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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 an enhanced alternative drug benefit. This plan has a $0 deductible. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For example, you'll pay a $10 copay at a preferred pharmacy for preferred generic drugs, or 50% coinsurance for preferred brand drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The BCN Advantage HMO-POS Community Value (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital care, with varying copays. The plan also covers primary care, specialist visits, and mental health services, with some services having no copay. Additionally, the plan includes coverage for ambulance and transportation services, emergency services, preventive services, hearing, vision, and dental care. This plan provides coverage for home health services, durable medical equipment, and diagnostic services, with specific copays and coinsurance for certain services. It also includes benefits like hearing aids, eyewear, and dental services, with maximum benefit amounts. However, it is important to note that some services, such as cardiac rehabilitation, certain vision and dental services, and additional hours of care, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, with a $300 copay for days 1-7 and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, as well as additional days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $260 copay, observation services with a $90 copay, ambulatory surgical center services with no copay, outpatient substance abuse services with a $40 copay for individual and group sessions, and outpatient blood services with a waived three-pint deductible.
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, including both ground and air ambulance services, each with a $275 copay. Transportation Services to a plan-approved health-related location are also covered, with medical transport available for 28 days.
Emergency Services See details
Emergency Services, including Urgently Needed Services and Worldwide Emergency Services, are covered. 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 Physician Services with no copay, Chiropractic Services with a $15 copay, Occupational Therapy Services with a $30 copay, Physician Specialist Services with a $40 copay, and Mental Health Specialty Services, including Individual and Group Sessions, with a $20 copay. Physical Therapy and Speech-Language Pathology Services are covered with a $30 copay, and Additional Telehealth Benefits and Opioid Treatment Program Services are also covered. Podiatry Services are not covered.
Preventive Services See details
The BCN Advantage HMO-POS Community Value (HMO-POS) plan covers preventive services, including Medicare-covered services, annual physical exams, and additional preventive services. The plan includes coverage for health education, nutritional/dietary benefits (up to 6 visits), additional sessions for smoking and tobacco cessation counseling (up to 999 visits), fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a welcome visit, while in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, enhanced disease management, telemonitoring services, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams (1 every year) and fitting/evaluation for hearing aids (1 every three years), and prescription hearing aids (2 every three years) with a maximum plan benefit coverage of $750.00 per ear. 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
Vision services include eye exams with a copay of $0-$40, and eyewear, which includes contact lenses, and eyeglass lenses and frames. Eyeglasses (lenses and frames) and upgrades are not covered. The plan provides a maximum benefit of $150 per year for frames and elective contact lenses.
Dental Services See details
Dental services are covered, with a maximum plan benefit of $1,500 per year. The plan offers oral exams, dental X-rays, prophylaxis (cleaning), fluoride treatment, restorative services, endodontics, periodontics, and oral and maxillofacial surgery, with varying limits on the number of visits and services covered. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a 20% coinsurance. There is no copay for this benefit.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. 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-POS Community Value (HMO-POS) plan. Diagnostic Procedures/Tests have a copay between $0 and $20, while 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 not covered by the BCN Advantage HMO-POS Community Value (HMO-POS) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional 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, and a $214 copay for days 21-100. 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 Community Value (HMO-POS) plan covers Over-the-Counter (OTC) items with a maximum benefit of $50 every three months. This plan also covers Mobile Mental Health with a $20 copay, and Ambulance No Transport with a $90 copay. Other services such as Acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and many others are not covered.
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