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BCN Advantage Prestige (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage Prestige (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 Prestige (HMO-POS) in 2026, please refer to our full plan details page.
BCN Advantage Prestige (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 2026.
It's important to know that BCN Advantage Prestige (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 Prestige (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 Prestige (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $178.00. 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 $4000.00 (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 $4000.00 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 Prestige (HMO-POS) plan features a $0 prescription drug deductible, meaning your coverage begins immediately with no upfront drug deductible to meet. Tier 1 preferred generic drugs have no copay for a 1-month or 3-month supply when filled at preferred pharmacies or through preferred mail order. Tier 2 generic drugs cost a $7 copay for a 1-month supply, and you will pay no copay for a 3-month supply at preferred locations. Higher-tier medications require coinsurance instead of flat copays, regardless of whether you use a preferred or standard pharmacy. Tier 3 preferred brand drugs require 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance. Tier 5 specialty drugs are covered with a 33% coinsurance for a 1-month supply across all pharmacy and mail-order networks.
Additional Benefits
The BCN Advantage Prestige (HMO-POS) plan offers comprehensive healthcare coverage with many essential services requiring no copayments or coinsurance. Members enjoy no copays for primary care visits, routine preventive services, home health care, and the first 20 days of a skilled nursing facility stay. For inpatient hospital stays, emergency room visits, and outpatient hospital care, patients will pay predictable flat copays with no coinsurance. This plan also features robust dental, vision, and hearing benefits, providing routine exams and preventive dental care with no copay up to specified annual limits. Additionally, diagnostic services and medical equipment are covered with low copays or coinsurance ranging up to 20 percent. While certain specialty care and equipment require prior authorization, the plan minimizes overall out-of-pocket costs by eliminating coinsurance on the majority of its covered benefits.
Inpatient Hospital See details
BCN Advantage Prestige (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $200 daily copay for days 1 through 7 and no copay for days 8 through 90. While unlimited additional acute hospital days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BCN Advantage Prestige (HMO-POS) covers outpatient hospital services with a $200 copay and observation services with a $130 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse individual and group sessions require a $25 copay and no coinsurance.
Partial Hospitalization See details
BCN Advantage Prestige (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
BCN Advantage Prestige (HMO-POS) covers Medicare-approved ground and air ambulance services with a $250 copay and no coinsurance per service. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
BCN Advantage Prestige (HMO-POS) covers emergency services with a $130 copay, which is waived if you are admitted to the hospital within three days, and no coinsurance. Urgently needed services feature no copay to a $35 copay with no coinsurance, while worldwide emergency services are covered up to a $50,000 maximum with no coinsurance and copays ranging from $35 to $250.
Primary Care See details
BCN Advantage Prestige (HMO-POS) partially covers primary care benefits, offering primary care physician visits, telehealth, and opioid treatment with no copay and no coinsurance, while podiatry services are not covered. Other covered services, including specialists, mental health, chiropractic, and therapies, require copays ranging from $10 to $25 with no coinsurance.
Preventive Services See details
Preventive services are covered by BCN Advantage Prestige (HMO-POS) with no copay and no coinsurance for services such as annual physicals, kidney disease education, and diabetes self-management training. However, additional preventive benefits are only partially covered, excluding health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety modifications, and counseling.
Hearing Services See details
BCN Advantage Prestige (HMO-POS) covers hearing services, offering one routine hearing exam per year and unlimited fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $495 to $1,695 for up to two aids per year, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
BCN Advantage Prestige (HMO-POS) provides partially covered vision services, including routine eye exams with a $0 to $25 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, such as contact lenses, eyeglass lenses, and frames, has no copay or coinsurance up to a $150 annual limit, but upgrades and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
BCN Advantage Prestige (HMO-POS) dental services are partially covered, offering no copay and no coinsurance for preventive and comprehensive care up to a $1,500 annual limit, while Medicare-covered dental has a $0 to $200 copay and no coinsurance. Covered services include exams, cleanings, x-rays, fillings, and root canals, but other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
BCN Advantage Prestige (HMO-POS) covers home infusion bundled services with no copay, although Part D home infusion drugs are not covered as a mandatory supplemental benefit. Associated Medicare Part B drugs, including chemotherapy, require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the BCN Advantage Prestige (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by BCN Advantage Prestige (HMO-POS) with no copay and coinsurance ranging from no coinsurance to 20%, though diabetic therapeutic shoes and inserts are not covered. Prior authorization is required for durable medical equipment, prosthetics, and diabetic supplies, which may also be limited to preferred vendors and manufacturers.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by BCN Advantage Prestige (HMO-POS) with no coinsurance, though prior authorization is required. Covered diagnostic procedures and tests range from no copay to a $10 copay, and outpatient X-rays and diagnostic radiological services carry a $10 copay, while lab services and therapeutic radiological services are not covered.
Home Health Services See details
Home Health Services are covered under the BCN Advantage Prestige (HMO-POS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
BCN Advantage Prestige (HMO-POS) covers Cardiac Rehabilitation Services with no coinsurance and required prior authorization. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require copays ranging from $10 to $15.
Skilled Nursing Facility (SNF) See details
BCN Advantage Prestige (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Patients pay no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by BCN Advantage Prestige (HMO-POS), with acupuncture not covered under the plan. Covered benefits include over-the-counter items and meals for chronic illness with no copay and no coinsurance, mobile mental health services for a $20 copay and no coinsurance, and ambulance services with no transport for a $90 copay and no coinsurance.
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