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Medicare Plans to Fit Your Needs

BayCarePlus offers several plan options so you can choose the plan that best meets your personal needs. All plans include medical and hospital coverage as well as prescription drugs, dental, vision, hearing and fitness benefits, plus more. View our plan comparison below to see highlights and request an Enrollment Guide to see a Summary of Benefits. 

Find a BayCarePlus® (HMO) Plan 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 Value
(HMO)
H2235-005
BayCarePlus Complete
(HMO)
H2235-001
BayCarePlus Premier
(HMO)
H2235-003
BayCarePlus Freedom
(HMO-POS)
H2235-006

Medical and Hospital

Monthly Premium

$0

$0

$0

$42
You may be able to lower your premium, if you get Extra Help from Medicare

$0

Part B Premium Monthly Saving

$134 per month $113 per month

Not Covered

Maximum Out-Of-Pocket Limit

$4,500 per calendar year $4,500 per calendar year $3,100 per calendar year $2,500 per calendar year

In Network 

$3,850 per calendar year

Out of Network

$8,950 per calendar year

Annual Deductible

$0

Primary Care Physician Visits

$0 copay $0 copay $0 copay $0 copay In Network
$0 copay

Out of Network
$50 copay

Specialist Visits

$40 copay $40 copay $15 copay $15 copay In Network
$35 copay

Out of Network
$70 copay

Inpatient Hospital Care

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

$200 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

$175 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

In Network

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

Out of Network

45% coinsurance

Urgent Care

$35 copay $35 copay $35 copay $30 copay $40 copay

Emergency Care

$100 copay $100 copay $90 copay $120 copay $135 copay

Lab Services

$0 copay

$0 copay

$0 copay

$0 copay

In Network

$0 copay

Out of Network

45% coinsurance

Part D Prescription Drug Coverage*

Annual Deductible

$0

Tier 1 Preferred Generic

$0 copay

Tier 2 Generic

$10 copay $10 copay $3 copay $0 copay $3 copay

Tier 3 Preferred Brand

$47 copay $47 copay $35 copay $30 copay $35 copay

Tier 4 Non-Preferred Brand

$100 copay

$100 copay $85 copay $85 copay $85 copay

Tier 5 Specialty Drug

33% coinsurance

Mail Order 90-Day Supply (Tiers 1-4)

$0/ $0/ $125/ $275

$0/ $0/ $125/ $275

$0/ $0/ $95/ $245

$0/ $0/ $80/ $245

$0/ $0/ $95/ $245

Diabetic Insulin 30-Day Supply (Tiers 1-5)

NA/$10/$35/NA/NA

NA/$10/$35/NA/NA

NA/$3/$35/NA/NA

NA/$0/$30/NA/NA

NA/$3/$35/NA/NA

Initial Coverage Limit

$5,030

View the drugs covered by this plan

Extra Benefit Highlights

Dental (Base Option)

$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $2,000 for comprehensive dental

Optional Comprehensive Dental ($49 per month)

See any dentist you want!**
$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $4,000 for comprehensive dental

Vision

$0 copay for routine eye exam

$0 copay or 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

$300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts

Hearing Aids (Up to two hearing aids every calendar year [one per ear])

$599 or $899 copay per hearing aid

$699 or $999 copay per hearing aid

$599 or $899 copay per hearing aid

$699 or $999 copay per hearing aid

Over-the-Counter (OTC) Items

Not covered

$50 per quarter

$107 per quarter +$25 per quarter for members with diabetes

$135 per quarter
+$50 per quarter for members with diabetes

$25 per quarter

Transportation Assistance

Not covered

$0 copay for 16 one-way trips to approved locations per calendar year

$0 copay for 24 one-way trips to approved locations per calendar year

Not covered

Meals

Not covered

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

Not covered

Grocery Allowance

Not covered

$50 per quarter (Must meet health condition requirements to qualify. See Evidence of Coverage.)

Not covered

Travel Benefits

Emergency or urgent care coverage if you’re making a trip out of state or country.

Important Documents (All Plans)
 

Provider Directory
Drug Formulary
Star Ratings
Formulary Change Notice
Summary of Benefits

Documentos Importantes (Todos los planes)

Directorio d Proveedores
Formulario de Medicamentos Recetados
Calificaciones por Estrellas
Resumen de Beneficios (Disponible próximamente)

Important Documents (Plan Specific)

Evidence of Coverage
Annual Notice of Change

Evidence of Coverage

Evidence of Coverage
Annual Notice of Change

Evidence of Coverage
Annual Notice of Change

Evidence of Coverage

Documentos Importantes (Específico del Plan)

Evidencial de Cobertura
Aviso Anual de Cambio

Evidencial de Cobertura

Evidencial de Cobertura
Aviso Anual de Cambio

Evidencial de Cobertura
Aviso Anual de Cambio

Evidence of Coverage

Medical and Hospital

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Value
(HMO)
H2235-005

Monthly Premium

$0

$0

Part B Premium Monthly Saving

$134 per month $113 per month

Maximum Out-Of-Pocket Limit

$4,500 per calendar year $4,500 per calendar year

Annual Deductible

$0

Primary Care Physician Visits

$0 copay $0 copay

Specialist Visits

$40 copay $40 copay

Inpatient Hospital Care

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

Urgent Care

$35 copay $35 copay

Emergency Care

$100 copay $100 copay

Lab Services

$0 copay

$0 copay

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Complete
(HMO)
H2235-001

Monthly Premium

$0

$0

Part B Premium Monthly Saving

$134 per month

Not Covered

Maximum Out-Of-Pocket Limit

$4,500 per calendar year $3,100 per calendar year

Annual Deductible

$0

Primary Care Physician Visits

$0 copay $0 copay

Specialist Visits

$40 copay $15 copay

Inpatient Hospital Care

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

$200 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

Urgent Care

$35 copay $35 copay

Emergency Care

$100 copay $90 copay

Lab Services

$0 copay

$0 copay

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Premier
(HMO)
H2235-003

Monthly Premium

$0

$42
You may be able to lower your premium, if you get Extra Help from Medicare

Part B Premium Monthly Saving

$134 per month

Not Covered

Maximum Out-Of-Pocket Limit

$4,500 per calendar year $2,500 per calendar year

Annual Deductible

$0

Primary Care Physician Visits

$0 copay $0 copay

Specialist Visits

$40 copay $15 copay

Inpatient Hospital Care

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

$175 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

Urgent Care

$35 copay $30 copay

Emergency Care

$100 copay $120 copay

Lab Services

$0 copay

$0 copay

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Freedom
(HMO-POS)
H2235-006

Monthly Premium

$0

$0

Part B Premium Monthly Saving

$134 per month

Not Covered

Maximum Out-Of-Pocket Limit

$4,500 per calendar year

In Network 

$3,850 per calendar year

Out of Network

$8,950 per calendar year

Annual Deductible

$0

Primary Care Physician Visits

$0 copay In Network
$0 copay

Out of Network
$50 copay

Specialist Visits

$40 copay In Network
$35 copay

Out of Network
$70 copay

Inpatient Hospital Care

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

In Network

$250 copay per day, per stay: days 1–5

$0 copay per day, per stay: days 6 and beyond

Out of Network

45% coinsurance

Urgent Care

$35 copay $40 copay

Emergency Care

$100 copay $135 copay

Lab Services

$0 copay

In Network

$0 copay

Out of Network

45% coinsurance

Part D Prescription Drug Coverage*
BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Value
(HMO)
H2235-005

Annual Deductible

$0

Tier 1 Preferred Generic

$0 copay

Tier 2 Generic

$10 copay $10 copay

Tier 3 Preferred Brand

$47 copay $47 copay

Tier 4 Non-Preferred Brand

$100 copay

$100 copay

Tier 5 Specialty Drug

33% coinsurance

Mail Order 90-Day Supply (Tiers 1-4)

$0/ $0/ $125/ $275

$0/ $0/ $125/ $275

Diabetic Insulin 30-Day Supply (Tiers 1-5)

NA/$10/$35/NA/NA

NA/$10/$35/NA/NA

Initial Coverage Limit

$5,030

View the drugs covered by this plan

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Complete
(HMO)
H2235-001

Annual Deductible

$0

Tier 1 Preferred Generic

$0 copay

Tier 2 Generic

$10 copay $3 copay

Tier 3 Preferred Brand

$47 copay $35 copay

Tier 4 Non-Preferred Brand

$100 copay

$85 copay

Tier 5 Specialty Drug

33% coinsurance

Mail Order 90-Day Supply (Tiers 1-4)

$0/ $0/ $125/ $275

$0/ $0/ $95/ $245

Diabetic Insulin 30-Day Supply (Tiers 1-5)

NA/$10/$35/NA/NA

NA/$3/$35/NA/NA

Initial Coverage Limit

$5,030

View the drugs covered by this plan

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Premier
(HMO)
H2235-003

Annual Deductible

$0

Tier 1 Preferred Generic

$0 copay

Tier 2 Generic

$10 copay $0 copay

Tier 3 Preferred Brand

$47 copay $30 copay

Tier 4 Non-Preferred Brand

$100 copay

$85 copay

Tier 5 Specialty Drug

33% coinsurance

Mail Order 90-Day Supply (Tiers 1-4)

$0/ $0/ $125/ $275

$0/ $0/ $80/ $245

Diabetic Insulin 30-Day Supply (Tiers 1-5)

NA/$10/$35/NA/NA

NA/$0/$30/NA/NA

Initial Coverage Limit

$5,030

View the drugs covered by this plan

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Freedom
(HMO-POS)
H2235-006

Annual Deductible

$0

Tier 1 Preferred Generic

$0 copay

Tier 2 Generic

$10 copay $3 copay

Tier 3 Preferred Brand

$47 copay $35 copay

Tier 4 Non-Preferred Brand

$100 copay

$85 copay

Tier 5 Specialty Drug

33% coinsurance

Mail Order 90-Day Supply (Tiers 1-4)

$0/ $0/ $125/ $275

$0/ $0/ $95/ $245

Diabetic Insulin 30-Day Supply (Tiers 1-5)

NA/$10/$35/NA/NA

NA/$3/$35/NA/NA

Initial Coverage Limit

$5,030

View the drugs covered by this plan

Extra Benefit Highlights
BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Value
(HMO)
H2235-005

Dental (Base Option)

$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $2,000 for comprehensive dental

Optional Comprehensive Dental ($49 per month)

See any dentist you want!**
$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $4,000 for comprehensive dental

Vision

$0 copay for routine eye exam

$0 copay or 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

$300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts

Hearing Aids (Up to two hearing aids every calendar year [one per ear])

$599 or $899 copay per hearing aid

$699 or $999 copay per hearing aid

Over-the-Counter (OTC) Items

Not covered

$50 per quarter

Transportation Assistance

Not covered

$0 copay for 16 one-way trips to approved locations per calendar year

Meals

Not covered

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

Grocery Allowance

Not covered

$50 per quarter (Must meet health condition requirements to qualify. See Evidence of Coverage.)

Travel Benefits

Emergency or urgent care coverage if you’re making a trip out of state or country.

Important Documents (All Plans)
 

Provider Directory
Drug Formulary
Star Ratings
Formulary Change Notice
Summary of Benefits

Documentos Importantes (Todos los planes)

Directorio d Proveedores
Formulario de Medicamentos Recetados
Calificaciones por Estrellas
Resumen de Beneficios (Disponible próximamente)

Important Documents (Plan Specific)

Evidence of Coverage
Annual Notice of Change

Evidence of Coverage

Documentos Importantes (Específico del Plan)

Evidencial de Cobertura
Aviso Anual de Cambio

Evidencial de Cobertura

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Complete
(HMO)
H2235-001

Dental (Base Option)

$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $2,000 for comprehensive dental

Optional Comprehensive Dental ($49 per month)

See any dentist you want!**
$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $4,000 for comprehensive dental

Vision

$0 copay for routine eye exam

$0 copay or 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

$300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts

Hearing Aids (Up to two hearing aids every calendar year [one per ear])

$599 or $899 copay per hearing aid

$599 or $899 copay per hearing aid

Over-the-Counter (OTC) Items

Not covered

$107 per quarter +$25 per quarter for members with diabetes

Transportation Assistance

Not covered

$0 copay for 24 one-way trips to approved locations per calendar year

Meals

Not covered

Not covered

Grocery Allowance

Not covered

Not covered

Travel Benefits

Emergency or urgent care coverage if you’re making a trip out of state or country.

Important Documents (All Plans)
 

Provider Directory
Drug Formulary
Star Ratings
Formulary Change Notice
Summary of Benefits

Documentos Importantes (Todos los planes)

Directorio d Proveedores
Formulario de Medicamentos Recetados
Calificaciones por Estrellas
Resumen de Beneficios (Disponible próximamente)

Important Documents (Plan Specific)

Evidence of Coverage
Annual Notice of Change

Evidence of Coverage
Annual Notice of Change

Documentos Importantes (Específico del Plan)

Evidencial de Cobertura
Aviso Anual de Cambio

Evidencial de Cobertura
Aviso Anual de Cambio

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Premier
(HMO)
H2235-003

Dental (Base Option)

$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $2,000 for comprehensive dental

Optional Comprehensive Dental ($49 per month)

See any dentist you want!**
$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $4,000 for comprehensive dental

Vision

$0 copay for routine eye exam

$0 copay or 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

$300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts

Hearing Aids (Up to two hearing aids every calendar year [one per ear])

$599 or $899 copay per hearing aid

$699 or $999 copay per hearing aid

Over-the-Counter (OTC) Items

Not covered

$135 per quarter
+$50 per quarter for members with diabetes

Transportation Assistance

Not covered

Not covered

Meals

Not covered

Not covered

Grocery Allowance

Not covered

Not covered

Travel Benefits

Emergency or urgent care coverage if you’re making a trip out of state or country.

Important Documents (All Plans)
 

Provider Directory
Drug Formulary
Star Ratings
Formulary Change Notice
Summary of Benefits

Documentos Importantes (Todos los planes)

Directorio d Proveedores
Formulario de Medicamentos Recetados
Calificaciones por Estrellas
Resumen de Beneficios (Disponible próximamente)

Important Documents (Plan Specific)

Evidence of Coverage
Annual Notice of Change

Evidence of Coverage
Annual Notice of Change

Documentos Importantes (Específico del Plan)

Evidencial de Cobertura
Aviso Anual de Cambio

Evidencial de Cobertura
Aviso Anual de Cambio

BayCarePlus Rewards
(HMO)
H2235-002
BayCarePlus Freedom
(HMO-POS)
H2235-006

Dental (Base Option)

$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $2,000 for comprehensive dental

Optional Comprehensive Dental ($49 per month)

See any dentist you want!**
$0 copay for preventive dental services including oral exams, X-rays and cleanings
$0 copay for comprehensive dental services
Annual maximum of $4,000 for comprehensive dental

Vision

$0 copay for routine eye exam

$0 copay or 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

$300 max benefit (non-Medicare-covered eyewear) per calendar year for eyeglass (lenses and frames) or $350 max benefit per year for contacts

Hearing Aids (Up to two hearing aids every calendar year [one per ear])

$599 or $899 copay per hearing aid

$699 or $999 copay per hearing aid

Over-the-Counter (OTC) Items

Not covered

$25 per quarter

Transportation Assistance

Not covered

Not covered

Meals

Not covered

Not covered

Grocery Allowance

Not covered

Not covered

Travel Benefits

Emergency or urgent care coverage if you’re making a trip out of state or country.

Important Documents (All Plans)
 

Provider Directory
Drug Formulary
Star Ratings
Formulary Change Notice
Summary of Benefits

Documentos Importantes (Todos los planes)

Directorio d Proveedores
Formulario de Medicamentos Recetados
Calificaciones por Estrellas
Resumen de Beneficios (Disponible próximamente)

Important Documents (Plan Specific)

Evidence of Coverage
Annual Notice of Change

Evidence of Coverage

Documentos Importantes (Específico del Plan)

Evidencial de Cobertura
Aviso Anual de Cambio

Evidence of Coverage

*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.

** The Delta Dental plan will pay benefits for covered services provided by a non-participating provider.  However, a non-participating provider may charge you more than the Maximum Plan Allowance payable under this Medicare Advantage plan and you’ll be responsible for all cost-sharing charges. See the Evidence of Coverage for full details.


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

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Learn more about BayCarePlus plans at a FREE live seminar or webinar.

 Attend a Meeting CTA

Schedule a Personal Consultation

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

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Discuss your options with a licensed Medicare advisor.