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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 $267.00. 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 drug coverage begins immediately with no upfront deductible to meet. For Tier 1 preferred generic drugs, you will pay no copay for both 1-month and 3-month supplies when using preferred pharmacies or preferred mail-order services. Tier 2 generic drugs are also highly affordable, costing a $7 copay for a 1-month supply and no copay for a 3-month supply at preferred locations. Higher-tier medications under this plan require coinsurance payments rather than flat copays at all pharmacy types. Tier 3 preferred brand drugs require 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for both 1-month and 3-month fills. Specialty drugs in Tier 5 are limited to a 1-month supply and require a 33% coinsurance across all standard and preferred networks.
Additional Benefits
The BCN Advantage Prestige (HMO-POS) plan offers comprehensive medical coverage with many services requiring no coinsurance and low-to-moderate copays. You will pay no copay for primary care visits, home health services, and routine preventive care, while specialist visits carry a low copay ranging from $10 to $25. For hospital stays, there is no coinsurance, though inpatient admissions require a $200 daily copay for the first seven days, and emergency room visits feature a $130 copay. Supplemental benefits include dental coverage up to $1,500 annually and a $150 annual eyewear allowance, both with no copays or coinsurance for covered services. Routine hearing exams are also available with no copay, while prescription hearing aids require copays between $495 and $1,695. Additionally, the plan provides an over-the-counter item allowance of $50 every three months with no copay, and home medical equipment is covered with coinsurance up to 20% and no copays.
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 to 7 and no copay for days 8 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by BCN Advantage Prestige (HMO-POS) with no coinsurance, featuring a $200 copay for outpatient hospital services, a $130 copay per stay for observation services, and a $25 copay for outpatient substance abuse sessions. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance.
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 this benefit.
Ambulance and Transportation Services See details
BCN Advantage Prestige (HMO-POS) covers Medicare-covered ground and air ambulance services with a $250 copay and no coinsurance. While some transportation services are covered, 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 and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services feature no coinsurance and range from no copay to a $35 copay, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with no coinsurance and copays ranging from $35 to $250.
Primary Care See details
BCN Advantage Prestige (HMO-POS) offers partially covered primary care benefits with no coinsurance for all covered services, including no copay for primary care provider visits, telehealth, and opioid treatment. While podiatry services are not covered, patients will pay copays ranging from $10 to $25 for specialists, physical and occupational therapies, mental health sessions, and chiropractic care.
Preventive Services See details
Preventive services are partially covered by BCN Advantage Prestige (HMO-POS) with no copay and no coinsurance for covered benefits like annual physicals, kidney disease education, fitness programs, and nutritional visits. Uncovered sub-services include health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy-related wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
BCN Advantage Prestige (HMO-POS) covers hearing services with no copay and no coinsurance for annual routine hearing exams and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $495 to $1,695 for up to two aids per year, though OTC hearing aids as well as inner ear, outer ear, and over-the-ear prescription aids are not covered.
Vision Services See details
BCN Advantage Prestige (HMO-POS) covers one routine eye exam per year with a $0 to $25 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $150 annual limit for contact lenses, standard lenses, and frames, but upgrades and combined eyeglasses are not covered.
Dental Services See details
Dental services are partially covered by BCN Advantage Prestige (HMO-POS), offering up to $1,500 annually with no copay and no coinsurance for preventive and comprehensive care like cleanings, fillings, and root canals. Medicare-covered dental services require a $0 to $200 copay and no coinsurance, though other diagnostic, other preventive, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
BCN Advantage Prestige (HMO-POS) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has 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) partially covers medical equipment with no copays, although prior authorization is required for these services. Covered durable medical equipment (DME) and diabetic supplies carry no coinsurance to 20% coinsurance, prosthetic devices and medical supplies require 20% coinsurance, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by BCN Advantage Prestige (HMO-POS) with no coinsurance, though prior authorization is required. Covered diagnostic procedures range from no copay to a $10 copay, outpatient X-rays carry a $10 copay, and diagnostic radiological services require a minimum $10 copay, while lab services and therapeutic radiological services are not covered.
Home Health Services See details
Home Health Services are covered under the BCN Advantage Prestige (HMO-POS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the BCN Advantage Prestige (HMO-POS) plan, though only some services are covered in practice and prior authorization is required. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, and SET for PAD services are not covered (each carrying a $15 copay), and pulmonary rehabilitation services are also not covered (carrying a $10 copay).
Skilled Nursing Facility (SNF) See details
BCN Advantage Prestige (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
BCN Advantage Prestige (HMO-POS) partially covers other services, excluding acupuncture. Over-the-counter items (up to $50 every three months) and chronic illness meal benefits are available with no copay and no coinsurance. Additionally, mobile mental health services require a $20 copay and no coinsurance, and ambulance services without transport require a $90 copay and no coinsurance.
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