Medicare Advantage

• Partial coverage for inpatient hospital
• Partial coverage for skilled nursing facility
• Partial coverage for home healthcare

• Partial coverage for primary care physician visits
• Partial coverage for outpatient surgery
• Partial coverage for lab services
• Partial coverage for durable medical equipment

Similar to and takes the place of Part A and B with predictable out-of-pocket costs and more coverage. Including:

• Hearing benefits
• Vision benefits
• Dental benefits
• Gym membership

• Coverage for prescription drugs beyond what is covered by Original Medicare.
• Our plans are available with or without Part D coverage.
• For 2025, maximum out-of-pocket amount is $2,000.

This guide shows you the Medicare Advantage plans offered by Baylor Scott & White Health Plan in North, Central and West Texas. Plans vary by region, and you must live in the county where the plan is offered to be eligible to enroll in the plan. Also:

• You must be enrolled in Medicare Part B.
• You must be entitled to benefits under Medicare Part A. If you do not have Medicare Part A, you can purchase it from Social Security

Don't miss your important enrollment dates

Turning 65?

There is a 7-month window during the calendar year that you turn 65 in which you can enroll in Medicare. You are eligible to enroll in Medicare for the first time during the three months leading up to your 65th birthday, your birthday month and the three months afterward. This timeframe is called your Initial Enrollment Period or IEP.

Avoid the penalties.

You might have to pay penalty fees if you do not enroll in Part A, Part B or Part D coverage on time.

Call a licensed insurance agent.

Learn how to avoid these fees and make your Medicare Advantage experience as seamless as possible. Contact a Medicare Advisor by calling 800.782.5068 (TTY: 711).

• Are you in good health?
• How often do you see your doctor?
• Do you take prescription drugs?
• How much can you afford each month?
• Are you willing to change doctors if it means lower healthcare costs?

Medical Costs

• How much are your premiums, deductibles and other costs?
• How much do you pay for services like hospital stays or doctor visits?
• Is there a yearly limit on what you could pay out of pocket for medical services?

Prescription Costs

• Do you currently have prescription drug coverage?
• Will you pay a penalty if you join a drug plan later?
• What will your prescription drugs cost under each plan?
• Are your drugs covered under the plan's formulary?
• Are there any coverage rules that apply to your prescriptions?
• Is your pharmacy in the plan's network?

Medical Care

• Do your doctors accept the coverage?
• Are the doctors you want to see accepting new patients?
• Do you have to choose your hospital and healthcare providers from a network?
• Do you need to get referrals?
• Are you satisfied with your medical care?