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BCN Advantage HMO-POS Prestige (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage HMO-POS 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 HMO-POS Prestige (HMO-POS) in 2025, please refer to our full plan details page.
BCN Advantage HMO-POS 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 2025.
It's important to know that BCN Advantage HMO-POS 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 HMO-POS 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 HMO-POS Prestige (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $174.00. 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 $3400.00 (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 $3400.00 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 Prestige (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $7 copay at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, your monthly premium is $8.10.
Additional Benefits
The BCN Advantage HMO-POS Prestige (HMO-POS) plan offers a variety of benefits, including coverage for inpatient hospital stays with a $125 copay for the first seven days, and outpatient services with copays ranging from $0 to $200. The plan also covers primary care, preventive, hearing, vision, and dental services, each with varying copays and coverage limits. Additional benefits include ambulance services with a $250 copay, emergency services, and home health services with no copay. This plan also includes coverage for diagnostic and radiological services, and skilled nursing facility (SNF) services with a copay after the first 20 days. The plan also offers coverage for home infusion and dialysis services, as well as medical equipment, with varying coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the BCN Advantage HMO-POS Prestige (HMO-POS) plan, with a $125 copay for days 1-7 and no copay for days 8-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $200 copay, observation services, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay between $20 and $20, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground and air ambulance services, each with a $250 copay, and transportation services to any health-related location, limited to one round trip per year. Transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $35, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage, $35 for Worldwide Urgent Coverage, and $250 for Worldwide Emergency Transportation. There is no coinsurance for these services.
Primary Care See details
The BCN Advantage HMO-POS Prestige (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $15 copay, physician specialist services with a $20 copay, mental health specialty services with a $20 copay, other health care professional services with a copay between $0 and $20, psychiatric services with a $20 copay, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits, and opioid treatment program services. Routine Chiropractic Care has a $20 copay for up to 3 visits per year, and other chiropractic services have a $10 copay for up to 1 visit per year.
Preventive Services See details
The BCN Advantage HMO-POS Prestige (HMO-POS) plan covers preventive services, including an annual physical exam with no copay, as well as additional preventive services, with a copay for Personal Emergency Response System (PERS). The plan also covers health education, nutritional/dietary benefits (6 visits), additional sessions of smoking and tobacco cessation counseling, fitness benefits, 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, 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 hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered up to a maximum of $600 every three years, but prescription hearing aids for the inner, outer, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a copay of $0-$20, routine eye exams once per year, contact lenses with no limit, eyeglass lenses once per year, and eyeglass frames once per year with a combined maximum benefit of $150 per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $1,500 per year. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, and oral and maxillofacial surgery are covered with varying limitations, while maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B insulin drugs, there is a $35 copay and coinsurance between 0-20%. 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 Prestige (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment 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 and Therapeutic Radiological Services are not covered. Diagnostic Procedures/Tests have a copay between $0 and $10, while Diagnostic Radiological Services have a copay up to $50 and Outpatient X-Ray Services have a $10 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization, with 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 SNF stays are not covered.
Other Services See details
The BCN Advantage HMO-POS Prestige (HMO-POS) plan's "Other Services" benefit covers over-the-counter items with a maximum benefit of $90 every three months, meal benefits for chronic illnesses, and mobile mental health services with a $20 copay. 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.
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