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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 $228.00. 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 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 the pharmacy you use. For example, you can expect to pay a $7 copay for preferred generic drugs at a preferred pharmacy. After your total drug costs reach $2,000, 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 will be $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 find coverage for inpatient hospital stays with a $125 copay for the first week, and no copay after that. Outpatient services, emergency services, and primary care services are also covered, with copays ranging from $0 to $200 depending on the service. This plan includes coverage for preventive services, hearing, vision, and dental services. It covers hearing exams, and offers up to $600 for hearing aids every three years. Vision includes eye exams and a $150 annual benefit for eyewear, and dental services are covered up to $1,500 per year.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $125 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. Inpatient Hospital Psychiatric has the same cost sharing as Inpatient Hospital-Acute, but additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $200 copay, observation services, and ambulatory surgical center services with no copay. Individual and group outpatient substance abuse sessions have a $20 copay, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for all ambulance services, with a $250 copay for both ground and air ambulance services, with no coinsurance. Transportation Services - Any Health-related Location is covered for one round trip per year via medical transport.
Emergency Services See details
Emergency Services are covered, including worldwide emergency services, with a $125 copay for emergency services and worldwide emergency coverage, a $35 copay for urgently needed services and worldwide urgent coverage, and a $250 copay for worldwide emergency transportation. There is no coinsurance for any of 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, physician specialist services with a $20 copay, mental health specialty services with a $20 copay for individual and group sessions, other health care professional services, psychiatric services with a $20 copay for individual and group sessions, 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 a variety of preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services. Additional preventive services may have a copay, and the plan also covers health education, Personal Emergency Response Systems (PERS) with no copay, nutritional/dietary benefits for up to 6 visits, additional smoking cessation counseling, fitness benefits, remote access technologies, Home and Bathroom Safety Devices and Modifications up to $100 per year, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams with no copay, and prescription hearing aids with a maximum benefit of $600 every three years, while OTC hearing aids, and prescription hearing aids for the inner, outer, and over the ear are not covered. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is covered once every three years.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$20, and routine eye exams once per year. Eyewear has a combined maximum benefit of $150 per year, and contact lenses are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The BCN Advantage HMO-POS Prestige (HMO-POS) plan covers dental services with a maximum benefit of $1,500 per year. Oral exams are covered with no copay, and Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery are also 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 and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
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 is covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan, with no copay for Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0-20%, Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. 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 by BCN Advantage HMO-POS Prestige (HMO-POS). 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 by the BCN Advantage HMO-POS Prestige (HMO-POS) plan. There is no copay or coinsurance for this benefit, but authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan, however, Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
Other Services include coverage for over-the-counter items, with a maximum benefit of $90 every three months, and a meal benefit for chronic illnesses. Acupuncture and several other services are not covered.
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