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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 $257.00. 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 no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for generic drugs, starting at $7.00, and coinsurance for brand-name drugs, which is 50%. After your total drug costs reach $2000.00, you enter the catastrophic coverage phase, where you pay nothing for Part D covered 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 comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll find benefits for primary care, preventive services with no copay for Medicare-covered services, and vision and hearing services. Dental services are covered with a $1,500 maximum benefit each year. The plan also covers ambulance services, emergency services, and home health services with no copay. Additional benefits include coverage for durable medical equipment, and skilled nursing facility (SNF) stays. However, it's important to note that some services like cardiac rehabilitation, and certain dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-7, there is a $125 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $200 copay, observation services, ambulatory surgical center services with no copay, outpatient substance abuse services with a $20 copay for individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under this plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services, each with a $250 copay, and transportation services to a plan-approved health-related location for 28 days. Transportation services to any other health-related location is not covered. There is no coinsurance for ambulance services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0 and $35, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $35 copay, and Worldwide Emergency Transportation has a $250 copay. 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 Services with a $15 copay, 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 with a copay between $0 and $20, 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 preventive services, including no copay for Medicare-covered services, and annual physical exams. Additional preventive services are covered, with a copay for Personal Emergency Response System (PERS). Other covered services include Health Education, Nutritional/Dietary Benefit (up to 6 visits), Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit (Memory Fitness), 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. 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) with a copay between $0 and $20, and fitting/evaluation for hearing aids (1 per three years). Prescription hearing aids are covered up to a maximum of $600 per ear every three years, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$20, and routine eye exams once per year. Eyewear benefits include coverage for contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 per year; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The BCN Advantage HMO-POS Prestige (HMO-POS) plan covers Medicare Dental Services with a copay ranging from $0 to $200, and other dental services with a $1,500 maximum benefit each year. Oral exams are covered for 2 visits per year, dental x-rays are covered once every two years, prophylaxis (cleaning) is covered for 2 visits per year, and fluoride treatment is covered once per year. Restorative services, endodontics, periodontics, and oral and maxillofacial surgery are also covered, while maxillofacial prosthetics and orthodontics are not covered. Prosthodontics (removable and fixed) and implant services are offered as optional, supplemental benefits; contact the plan for details.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance for Medicare-covered devices, but Durable Medical Equipment for use outside the home and Diabetic Supplies/Therapeutic Shoes/Inserts are not covered. BCN Advantage HMO-POS Prestige (HMO-POS) also covers Diabetic Equipment, but Diabetic Supplies and Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the BCN Advantage HMO-POS Prestige (HMO-POS) plan, but lab services and therapeutic radiological services are not covered. For diagnostic procedures and tests, there is a copay between $0 and $10, while diagnostic radiological services have a copay up to $50. 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 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 not covered by the BCN Advantage HMO-POS Prestige (HMO-POS) plan. Specific services such as 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.
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 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 does not cover acupuncture, 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. Over-the-Counter (OTC) Items are covered with a maximum benefit of $90 every three months, and Other 1 includes Mobile Mental Health services with a $20 copay, and Other 2 includes Ambulance No Transport services with a $90 copay.
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