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Baylor Scott & White Health Plan Medicare Advantage 2024 Review
Baylor Scott & White has happy members, but its Medicare Advantage plans are only available in parts of Texas.
Alex Rosenberg Lead Writer | Medicare, health care, legislation
Alex Rosenberg is a NerdWallet writer focusing on Medicare and information technology. He has more than 10 years of experience researching and writing about health care, insurance, technology, data privacy and public policy. His research has supported lawmakers in the Wisconsin State Legislature as well as health systems and national health authorities in the U.S. and more than 10 other countries. He is based in Stoughton, Wisconsin.
Holly Carey joined NerdWallet in 2021 as an editor on the team responsible for expanding content to additional topics within personal finance. She currently leads the Medicare team. Previously, Holly wrote and edited content and developed digital media strategies as a public affairs officer for the U.S. Navy. She is based in Virginia Beach, Virginia.
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Baylor Scott & White Health Plan
3.96
CMS Star RatingAverage Medicare star rating, weighted by enrollment. Star ratings are determined by the Centers for Medicare & Medicaid Services (CMS).
Baylor Scott & White Health Plan sells Medicare Advantage plans in 47 Texas counties. It has great member experience scores and average overall quality ratings from CMS.
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
High (90% or more)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
4.18 (Above average)
Pros
Strong ratings for member experience.
Some plans offer $0 generic drugs and an allowance for over-the-counter pharmacy items.
Cons
Fewer $0-premium plans than many competitors.
Available only in Texas.
States available
1 state
Members in high-rated plansPercentage of members who are in rated contracts with a Medicare star rating of 4 or higher.
High (90% or more)
Member experienceThe average of CMS' star ratings for quality measures in the domain "Member Experience with the Health Plan," weighted by contract enrollment.
4.18 (Above average)
Pros
Strong ratings for member experience.
Some plans offer $0 generic drugs and an allowance for over-the-counter pharmacy items.
Cons
Fewer $0-premium plans than many competitors.
Available only in Texas.
Baylor Scott & White Health Plan Medicare Advantage plans are available in 47 Texas counties. The company excels on measures of member experience, and its overall quality ratings are about average.
Here’s what you should know about Baylor Scott & White Health Plan Medicare Advantage.
Baylor Scott & White Medicare Advantage pros and cons
Baylor Scott & White’s Medicare Advantage plans have advantages and disadvantages.
Pros
Member experience: Baylor Scott & White Health Plan gets great member experience ratings on metrics including customer service and care coordination.
Pharmacy benefits: Baylor Scott & White Health Plan advertises $0 generic prescriptions and a card that covers $30-$75 per quarter for over-the-counter items.
Cons
Fewer $0-premium options: Baylor Scott & White Health Plan has fewer $0-premium plans than major Medicare Advantage companies.
Limited availability: Baylor Scott & White plans are available only in 47 of the 254 counties in Texas.
The Centers for Medicare & Medicaid Services’ (CMS) annual star ratings rank Medicare plans from best (5 stars) to worst (1 star). The agency’s ratings are based on data measuring plans’ quality of care and customer satisfaction.
Based on the most recent year of data and weighted by enrollment, Baylor Scott & White Health Plan’s 2024 Medicare Advantage plans get an average overall rating of 3.96 stars
Even as a Medicare Advantage user, you’ll still be responsible for paying your Medicare Part B premium, which is $174.70 per month in 2024, although some plans cover part or all of this cost
Requirements for copays, coinsurance and deductibles vary depending on your plan, location and the services you use. Other out-of-pocket costs to consider include:
Whether the plan covers any part of your monthly Medicare Part B premium.
The plan’s yearly deductibles and any other deductibles, such as a drug deductible.
Copayments and/or coinsurance for each visit or service. For instance, there may be a $10 copay for seeing your primary doctor and a $45 copay for seeing a specialist.
The plan’s in-network and out-of-network out-of-pocket maximums.
Whether your medical providers are in-network or out-of-network, or how often you may go out-of-network for care.
Whether you require extra benefits, and whether the plan charges for them.
To get a sense of costs, use Medicare’s plan finding tool to compare information among available plans in your area. You can select by insurance carrier to see only Baylor Scott & White plans or compare across carriers.
Baylor Scott & White Medicare Advantage plan types
There are several kinds of Baylor Scott & White Medicare Advantage plans, and they vary in structure, costs and benefits. About 65% of Baylor Scott & White Medicare Advantage plans include prescription drug coverage.
Plan offerings include the following types:
HMO plans
A health maintenance organization (HMO) generally requires that you use a specific network of doctors and hospitals. You may need a referral from your primary doctor in order to see a specialist, and out-of-network benefits are usually very limited.
HMO-POS plans
HMO point of service (POS) plans are HMO plans that allow members to get some out-of-network services, but they’ll pay more for those services.
PPO plans
Preferred provider organization (PPO) plans provide the most freedom, allowing you to see any provider that accepts the insurance. You may not need to choose a primary doctor, and you don’t need referrals to see specialists. You can seek out-of-network care, although it may cost more than seeing an in-network doctor.
Baylor Scott & White Medicare Advantage service area
Baylor Scott & White Health Plan offers Medicare Advantage plans in 47 counties in Texas. The company covers about 30,000 Medicare Advantage beneficiaries
Get more information below about some of the major Medicare Advantage providers. These insurers offer plans in most states. The plans you can choose from will depend on your ZIP code and county.
What are the plan’s costs? Do you understand what the plan’s premium, deductibles, copays and/or coinsurance will be? Can you afford them?
Is your doctor in-network? If you have a preferred medical provider or providers, make sure they participate in the plan’s network.
Are your prescriptions covered? If you’re on medication, it’s crucial to understand how the plan covers it. What tier are your prescription drugs on, and are there any coverage rules that apply to them?
Is there dental coverage? Does the plan offer routine coverage for vision, dental and hearing needs?
Are there extras? Does the plan offer any extra benefits, such as fitness memberships, transportation benefits or meal delivery?
If you have additional questions about Medicare, visit Medicare.gov or call 800-MEDICARE (800-633-4227, TTY 877-486-2048).
