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BCN Advantage HMO-POS Prime Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage HMO-POS 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 HMO-POS Prime Value (HMO-POS) in 2025, please refer to our full plan details page.
BCN Advantage HMO-POS 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 2025.
It's important to know that BCN Advantage HMO-POS 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 HMO-POS 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 HMO-POS Prime Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $7.50. 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 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 $4200.00 (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 $4200.00 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 Prime Value (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have an $11 or $20 copay, while preferred brand drugs have a 50% coinsurance. After your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for Part D covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS), also known as "Extra Help".
Additional Benefits
The BCN Advantage HMO-POS Prime Value (HMO-POS) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. Emergency services have a $125 copay, while primary care visits range from no copay to a $35 copay depending on the service. The plan also includes coverage for hearing, vision, and dental services, with specific copays and limitations on certain services. Additional benefits include home health services with no copay, and skilled nursing facility coverage with a $0 copay for the first 20 days, and a $214 copay for days 21-100. The plan also provides coverage for ambulance and transportation services, as well as over-the-counter items up to $60 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will 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 include coverage for outpatient hospital services with a $275 copay, observation services, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay between $35.00 and $35.00, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. 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 $310 copay, and transportation services to any health-related location, with one round trip covered per year. Transportation services to plan-approved health-related locations are not covered. There is no coinsurance for any of these services.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $45. Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, a $45 copay for Worldwide Urgent Coverage, and a $310 copay for Worldwide Emergency Transportation, with a maximum plan benefit of $50,000.
Primary Care See details
The BCN Advantage HMO-POS Prime Value (HMO-POS) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services 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 professional services with a copay between $0 and $35, 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
Preventive services include coverage for Medicare-covered services, annual physical exams, and additional preventive services; however, 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 modifications, and counseling services are not covered. This plan also covers health education, nutritional/dietary benefits (up to 6 visits), additional sessions for smoking and tobacco cessation counseling, fitness benefits, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, EKG following Welcome Visit, and remote access technologies.
Hearing Services See details
Hearing Services include hearing exams with no copay, Routine Hearing Exams with a copay between $0 and $35, and Fitting/Evaluation for Hearing Aid with a copay between $0 and $35. Prescription Hearing Aids (all types) are covered, and the plan covers up to $600 every three years, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services include routine eye exams with a copay between $0 and $35, and eyewear benefits. Eyeglass frames are covered with a $150 combined maximum benefit per year, and contact lenses and eyeglass lenses are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The BCN Advantage HMO-POS Prime Value (HMO-POS) plan covers dental services, including oral exams with no copay for 2 visits per year, dental x-rays with no copay for 1 x-ray every two years, and prophylaxis (cleaning) and fluoride treatments with no copay for 2 and 1 visits per year, respectively. Other dental services, such as 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 other drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all diagnostic services requiring prior authorization and a copay for Medicare-covered lab services. Diagnostic Procedures/Tests have a maximum copay of $20.00. Radiological Services are covered with a copay, including Diagnostic Radiological Services with a maximum copay of $100.00 (minimum $20.00), Therapeutic Radiological Services with a $25.00 copay (minimum $25.00), and Outpatient X-Ray Services with a $20.00 copay. However, Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan, with no copay or 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 Prime 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 Prime Value (HMO-POS) plan, with a $0 copay for days 1-20 and 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
The BCN Advantage HMO-POS Prime Value (HMO-POS) plan covers Over-the-Counter (OTC) items with a maximum benefit of $60 every three months, and covers meal benefits for a chronic illness. 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, 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. Other services include Mobile Mental Health with a $20 copay, and Ambulance No Transport with a $90 copay.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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