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BCN Advantage HMO-POS Classic (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage HMO-POS Classic (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 HMO-POS Classic (HMO-POS) in 2025, please refer to our full plan details page.
BCN Advantage HMO-POS Classic (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 HMO-POS Classic (HMO-POS) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BCN Advantage HMO-POS Classic (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 HMO-POS Classic (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $95.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $3800.00 (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 $3800.00 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
The BCN Advantage HMO-POS Classic (HMO-POS) plan has an enhanced alternative drug benefit with no deductible. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $7 copay at preferred pharmacies, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The BCN Advantage HMO-POS Classic (HMO-POS) plan offers a variety of benefits, including inpatient and outpatient hospital services with copays, and emergency services with copays. This plan also includes coverage for primary care, preventive services, hearing, vision, dental, and home health services, with varying copays and maximum benefits for each service. Additional benefits include ambulance services, partial hospitalization, and home infusion services, with specific copays and prior authorization requirements. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility services, with different cost-sharing structures.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care, with a $225 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a $225 copay, observation services, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient substance abuse services, and outpatient blood services are also covered, with individual and group sessions for outpatient substance abuse having a $30 copay, and outpatient blood services including an enhanced benefit.
Partial Hospitalization See details
Partial Hospitalization is covered by the BCN Advantage HMO-POS Classic (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 HMO-POS Classic (HMO-POS) plan. Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance. Transportation Services to any health-related location are covered for one round trip per year.
Emergency Services See details
Emergency Services are covered, with a $125 copay and no coinsurance. Urgently Needed Services are covered, with a copay between $0 and $40 and no coinsurance. Worldwide Emergency Services are covered, with a $125 copay for Worldwide Emergency Coverage, a $40 copay for Worldwide Urgent Coverage, and a $250 copay for Worldwide Emergency Transportation; there is a maximum plan benefit of $50,000.
Primary Care See details
Primary Care services include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services have a $15 copay, Routine Chiropractic Care has a $30 copay, and Other Chiropractic Services have a $20 copay. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services, and Physician Specialist Services each have a $30 copay, while Individual and Group Sessions for Mental Health and Psychiatric Services have a $20 copay. Other Health Care Professional services have a copay between $0 and $30.
Preventive Services See details
Preventive services include coverage for Medicare-covered services with no copay, annual physical exams, additional preventive services, health education, Personal Emergency Response System (PERS) with no copay, Nutritional/Dietary benefit with 6 visits, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications up to $100 every 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, 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 includes coverage for hearing exams with no copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $600 every three years, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The BCN Advantage HMO-POS Classic (HMO-POS) plan covers routine eye exams with a copay between $0 and $30, and eyewear with a combined maximum benefit of $150 every year. Contact lenses, eyeglass lenses, and eyeglass frames are also covered, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1,500 per year. Medicare Dental Services have a copay between $0 and $225, while Oral Exams are limited to two visits per year. Other dental services such as Oral and Maxillofacial Surgery, Restorative Services, Endodontics, and Periodontics are covered, with specific limitations on the number of visits or services covered. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis services are covered by the BCN Advantage HMO-POS Classic (HMO-POS) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, and Prosthetics/Medical Supplies with no copay and 20% coinsurance; however, DME for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, but Lab Services are not. Diagnostic Procedures/Tests have a copay between $0 and $20, Diagnostic Radiological Services have a copay up to $75, Therapeutic Radiological Services have a copay up to $15, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the BCN Advantage HMO-POS Classic (HMO-POS) plan with no copay or coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services are not covered. There is a copay for some services, but the specific copay amount is not detailed in the provided information.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, and there is no copay for days 1-20, and a $214 copay per day for days 21-100. Additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $65 every three months, and for meals for a chronic illness, but acupuncture, 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, 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. Other services, including Mobile Mental Health and Ambulance No Transport, have a copay of $20 and $90, respectively.
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