Baylor Scott and White Plan Guide for Texas 2023

All You Need to Know About Baylor Scott and White Plans for 2023 in Texas

When you search for health insurance, you may begin with the big names: Blue Cross Blue Shield, Aetna, and UnitedHealthcare. These are usually at the top of the list for health insurance in Texas. But did you know that there are other health insurers out there? You have options that can help you save money that provides you with the same health coverage as the big three above. This is because of the health mandate. All providers must carry the same insurance for all. We at Cover Mile are here to assist you in understanding what Baylor Scott and White plans offer you and to guide you through what their coverage chart means to you.

Health Insurance Terms to Understand

Before we begin, let’s go over the definitions of the terms you will see frequently but may not understand completely. These terms will be the same whatever health insurance company you select. Knowing the basics will help you determine the best health insurance coverage for your family situation.

Deductible – A deductible is the amount you will pay out-of-pocket before the co-insurance kicks in. BSW has deductibles between $0 and $7600, depending on the plan you select. Deductibles are based on the calendar year and refresh each year. They will also determine how much your premium is. The higher your deductible, the lower your premium will be; the lower your deductible, the higher your premium. Deductibles are broken down into two parts:

            Single: This is the per-person deductible.

            Family: This is the deductible for the entire family

These numbers will be listed on your Summary of Benefits, often in fraction form. For instance, $750 Single/$1500Family; or abbreviated, $750/$1500. Each family member has their own $750 out-of-pocket expense to reach. You can read more about deductibles here.

Co-insurance – Co-insurance is where your insurance begins to pay its portion. This is a cost-sharing between you and the insurance company. It is expressed as a percentage. For instance, for a Silver metal level, you pay 40% of medical expenses after your deductible is met. Your Summary of Benefits always shows how much you will pay. This, too, refreshes each year.

Out-of-Pocket Max – Insurance plans have an out-of-pocket max. This is a failsafe to help those with larger families, who visit the doctor regularly, or those with chronic medical conditions. When you meet your deductible, pay through your co-insurance, and reach your out-of-pocket max, your policy will pay 100 percent of medical expenses for that person on the policy. This continues for the remainder of the calendar year.

Primary Care Physician – Your Primary Care Physician is the main doctor you see for your medical care. Baylor Scott and White is an HMO and, in some locations, an EPO; you are required to coordinate all treatment through them.All BSW plans offer Pediatric Primary Care Physician visits with a zero-dollar copay.

Copay –Copays are fees doctors and facilities charge when you have an office visit. It is important to understand that this fee is for the visit alone and not for the treatment you receive. It can be a flat dollar amount or a co-insurance-like percentage and can vary by plan. Some treatments, like a well checkup can be included in your visit. See your medical plan for details.

Now that you know the basics of health insurance, let’s get into the plans Baylor Scott and White have to offer.

Baylor Scott and White and the Affordable Care Act

Baylor Scott and White offers health insurance plans in Texas as part of the Affordable Care Act. Their Bronze, Silver, and Gold plans are available on the Marketplace as well as on their website. You can view a full selection of their plans on their website.

Below we have listed a variety of plans that BSW offers. We have listed plans based on price, deductible, and co-insurance. To simplify our table, we have listed deductibles and out-of-pocket maximums as a fraction. The first number is the single person, and the second is the family. Also, keep in mind that these numbers reflect in-network doctors and facilities.

Baylor Scott and White Bronze

BSW Bronze has three plans, all offered on the Marketplace. Each has nearly the same deductible. One is a High Deductible Health Plan (HDHP) paired with a Health Saving Account (HSA). HDHPs have a lower premium and allow you to contribute those savings to a savings account for your medical needs as they arise. The downfall is you must pay out of pocket until you meet your deductible, but the more you contribute to your HSA, the more you have to use toward your medical expenses, and you can elect to have those funds deducted from your paycheck pretax.

Bronze	BSW Vital Bronze HMO 009	BSW Vital Bronze HMO 007	BSW Savers  HMO – HSA – 006
Deducible	$7600/$15,200	$7500/$15,000	$7500/$15,000
Co-insurance	30%	50%	0%
Out-of-Pocket Max	$9100/$18,200	$9000/$18,000	$7500/$15,000
Primary Care Visit	$35 copay	$50 copay	0%
Specialist Visit	$100 copay	$100 copay	0%
Emergency Room	30%	50%	0%
Urgent Care	$100 copay	$75 copay	0%
Inpatient Hospital	30%	50%	0%
Outpatient Hospital	30%	50%	0%
Prescription (Pharmacy)	$25/$55/$15/ $500*	$25/$50/$100/ $500*	0%

*Prescriptions are Generic, Preferred, Non-Preferred Brand. and Specialty

Baylor Scott and White Silver

BSW Silver has fourteen plans. Twelve are offered on the Affordable Care Act Marketplace. The plans sold at the Silver metal level offer premium tax credits. You can also qualify for cost-sharing reductions(CSR) if you live between 100% and 250% of the Federal Poverty Level (FPL). These plans have lower premiums and much lower out-of-pocket maximums.

Silver	BSW Prime Silver HMO – 003	BSW Prime Silver HMO – 008	BSW Prime Silver HMO – 005
Deducible	$5800/$11,600	$4800/$9600	$0/0
Co-insurance	40%	40%	0%
Out-of-Pocket Max	$8900/$17,800	$9100/$18,200	$9100/$18,200
Primary Care Visit	$40 copay	$30 copay	$45 copay
Specialist Visit	$80 copay	$70 copay	$85 copay
Emergency Room	40%	40%	$750
Urgent Care	$60 copay	$70 copay	$85 copay
Inpatient Hospital	40%	40%	$2000
Outpatient Hospital	40%	40%	$1000
Prescription (Pharmacy)	$20/$40/$80/ $350	$15/$90/$150/ $500*	$20/$100/$200/ $500*

*Prescriptions are Generic, Preferred, Non-Preferred Brand. and Specialty

Below are the CSR plans Baylor Scott and White offers through the Marketplace to those who qualify. Each plan level fits a different FPL bracket. You will notice these plans will have lower copays and out-of-pocket maximums.

Silver	BSW Prime Silver HMO – CSR 73 AV	BSW Prime Silver HMO – CSR 87 AV	BSW Prime Silver HMO – CSR 94 AV
FPL bracket	201% – 250%	151% – 200%	100% -105
Deducible	$5700/$11,400	$800/$1600	$0/0
Co-insurance	40%	30%	0%
Out-of-Pocket Max	$7,200/14,400	$3000/$3000	$1700/$3400
Primary Care Visit	$30 copay	$20 copay	$0 copay
Specialist Visit	$60 copay	$40 copay	$10 copay
Emergency Room	40%	30%	25%
Urgent Care	$45 copay	$30 copay	$5 copay
Inpatient Hospital	40%	30%	25%
Outpatient Hospital	40%	30%	25%
Prescription (Pharmacy)	$20/$40/$80/ $350	$10/$20/$60/ $250*	$0/$15/$50/ $150*

Baylor Scott and White Gold

Baylor Scott and White Gold has four plans, three are offered on the Marketplace. The other is offered through their website. Gold is the highest level of coverage. It generally provides the lowest deductibles, copays, and overall cost of insurance. However, with the level of insurance comes the price tag. Gold plans are best suited for those who visit the doctor frequently, have chronic medical conditions, or expect to require advanced medical care in the near future.

Another thing to note, when shopping for Gold plans, read the Summary of Benefits carefully. Many benefits do not kick in until after you meet your deductible. If you need assistance selecting a policy, contact Cover Mile. We would be glad to assist you with selecting the policy best suited for your family’s needs.

Gold	BSW Elite Gold HMO – 001	Blue Advantage HMO – 603	Blue Advantage Plus-203
Deducible	$2000/$4000	$750/$1500	$1500/$3000
Co-insurance	25%	25%	20%
Out-of-Pocket Max	$8700/$17,400	$9100/$18,200	$9100/$18,200
Primary Care Visit	$30 copay	$30 copay	$0 copay
Specialist Visit	$60 copay	$60 copay	$60 copay
Emergency Room	25%	$750 copay	$750 copay
Urgent Care	$45 copay	$60 copay	$60 copay
Inpatient Hospital	25%	$1500 copay	$500 copay
Outpatient Hospital	25%	$300 copay, 25% after deductible	20%
Prescription (Pharmacy)	$15/$50/$60/ $250*	$15/$55/$150/ $500*	$15/$55/$150/ $500*

*Prescriptions are Generic, Preferred, Non-Preferred Brand. and Specialty

Baylor Scott and White HMO/EPO for Central Texas

Baylor Scott and White has been known primarily as a North and somewhat Central Texas insurance provider. They have been steadily growing their reach south. This now includes Bexar County, which houses San Antonio; of course, Dallas County, the city’s namesake; and Travis County, where the state’s capital, Austin, resides. BSW has an HMO/EPO plan for these areas. The plan is identical except for the network.

Bronze	BSW Vital Bronze – HMO / EPO 001
Deducible	$7600/$15,200
Co-insurance	30%
Out-of-Pocket Max	$9100/$18,200
Primary Care Visit	$35 copay
Specialist Visit	$100 copay
Emergency Room	30%
Urgent Care	$100 copay
Inpatient Hospital	30%
Outpatient Hospital	30%
Prescription (Pharmacy)	$25/$55/$150/ $500*

Additional Coverages through Baylor Scott and White

Medicare Advantage

BSW also offers Medicare Advantage plans. BSW SeniorCare Advantage HMO. These plans area available to Central and North Texas residents. You can find out more through the links below:

Central: BSW SeniorCare Advantage HMO Central

North: BSW SeniorCare Advantage HMO North

STAR Medicaid

BSWs parent company is Scott and White Health. They offer STAR Medicaid and the CHIP program for low-income families, children and pregnant women for those in Central Texas. You can contact them directly for more information.

Finding a Doctor or Facility in Your Network

Baylor Scott and White is an HMO and an EPO. You are required to remain within the network of providers they are contracted with. However, in a medical emergency, you are able to see a provider outside the network. Also, with an HMO, you may seek treatment with a provider out-of-network if medically necessary and with BSW approval.

Baylor Scott and White allows you to search for doctors and facilities near you on their website. You can also determine the cost of treatment.

Baylor Scott and White Comparison Charts:

For a complete comprehensive list of Baylor Scott and White Affordable Care Act plans, follow the links below.

Comparison Chart	Plan	Plan
BSW Gold Plan	English	Spanish
BSW Silver Plan	English	Spanish
BSW Bronze Plan	English	Spanish

Benefit Notices:

Keep in mind that the above is a summary of highlights only.

—The benefits above represent what a member would pay. When a non-participating provider is used, benefits are reduced.

–You are required to pay costs up to your deductible before the plan pays its portion for covered services. What is shown is the per-person deductible and out-of-pocket maximum. Please see your plan for details.

 –All percentages shown are of the allowable amount for covered services.

 –Prescription drug payment level tiers: Generic, Preferred, Non-Preferred Brand. and Specialty

Prescription Coverage with Baylor Scott and White

With all Baylor Scott and White health plans, subscribers receive prescription coverage. You can search your prescription drug by plan. Then by name, class, and tier. Benefits plans have:

• Specialty Pharmacy Program – When you require specialty medication, to receive your maximum benefits, you must obtain your prescription from a Preferred Specialty Pharmacy provider.
• Mail Order Pharmacy – BSW offers two options for mail order pharmacy. Their own mail service, as well as OptumRx. Baylor Scott and White offer medications as low as $5.
• Drug Pricing Tool – By selecting the plan you are on, you can select your medication and find the general cost of your prescription.
• 90-day Supply – Depending on your drug benefit, you may be able to receive a 90-day supply of your prescription to save on your medication cost.

Baylor Scott and White can help you find a pharmacy in your area through its website.

At Cover Mile, we desire to assist you in finding the health insurance in Texas that best suits you and your family. We will take the time to talk you through each plan, help you understand each Baylor Scott and White plan, and help you sign up for Affordable Care Act insurance. Contact us today.