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BCN Advantage HMO-POS Community Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage HMO-POS Community Value (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 Community Value (HMO-POS) in 2025, please refer to our full plan details page.
BCN Advantage HMO-POS Community Value (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 Metro Detroit Area, Genesee, Livingston, St. Clair. 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 Community Value (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 Community Value (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 Community Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $12.00. 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 $4300.00 (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 $4300.00 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 Community Value (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at preferred pharmacies, while standard generic drugs have a $45 copay. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BCN Advantage HMO-POS Community Value (HMO-POS) plan offers a wide range of benefits with varying costs. This plan includes coverage for inpatient hospital stays with a $300 copay for the first seven days, outpatient services, and emergency services with a $125 copay. You can also expect coverage for primary care, preventive, hearing, vision, and dental services, often with copays ranging from $0 to $40. Additional benefits include coverage for ambulance services, home infusion, home health services, and skilled nursing facilities (SNF) with a $214 copay for days 21-100. The plan also offers coverage for diagnostic and radiological services, cardiac rehabilitation, and other services like over-the-counter items with a $50 allowance every three months. However, some services like podiatry, certain hearing aids, and orthodontics are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $300 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric services, you will also pay a $300 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services and outpatient substance abuse services. Outpatient hospital services have a $260 copay, observation services have a $90 copay, and outpatient substance abuse individual and group sessions have a copay between $40 and $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the BCN Advantage HMO-POS Community Value (HMO-POS) plan with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the BCN Advantage HMO-POS Community Value (HMO-POS) plan. Both ground and air ambulance services have a $275 copay, and transportation services to any health-related location are covered for one round trip per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the BCN Advantage HMO-POS Community Value (HMO-POS) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $275 copay.
Primary Care See details
The BCN Advantage HMO-POS Community Value (HMO-POS) plan covers primary care services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, and physician specialist services with a $40 copay. Mental health specialty services and psychiatric services have a $20 copay for individual and group sessions, while physical therapy and speech-language pathology services have a $30 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, health education, nutritional/dietary benefits (up to 6 visits), additional sessions of smoking and tobacco cessation counseling, fitness benefits (memory fitness), remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, are covered by the BCN Advantage HMO-POS Community Value (HMO-POS) plan. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, Routine Hearing Exams with a copay between $0 and $40, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids (all types) are covered, with a maximum benefit of $750 every three years, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
The BCN Advantage HMO-POS Community Value (HMO-POS) plan covers vision services including routine eye exams with a copay between $0 and $40, and eyewear with a $150 maximum benefit per year. Eyeglass lenses, frames, and contact lenses are covered as well. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The BCN Advantage HMO-POS Community Value (HMO-POS) plan covers dental services with a maximum benefit of $1,500 per year, including oral exams with no copay for up to 2 visits per year, dental x-rays, prophylaxis (cleaning) with no copay for up to 2 visits per year, and fluoride treatment with no copay for 1 visit per year. Restorative services, endodontics, periodontics, and oral and maxillofacial surgery are also covered, but maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. You will pay a $35 copay for Medicare Part B Insulin Drugs, and coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs.
Dialysis Services See details
Dialysis Services are covered under the BCN Advantage HMO-POS Community Value (HMO-POS) plan. You will pay a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered by BCN Advantage HMO-POS Community Value (HMO-POS), but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. For Durable Medical Equipment, there is a coinsurance between 0% and 20%, and no copay. For Prosthetic Devices and Medical Supplies, there is a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
The BCN Advantage HMO-POS Community Value (HMO-POS) plan covers diagnostic and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $20, while Lab Services are not covered. Diagnostic Radiological Services have a copay between $20 and $100, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered by the BCN Advantage HMO-POS Community Value (HMO-POS) 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, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for some Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BCN Advantage HMO-POS Community Value (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other services include coverage for Over-the-Counter (OTC) items with a maximum benefit of $50 every three months, and a meal benefit for chronic illness, but acupuncture is not covered. Other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and others are not covered. Other 1 includes Mobile Mental Health with a $20 copay, and Other 2 includes Ambulance No Transport with a $90 copay.
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