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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 $240.00. 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 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail order services, while standard pharmacies charge a $5 copay for a 1-month supply. Tier 2 generic drugs cost a $7 copay for a 1-month supply and have no copay for a 3-month supply at preferred locations, compared to a $12 monthly copay at standard locations. For higher-tier medications, costs transition to coinsurance across all pharmacy options. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for both 1-month and 3-month supplies. Specialty drugs in Tier 5 are subject to a 33% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The BCN Advantage Prestige (HMO-POS) plan offers comprehensive coverage with many essential services featuring no copay and no coinsurance, including primary care visits, preventive care, and home health services. Routine hearing and dental care are also highly accessible, featuring no copay for annual exams and dental cleanings up to a $1,500 limit. For routine vision, members can expect low copays and an eyewear allowance of up to $150 with no coinsurance. When it comes to specialized care, members pay predictable flat fees with no coinsurance, such as a $10 to $25 copay for specialists and a $130 copay for emergency services. Inpatient hospital stays require a $200 daily copay for the first seven days, while skilled nursing facilities offer the first 20 days with no copay. Certain specialized needs, such as dialysis and durable medical equipment, require no copay but carry a coinsurance of up to 20 percent.
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. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BCN Advantage Prestige (HMO-POS) covers outpatient services with no coinsurance, featuring a $200 copay for outpatient hospital services and a $130 copay per stay for observation services. Outpatient substance abuse individual and group sessions require a $25 copay, while ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the BCN Advantage Prestige (HMO-POS) plan 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. For transportation, some services are covered but 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 (waived if admitted within 3 days) and urgently needed services with no copay to a $35 copay, both with no coinsurance. Worldwide emergency services are also covered up to a $50,000 maximum with no coinsurance, carrying copays of $130 for emergency care, $35 for urgent care, and $250 for emergency transportation.
Primary Care See details
BCN Advantage Prestige (HMO-POS) provides partially covered primary care services with no coinsurance, featuring no copay for primary care doctor visits, telehealth, and opioid treatment, alongside copays ranging from $10 to $25 for specialists, chiropractic, and therapy services. Podiatry services are not covered under this plan.
Preventive Services See details
BCN Advantage Prestige (HMO-POS) covers preventive services with no copay and no coinsurance, including annual physicals, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered under the plan, but specific sub-services such as health education, weight management, alternative therapies, and in-home support are not covered.
Hearing Services See details
Hearing services under BCN Advantage Prestige (HMO-POS) are partially covered, providing one routine hearing exam annually and unlimited fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $495.00 and $1,695.00, though over-the-counter (OTC) hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Vision Services are partially covered by BCN Advantage Prestige (HMO-POS), offering routine eye exams with a $0 to $25 copay and no coinsurance, while other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 annual maximum for contact lenses, frames, and lenses, but upgrades and combined eyeglasses are not covered.
Dental Services See details
BCN Advantage Prestige (HMO-POS) partially covers dental services up to a $1,500 annual limit, featuring no copay and no coinsurance for most preventive and comprehensive care, while Medicare-covered dental services require a $0 to $200 copay and no coinsurance. Sub-services that are not covered under this plan include other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
BCN Advantage Prestige (HMO-POS) covers home infusion bundled services with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by BCN Advantage Prestige (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
BCN Advantage Prestige (HMO-POS) partially covers medical equipment with no copays, though prior authorization is required for these benefits. Covered durable medical equipment and diabetic supplies have no coinsurance to 20% coinsurance, and prosthetics and medical supplies require a 20% coinsurance, while diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
BCN Advantage Prestige (HMO-POS) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required for these services. Covered diagnostic procedures and tests have a copay ranging from no copay to $10, and outpatient X-rays and diagnostic radiological services require a $10 copay, while lab services and therapeutic radiological services are not covered.
Home Health Services See details
Home health services are covered by the BCN Advantage Prestige (HMO-POS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by BCN Advantage Prestige (HMO-POS) with no coinsurance and prior authorization required, although only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered and require copayments 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 inpatient hospital stay. There is 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 under BCN Advantage Prestige (HMO-POS) are partially covered, with acupuncture excluded from coverage. Covered benefits include over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, mobile mental health services with a $20 copay and no coinsurance, and ambulance no-transport services with a $90 copay and no coinsurance.
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