Advantage > HMO for Central Texas Plan Highlights

Text/HTML

Have any questions?

Need language assistance?

Call Sales

Talk to a licensed insurance agent at

1-800-782-5068

(TTY: 711).

2020 HMO Plans — Highlights for Central Texas

STAR ratings: Overall 4.5 stars rating.

Every year, Medicare evaluates plans based on a 5-star rating system.

Highlights of SeniorCare Advantage HMO Plans for Central Texas, and some popular options, are listed below for your convenience. These plans are available with or without Part D Prescription Drug Coverage. For more details, please see the plan documents.

Please note:

With Advantage Medicare plans, you must continue to pay Medicare Part B premium, see benefit documents for more details.
At Scott & White, you do not have to select a PCP to direct your care with SeniorCare Advantage HMO plan. You can see a specialist without a referral.
Except for urgent and emergency care, you must get your care and services from providers in Scott and White Health Plan’s SeniorCare Advantage HMO network.
With an HMO, if you choose to get non-emergency services out-of-network, you will be personally responsible for payment of all charges.

Find Provider(s) for this plan with our Find a Provider tool.

Find your prescription drug(s) for all SWHP Medicare plans in the Drug List Formulary

Plan Highlights Sections

Click header link to jump to that section.

Text/HTML

Enroll Now

Medical Plan Benefits*
(must continue to pay Medicare Part B premium, see benefit documents for more details)
Monthly Premium with Part D prescription drug coverage
(in-network)
HMO only - Monthly Premium without Part D prescription drug coverage

(in-network)
Deductible
Out-of-Pocket Maximum
(in-network)
Primary Care Physician (PCP) Office Visit or E-Visit
Specialist Office Visit
Diagnostic Tests, X-rays, Lab Services
(separate office visit copay may apply)
Advanced Diagnostic Imaging Services
(MRI, MRA, SPECT, CTA, CT, PET, Nuclear Cardiology)
Physical/ Occupational/ Speech Therapy
(per visit)
Inpatient Hospital
Inpatient Mental Health
Skilled Nursing Facility (SNF)
Outpatient Surgery
(facility)
Ambulatory Surgical Center
(facility)
Ambulance
Emergency Care
(U.S. only; copay waived if admitted within 24 hours)
Urgent Care
(U.S. only; copay waived if admitted within 24 hours)
Durable Medical Equipment (DME)

PPO for North Texas
Network Cost Sharing
$36
--
$0
$6,700
$0
copay
$40
copay
$0-$75
copay
$300
copay
$25
copay
Days 1-5: $350/day;
Days 6-90: $0/day
Days 1-5: $318/day;
Days 6-90: $0/day
Days 1-20: $0/day;
Days 21-100: $167.50/day
$350
copay
$250
copay
$350
copay
$90
copay
$50
copay
20%
coinsurance

PPO Basic for Central Texas
Network Cost Sharing
$36
--
$0
$6,700
$0
copay
$40
copay
$0-$75
copay
$300
copay
$25
copay
Days 1-5: $350/day;
Days 6-90: $0/day
Days 1-5: $318/day;
Days 6-90: $0/day
Days 1-20: $0/day;
Days 21-100: $167.50/day
$350
copay
$275
copay
$350
copay
$90
copay
$50
copay
20%
coinsurance

PPO Platinum for Central Texas
Network Cost Sharing
$136
--
$0
$3,500
$0

copay
$20
copay
$0-$20
copay
$200
copay
$25
copay
Days 1-5: $200/day;
Days 6-90: $0/day
Days 1-5: $200/day;
Days 6-90: $0/day
Days 1-20: $0/day;
Days 21-100: $50/day
$100
copay
$75
copay
$75
copay
$90
copay
$50
copay
20%
coinsurance

HMO Select for Central Texas
$0
$0
$0
$5,300
$0
copay
$40
copay
$0-$75
copay
$300
copay
$25
copay
Days 1-5: $350/day;
Days 6-90: $0/day
Days 1-5: $318/day;
Days 6-90: $0/day
Days 1-20: $0/day;
Days 21-100: $167.50/day
$350
copay
$275
copay
$265
copay

$90

copay

$50

copay

20%

coinsurance

HMO Preferred for Central Texas
$131
$90
$0
$3,900
$0
copay
$25
copay
$0
copay
$15
copay
$15
copay
$575/stay
$575/stay
Days 1-20: $0/day;
Days 21-100: $50/day
$15
copay
$100
copay
$75
copay
$90
copay
$40
copay
20%
coinsurance

HMO Premium for Central Texas
$241
$199
$0
$3,400
$0
copay
$0
copay
$0
copay
$0
copay
$0
copay
$0
copay
$0
copay
Days 1-20: $0/day;
Days 21-100: $15/day
$0
copay
$0
copay
$40
copay
$120
copay
$40
copay
$0
copay

Prescription Drug Benefits
Initial Coverage Amount
Deductible
Deductible Applies to:
Copays During Initial Coverage Period
Tier 1 — Preferred Generic Drugs
Tier 2 — Generic Drugs
Tier 3 — Preferred Brand Drugs
Tier 4 — Non-Preferred Drugs
Tier 5 — Specialty Drugs
After Initial Coverage Amount — You Pay
Preferred Generic Drugs
Other Generic Drugs
Brand-Name Drugs
Total Out-of-Pocket You Pay Before Catastrophic Coverage
Catastrophic Coverage Amounts — You Pay

PPO for North Texas
$4,020
$300
Tiers 3-5
$4
copay
$14
copay
$47
copay
$99
copay
27%
coinsurance
25%
coinsurance
25%
coinsurance
25%
coinsurance
$6,350
The greater of 5% or $3.60 for generic drugs (including brand drugs treated as generic) or $8.95 for all other drugs.

PPO Basic for Central Texas
$4,020
$250
Tiers 3-5
$3
copay
$14
copay
$47
copay
$99
copay
28%
coinsurance
25%
coinsurance
25%
coinsurance
25%
coinsurance
$6,350
The greater of 5% or $3.60 for generic drugs (including brand drugs treated as generic) or $8.95 for all other drugs.

PPO Platinum for Central Texas
$4,020
$50
Tiers 3-5
$2
copay
$12
copay
$45
copay
$95
copay
32%
coinsurance
$4
copay
25%
coinsurance
25%
coinsurance
$6,350
The greater of 5% or $3.60 for generic drugs (including brand drugs treated as generic) or $8.95 for all other drugs.

HMO Select for Central Texas
$4,020
$300
Tiers 3-5
$6
copay
$20
copay
$47
copay
$100
copay
27%
coinsurance
25%
coinsurance
25%
coinsurance
25%
coinsurance
$6,350
The greater of 5% or $3.60 for generic drugs (including brand drugs treated as generic) or $8.95 for all other drugs.

HMO Preferred for Central Texas
$4,020
$100
Tiers 3-5
$3
copay
$15
copay
$45
copay
$95
copay
31%
coinsurance
25%
coinsurance
25%
coinsurance
25%
coinsurance
$6,350
The greater of 5% or $3.60 for generic drugs (including brand drugs treated as generic) or $8.95 for all other drugs.

HMO Premium for Central Texas
$4,020
$0
Tiers 3-5
$2
copay
$12
copay
$45
copay
$95
copay
33%
coinsurance
$4
copay
25%
coinsurance
25%
coinsurance
$6,350
The greater of 5% or $3.60 for generic drugs (including brand drugs treated as generic) or $8.95 for all other drugs.

Enroll Now

Bonus Benefits
Routine Eye Exam
(one per year; must use a Superior Vision provider)
Eyewear
(must use a Superior Vision provider)
Routine Hearing Exam
(one per year)
Hearing Aids
Gym/Fitness Club Membership
(at participating Silver&Fit locations)
Dental

PPO for North Texas
$0
copay
$125
annual allowance toward purchase
$0
copay
Not included.
Not included.
$20 additional premium required
$2,000 maximum benefit per year

PPO Basic for Central Texas
$0
copay
$125
annual allowance toward purchase
$0
copay
$1,000
allowance toward purchase every 3 years
$0
$20 additional premium required
$2,000 maximum benefit per year

PPO Platinum for Central Texas
$0
copay
$125
annual allowance toward purchase
$0
copay
$1,000
allowance toward purchase every 3 years
$0
Included
$2,000 maximum benefit per year

HMO Select for Central Texas
$0
copay
$125
annual allowance toward purchase
$0
copay
$750 (with Rx)/$1,000 (without Rx)
allowance toward purchase every 3 years
$0
Included
$2,000 maximum benefit per year

HMO Preferred for Central Texas
$0
copay
$125
annual allowance toward purchase
$0
copay
$1,000
allowance toward purchase every 3 years
$0
Included
$2,000 maximum benefit per year

HMO Premium for Central Texas
$0
copay
$125
annual allowance toward purchase
$0
copay
$1,000
allowance toward purchase every 3 years
$0
Included
$2,000 maximum benefit per year

Enroll Now

Dental Benefits
Monthly Premium
Yearly Benefit Maximum
Deductible
Oral Exams
(every 6 months)
Dental X-rays
(every 3 years)
Extractions and Fillings
Dentures
(every 5 years)

PPO for North Texas
$20
$2,000
$0
$0
$0
50%
50%

HMO Basic for Central Texas
$20
$2,000
$0
$0
$0
50%
50%

HMO Platinum for Central Texas
Included
$2,000
$0
$0
$0
50%
50%

HMO Select for Central Texas
Included
$2,000
$0
$0
$0
50%
50%

HMO Preferred for Central Texas
Included
$2,000
$0
$0
$0
50%
50%

HMO Premium for Central Texas
Included
$2,000
$0
$0
$0
50%
50%

Enroll Now

Text/HTML

Have any questions?

Need language assistance?

Call Sales

Talk to a licensed insurance agent at

1-800-782-5068

(TTY: 711).

Plan Forms and Documents

View Printable Plan documents in PDF format. (May require free Adobe Acrobat Reader to view documents.)

To save a PDF document to your device, select "Save As" from your web browser's options.

Summary of Benefits

More SeniorCare Advantage HMO Plan Documents and Resources

Back to Top of Page

Text/HTML

This information is not a complete description of benefits. Call 1-800-782-5068 (TTY: 711) for more information.

Out-of-network/non-contracted providers are under no obligation to treat plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost- sharing that applies to out-of-network services.