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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 $237.00. 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. For example, preferred generic drugs have a $7 copay at preferred pharmacies. Once 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 Part D premium could be reduced to $8.10.
Additional Benefits
The BCN Advantage HMO-POS Prestige (HMO-POS) plan offers a wide range of benefits with varying cost-sharing. You'll have a $125 copay for inpatient hospital stays, and $250 for ground ambulance services. The plan also covers outpatient services, primary care, preventive services, hearing, vision, dental, and home health services. This plan includes additional benefits like coverage for hearing aids, eyewear, and a quarterly allowance for over-the-counter items. It also covers services such as cardiac rehabilitation, and skilled nursing facilities, with specific copays and prior authorization requirements.
Inpatient Hospital See details
Inpatient Hospital benefits are covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $125 copay for days 1-7 and no copay for days 8-90, while additional days are covered with no copay. Inpatient Hospital Psychiatric has the same cost-sharing structure as Inpatient Hospital-Acute. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a $200 copay, and outpatient substance abuse services, with a $20 copay for both individual and group sessions. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including Medicare-covered ground and air ambulance services with a $250 copay, and transportation services to any health-related location with one round trip per year. Transportation Services - 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 HMO-POS Prestige (HMO-POS) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $0-$35 copay, and Worldwide Emergency Services has a $125-$250 copay depending on the service.
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, and mental health specialty services with a $20 copay for individual and group sessions. The plan also covers other healthcare professional services with a copay between $0 and $20, psychiatric services, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The BCN Advantage HMO-POS Prestige (HMO-POS) plan covers preventive services, including an annual physical exam, with no copay or coinsurance. Additional preventive services are covered, including Health Education, Personal Emergency Response System (PERS) with no copay, Nutritional/Dietary Benefit (up to 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. However, 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, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 every three years). Prescription hearing aids are covered, with a maximum benefit of $600 every three years, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered.
Vision Services See details
Vision Services include eye exams with a copay of $0 - $20, and routine eye exams are covered once per year. Eyewear is covered with a combined maximum benefit of $150 per year, while contact lenses and eyeglass lenses are covered, and eyeglass frames are covered with a limit of one per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The BCN Advantage HMO-POS Prestige (HMO-POS) plan covers Medicare and other dental services, including oral exams, dental x-rays, cleaning, fluoride treatment, and some restorative services with varying copays, visit limits, and maximums. Oral exams are covered with no copay for 2 visits per year, while dental x-rays are covered once every two years. The plan also covers endodontics, periodontics, and oral and maxillofacial surgery, each with specific limitations on visit frequency and other restrictions. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BCN Advantage HMO-POS Prestige (HMO-POS) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance, Prosthetics/Medical Supplies with coinsurance for Medicare-covered devices and 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 include coverage for all diagnostic services and radiological services with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $10, while Diagnostic Radiological Services have a copay of at most $50, and Outpatient X-Ray Services have a $10 copay. Lab Services and Therapeutic Radiological Services are not covered.
Home Health Services See details
Home Health Services are covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan with no copay and no coinsurance, but prior authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BCN Advantage HMO-POS Prestige (HMO-POS) plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $90 every three months. The plan also covers a Meal Benefit for chronic illnesses, and Other 1 services including Mobile Mental Health with a $20 copay. Acupuncture, Dual Eligible SNPs, 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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