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BCN Advantage Prime Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage Prime 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 Prime Value (HMO-POS) in 2026, please refer to our full plan details page.
BCN Advantage Prime 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 Michigan. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that BCN Advantage Prime 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 Prime 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 Prime Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $35.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $12.80. You must continue to pay paying your reduced 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 a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5000.00 (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 $5000.00 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 Prime Value (HMO-POS) plan features an annual drug deductible of $150. For Tier 1 preferred generic drugs, you will pay no copay for 1-month or 3-month supplies at preferred pharmacies and preferred mail-order services, while standard locations charge a $5 copay for a 1-month supply. Tier 2 generic drugs cost a $5 copay for a 1-month supply at preferred locations, which drops to no copay for a 3-month supply. For higher-tier medications, the plan charges coinsurance instead of flat copays at both preferred and standard pharmacies. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance. Tier 5 specialty drugs require a 31% coinsurance for a 1-month supply under all pharmacy and mail-order options.
Additional Benefits
The BCN Advantage Prime Value (HMO-POS) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and preventive care. For inpatient hospital stays, there is no coinsurance, with a $300 daily copay for the first seven days and no copay for days eight through 90. Emergency services require a $130 copay, which is waived if you are admitted, while specialist visits and physical therapy are available with a $35 copay and no coinsurance. Dental services are covered with no copay and no coinsurance up to a $950 annual limit, while diagnostic hearing exams and home infusion services also feature no copay. For specialized care, medical equipment and Medicare Part B drugs carry coinsurance ranging up to 20 percent, while dialysis services require 20 percent coinsurance with no copay. Skilled nursing facility care is also highly accessible, offering no copay for the first 20 days and a $218 daily copay for days 21 through 100.
Inpatient Hospital See details
BCN Advantage Prime Value (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $300 daily copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under BCN Advantage Prime Value (HMO-POS) are covered with no coinsurance, featuring a $150 to $375 copay for hospital services and a $130 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay and no coinsurance.
Partial Hospitalization See details
BCN Advantage Prime Value (HMO-POS) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for some of these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by BCN Advantage Prime Value (HMO-POS), with ground and air ambulance services requiring a $310 copay and no coinsurance. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
BCN Advantage Prime Value (HMO-POS) covers emergency services with a $130 copay, which is waived if you are admitted to the hospital within three days, and urgently needed services with a copay ranging from no copay to $45, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with no coinsurance and copays ranging from $45 to $310.
Primary Care See details
BCN Advantage Prime Value (HMO-POS) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist, occupational, and physical therapy visits require a $35 copay and no coinsurance. Mental health and psychiatric services have a $20 copay and no coinsurance, chiropractic care is partially covered at a $15 copay and no coinsurance (routine and other chiropractic services are not covered), and podiatry is not covered.
Preventive Services See details
Preventive services are partially covered by BCN Advantage Prime Value (HMO-POS) with no copay and no coinsurance for covered benefits like annual physical exams and kidney disease education. However, the plan does not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, palliative care, in-home support, caregiver support, fitness benefits, disease management, telemonitoring, home safety modifications, or counseling.
Hearing Services See details
BCN Advantage Prime Value (HMO-POS) covers diagnostic hearing exams with no copay and no coinsurance, but routine hearing exams and fitting evaluations are not covered. Additionally, prescription and OTC hearing aids are not covered under this plan.
Vision Services See details
Vision services are covered under the BCN Advantage Prime Value (HMO-POS) plan, with eye exams requiring a $0 to $35 copay and no coinsurance, and eyewear having no copay or coinsurance. However, only some services are covered in practice, as routine eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
BCN Advantage Prime Value (HMO-POS) covers dental services with no copay and no coinsurance up to a $950 annual limit, though Medicare-covered dental services require a $0 to $375 copay and no coinsurance. This partially covered benefit excludes other diagnostic and preventive services, adjunctive general services, prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
BCN Advantage Prime Value (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and ranging from no coinsurance up to 20% coinsurance, while Medicare Part B insulin drugs require a $35 copay and up to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under BCN Advantage Prime Value (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
BCN Advantage Prime Value (HMO-POS) partially covers medical equipment with no copay, though prior authorization is required. Covered durable medical equipment and diabetic supplies have a coinsurance of 0% to 20%, and prosthetics and medical supplies carry a 20% coinsurance, but diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by BCN Advantage Prime Value (HMO-POS) with no coinsurance, though prior authorization is required and lab services are not covered. Outpatient diagnostic procedures and tests range from no copay to $20, while radiological services require a $20 copay for X-rays, a minimum $20 copay for diagnostic services, and a minimum $25 copay for therapeutic services.
Home Health Services See details
Home Health Services are covered under the BCN Advantage Prime Value (HMO-POS) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
BCN Advantage Prime Value (HMO-POS) covers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. While some services are covered, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy for symptomatic peripheral artery disease services are not covered.
Skilled Nursing Facility (SNF) See details
BCN Advantage Prime Value (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BCN Advantage Prime Value (HMO-POS) partially covers other services, excluding acupuncture, over-the-counter items, and meal benefits. Covered benefits include non-Medicare-covered mobile mental health for a $20 copay and no coinsurance, as well as ambulance no transport for a $90 copay and no coinsurance.
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