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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 $225.00. 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 offers prescription drug coverage with no drug deductible, allowing your benefits to kick in immediately. For Tier 1 preferred generic drugs, there is no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail order. Tier 2 generic drugs cost a $7 copay for a 1-month supply at preferred locations, and there is no copay if you opt for a 3-month supply. For brand-name and specialty medications, your costs are structured as coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 25% coinsurance. Specialty drugs under Tier 5 require a 33% coinsurance for a 1-month supply at both standard and preferred pharmacies.
Additional Benefits
BCN Advantage Prestige (HMO-POS) offers comprehensive medical coverage with no copay for primary care visits, telehealth, and home health services. Inpatient hospital stays require a $200 daily copay for the first seven days and no copay for days 8 through 90, with no coinsurance. Emergency room visits carry a $130 copay, while specialist and outpatient services are covered with low to moderate copays and no coinsurance. The plan also features valuable dental, vision, and hearing benefits, including routine hearing exams and preventive dental care with no copay. Members receive up to a $1,500 annual maximum for covered dental services and a $150 eyewear allowance with no copay or coinsurance. Skilled nursing facility stays require no copay for the first 20 days, and medical equipment is available with no copay and coinsurance ranging from zero to 20 percent.
Inpatient Hospital See details
BCN Advantage Prestige (HMO-POS) covers inpatient hospital services with no coinsurance and a copay of $200 per day for days 1 through 7, with no copay for days 8 through 90. While unlimited additional acute care days are covered with no copay, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BCN Advantage Prestige (HMO-POS) outpatient services are covered with no coinsurance, including a $200 copay for outpatient hospital services and a $130 copay per stay for observation services. Ambulatory surgical center and outpatient blood services require no copay, while individual and group outpatient substance abuse sessions have a $25 copay.
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 certain services under this benefit.
Ambulance and Transportation Services See details
BCN Advantage Prestige (HMO-POS) covers ground and air ambulance services with a $250 copay and no coinsurance, and this copayment is not waived upon hospital admission. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services are covered by BCN Advantage Prestige (HMO-POS) with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require no copay to a $35 copay with no coinsurance, and worldwide emergency services are covered up to $50,000 with no coinsurance and copays ranging from $35 to $250.
Primary Care See details
BCN Advantage Prestige (HMO-POS) covers primary care physician visits, telehealth, and opioid treatment with no copay and no coinsurance, although podiatry services are not covered. Other covered benefits feature no coinsurance, including specialist and therapy visits for a $25 copay, mental health and psychiatric sessions for a $20 copay, and chiropractic care with copays ranging from $10 to $25.
Preventive Services See details
BCN Advantage Prestige (HMO-POS) provides partially covered preventive services with no copay and no coinsurance for covered benefits like annual physical exams, kidney disease education, and select fitness and nutritional benefits. However, several additional services are not covered under this plan, including health education, in-home safety assessments, medical nutrition therapy, weight management programs, alternative therapies, and counseling services.
Hearing Services See details
BCN Advantage Prestige (HMO-POS) hearing services are partially covered, offering one annual routine exam and unlimited fitting evaluations with no copay, no coinsurance, and no deductible. Prescription hearing aids are covered with no coinsurance and copays ranging from $495 to $1,695, but OTC hearing aids and inner ear, outer ear, or over-the-ear prescription models are not covered.
Vision Services See details
BCN Advantage Prestige (HMO-POS) provides partially covered vision services with no deductibles, featuring annual 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, standard lenses, and frames, though upgrades and packaged eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services under BCN Advantage Prestige (HMO-POS) are partially covered, offering preventive and comprehensive care up to a $1,500 annual maximum with no copay and no coinsurance, while Medicare-covered dental carries 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, although prior authorization and step therapy are required. Associated Medicare Part B drugs, including chemotherapy and radiation, incur a coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and up 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) provides partially covered medical equipment with no copays, though prior authorization is required for these services. Covered durable medical equipment and diabetic supplies range from no coinsurance to 20% coinsurance, and prosthetics and medical supplies carry 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. Diagnostic procedures and tests range from no copay to a $10 copay, outpatient X-rays require a $10 copay, and diagnostic radiological services have a minimum $10 copay, while lab services and therapeutic radiological services are not covered.
Home Health Services See details
BCN Advantage Prestige (HMO-POS) covers Home Health Services 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, although prior authorization is required. While some services are covered, standard cardiac rehabilitation (with a $15 copay), intensive cardiac rehabilitation (with a $15 copay), pulmonary rehabilitation (with a $10 copay), and supervised exercise therapy for peripheral artery disease (with a $15 copay) are not covered.
Skilled Nursing Facility (SNF) See details
BCN Advantage Prestige (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization and allowing admission without a prior three-day 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
BCN Advantage Prestige (HMO-POS) partially covers other services, offering over-the-counter items and meal benefits for chronic illnesses with no copay and no coinsurance. Non-Medicare-covered mobile mental health services require a $20 copay and ambulance services with no transport require a $90 copay, both with no coinsurance, while acupuncture is not covered.
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