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BCN Advantage HMO ConnectedCare (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage HMO ConnectedCare (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BCN Advantage HMO ConnectedCare (HMO) in 2025, please refer to our full plan details page.
BCN Advantage HMO ConnectedCare (HMO) is a HMO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2025 to people living in Kalamazoo, Metro Detroit Area and Bay Region. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BCN Advantage HMO ConnectedCare (HMO) 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 ConnectedCare (HMO).
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 ConnectedCare (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $46.00. 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 Maximum Out-Of-Pocket cost of $3800.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 ConnectedCare (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2000, you enter the catastrophic coverage phase. In this phase, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The BCN Advantage HMO ConnectedCare (HMO) plan offers a range of benefits, including coverage for inpatient and outpatient hospital services with copays ranging from $0 to $225. Emergency, urgent, and worldwide emergency services are covered with copays, and transportation services are also included. Primary care, mental health, and specialist visits have copays, and the plan covers preventive services, hearing exams, and routine eye exams. Dental services are covered with a $1,500 annual maximum, and there is coverage for home infusion, dialysis, and medical equipment with varying cost-sharing. Additional benefits include coverage for diagnostic and radiological services, home health services, skilled nursing facilities, and other services like OTC items and mobile mental health. However, services such as podiatry, certain dental and vision services, and some therapies are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, there is a $225 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, there is a $225 copay for days 1-7, and no copay for days 8-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient services include Outpatient Hospital Services with a $225 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $35 copay for both individual and group sessions, and Outpatient Blood Services with an enhanced benefit. Observation Services are also covered under this plan.
Partial Hospitalization See details
Partial Hospitalization is covered by the BCN Advantage HMO ConnectedCare (HMO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services, each with a $230 copay and no coinsurance. Transportation services to a plan-approved health-related location are also covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BCN Advantage HMO ConnectedCare (HMO) plan. Emergency Services have a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $45, and no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $230 copay; all of these services have no coinsurance, and there is a maximum benefit coverage of $50,000.
Primary Care See details
The BCN Advantage HMO ConnectedCare (HMO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $30 copay, physician specialist services with a $35 copay, mental health specialty services with a $20 copay for individual and group sessions, other health care professionals with a $0-$35 copay, psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The BCN Advantage HMO ConnectedCare (HMO) plan covers preventive services, including annual physical exams, health education, nutritional/dietary benefits (up to 6 visits), additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, home and bathroom safety devices and modifications (up to $100 per year), kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, enhanced disease management, telemonitoring services, and counseling services are not covered.
Hearing Services See details
Hearing Services includes hearing exams with no copay, and fitting/evaluation for hearing aids. Prescription hearing aids and OTC hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams with a copay between $0 and $35, but eyewear benefits do not include contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, or upgrades. Routine eye exams are limited to one per year.
Dental Services See details
Dental services include coverage for Medicare Dental Services with a copay between $0 and $225, and other dental services with a $1,500 annual maximum. Oral exams, dental x-rays, cleanings, fluoride treatments, restorative services, endodontics, periodontics, and oral and maxillofacial surgery are covered with limitations, while maxillofacial prosthetics and orthodontics are not covered. Prosthodontics (removable and fixed) and implant services are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%, while for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the BCN Advantage HMO ConnectedCare (HMO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered by BCN Advantage HMO ConnectedCare (HMO). Durable Medical Equipment has a coinsurance between 0% and 20%, while Prosthetic Devices and Medical Supplies have a 20% coinsurance, and 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 the BCN Advantage HMO ConnectedCare (HMO) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, while Diagnostic Radiological Services have a copay of at most $100, Therapeutic Radiological Services have a copay of at most $25, and Outpatient X-Ray Services have a $20 copay; lab services are not covered.
Home Health Services See details
Home Health Services are covered by the BCN Advantage HMO ConnectedCare (HMO) plan with no copay and no coinsurance. 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 ConnectedCare (HMO) plan, but more specific details about the copay are available. However, the plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BCN Advantage HMO ConnectedCare (HMO) plan, 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 SNF stays, and non-Medicare-covered stays, are not covered.
Other Services See details
The "Other Services" benefit covers Over-the-Counter (OTC) items, with a maximum benefit of $75.00 every three months and including nicotine replacement therapy and Naloxone coverage. Other covered services include mobile mental health with a $20 copay, and ambulance no transport with a $90 copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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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