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BCN Advantage Elements (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage Elements (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BCN Advantage Elements (HMO-POS) in 2025, please refer to our full plan details page.
BCN Advantage Elements (HMO-POS) is a HMO-POS plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2025 to people living in Michigan. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BCN Advantage Elements (HMO-POS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BCN Advantage Elements (HMO-POS).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For BCN Advantage Elements (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $20.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $4500.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $4500.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
Prescription drugs are not covered by BCN Advantage Elements (HMO-POS).
Additional Benefits
The BCN Advantage Elements (HMO-POS) plan provides comprehensive coverage for various healthcare needs. It covers inpatient hospital stays with a copay, outpatient services with copays, and offers additional benefits like ambulance services, emergency care, and both primary and specialty care visits with varying copays. Preventive services, hearing, vision, and dental services are also included, often with copays, maximum benefit amounts, or other limitations. The plan also covers home health services and skilled nursing facility stays, with specific cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered. For inpatient hospital acute and psychiatric care, you pay a $205 copay for days 1-7, and no copay for days 8-90; additional days for inpatient hospital acute care are covered with no copay.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $200 copay, observation services, and outpatient substance abuse services with a $35 copay for both individual and group sessions. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services are covered, including services not usually covered by Medicare plans.
Partial Hospitalization See details
Partial Hospitalization is covered by the BCN Advantage Elements (HMO-POS) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BCN Advantage Elements (HMO-POS) plan. Ground and air ambulance services have a $300 copay, with no coinsurance, while transportation services to any health-related location are covered for one round trip per year with no copay or coinsurance. Transportation services to a plan-approved health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BCN Advantage Elements (HMO-POS) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a copay between $0-$45 with no coinsurance, and Worldwide Emergency Services have a $125-$300 copay with no coinsurance, depending on the specific service.
Primary Care See details
BCN Advantage Elements (HMO-POS) covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services with a $35 copay, mental health specialty services with a $20 copay, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The BCN Advantage Elements (HMO-POS) plan covers various preventive services, including annual physical exams and additional preventive services, with no copay or coinsurance. The plan also covers Health Education, Nutritional/Dietary Benefit (6 visits), Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications (up to $100 per year), Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with a copay between $0 and $35, and fitting/evaluation for hearing aids, with one visit every three years. Prescription hearing aids (all types) are covered, up to a maximum of $600 every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
The BCN Advantage Elements (HMO-POS) plan covers vision services, including eye exams with a copay between $0 and $35, and eyewear with a $150 maximum benefit every year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a copay of $0-$200, and Other Dental Services with an annual maximum of $1,500. Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, and Oral and Maxillofacial Surgery are covered with varying limitations. Orthodontic Services, Restorative Services, Endodontics, Periodontics, are also covered. Maxillofacial Prosthetics and Orthodontics are not covered, and Prosthodontics (removable and fixed), and Implant Services are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%. Other Medicare Part B drugs, and Medicare Part B Chemotherapy/Radiation Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BCN Advantage Elements (HMO-POS) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and Prosthetics/Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. The plan also covers Diabetic Equipment.
Diagnostic and Radiological Services See details
The BCN Advantage Elements (HMO-POS) plan covers diagnostic and radiological services, but lab services are not covered. Diagnostic Procedures/Tests have a copay between $0 and $20, Diagnostic Radiological Services have a copay of up to $100 with a minimum copay of $20, Therapeutic Radiological Services have a copay of up to $25 with a minimum copay of $25, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the BCN Advantage Elements (HMO-POS) plan with no copay or coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but specific services including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. The plan has a copay for some cardiac and pulmonary rehabilitation services, but the specific copay information is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BCN Advantage Elements (HMO-POS) plan. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The BCN Advantage Elements (HMO-POS) plan covers Over-the-Counter (OTC) items with a maximum benefit of $50.00 every three months, and Mobile Mental Health with a $20 copay; however, acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered. The plan also covers a meal benefit for a chronic illness.
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