty Drugs
|
Initial Coverage Limit |
$4,660 |
Special Supplemental Benefits for People with Diabetes†
Plan members who have been diagnosed with diabetes will receive the following extra benefits:
Additional Over-the-Counter (OTC) Dollars |
+$50/Quarter |
Enhanced Podiatry Benefit |
$0 Copay for up to six routine visits/calendar year, which include nail trimmings |
Extra Nutrition Counseling |
$0 Copay for six additional hours/calendar year |
Diabetic Supplies & Services |
$0 Copay |
†The benefits mentioned are part of a special supplemental program for the chronically ill. Not all members qualify.
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 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 |
30-Day Supply: $0 copay 60-Day Supply: $0 copay 90-Day Supply: $0 copay |
Tier 3 Select Insulins |
30-Day Supply: $30 copay 60-Day Supply: $60 copay 90-Day Supply: $90 copay |
Mail-Order Pharmacy
Tier 2 Select Insulins |
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: $80 copay |
Plans may offer supplemental benefits in addition to Part C benefits and Part D benefits.
Extra Benefits
Your BayCarePlus plan offers many valuable extras not offered by Original Medicare or Medicare supplement plans—at no additional cost to you.
| BaycarePlus Medicare Advantage Premier (HMO) |
|
|---|---|
Vision Care |
|
Preventive Dental Care |
|
Comprehensive Dental Care |
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. |
Over-the-Counter (OTC) Allowances |
$115 Per Quarter |
Hearing |
Up to two hearing aids every two years (one per ear per year). |
Transportation Assistance |
$0 Copay (24 one-way trips to approved locations per calendar year) |
Fitness Club Membership |
|
Travel Benefits |
Emergency or urgent care coverage if you are making a trip out of state or country |
Meals |
Up to 56 home-delivered, post-discharge meals per calendar year |
