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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 $23.50. 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 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 a $150 annual drug deductible. For Tier 1 preferred generics, you pay no copay for 1-month or 3-month supplies at preferred pharmacies and mail-order services. Tier 2 generic medications cost a $5 copay for a 1-month supply at preferred locations, which drops to no copay for a 3-month supply. Higher-tier medications require coinsurance across all pharmacy and mail-order channels. You will pay 20% coinsurance for Tier 3 preferred brands, 30% coinsurance for Tier 4 non-preferred drugs, and 31% coinsurance for Tier 5 specialty drugs. Choosing preferred pharmacies and generic options offers the lowest out-of-pocket costs under this plan.
Additional Benefits
The BCN Advantage Prime Value (HMO-POS) plan offers solid medical coverage with no copay and no coinsurance for primary care visits, telehealth, and home health care. For inpatient hospital stays, members pay a $300 daily copay for days 1 through 7 and no copay for days 8 through 90, with no coinsurance. Specialist visits and physical therapy require a $35 copay, while emergency care has a $130 copay that is waived if you are admitted to the hospital. Dental care is partially covered with no copay for select services up to a $950 annual limit, and preventive services like annual physicals are also available with no copay. Skilled nursing facility stays feature no copay for the first 20 days, followed by a $218 daily copay for days 21 through 100. Note that some benefits are excluded, as the plan does not cover routine vision or hearing exams, hearing aids, transportation, and cardiac rehabilitation.
Inpatient Hospital See details
BCN Advantage Prime Value (HMO-POS) covers inpatient hospital services with no coinsurance, requiring prior authorization, a $300 daily copay for days 1 to 7, and no copay for days 8 to 90. This benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by BCN Advantage Prime Value (HMO-POS) with no coinsurance, featuring a $150 to $375 copay for outpatient hospital services and a $130 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $35 copay with no coinsurance.
Partial Hospitalization See details
BCN Advantage Prime Value (HMO-POS) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by BCN Advantage Prime Value (HMO-POS), which features a $310 copay and no coinsurance for both ground and air ambulance services. However, transportation services to plan-approved or any health-related locations are not covered under this plan.
Emergency Services See details
BCN Advantage Prime Value (HMO-POS) covers emergency services with a $130 copay (waived if admitted to the hospital within 3 days) and no coinsurance. Urgently needed services require no copay to a $45 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are 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 visits, telehealth benefits, and opioid treatment with no copay and no coinsurance. Specialist visits, physical therapy, and occupational therapy require a $35 copay with no coinsurance, while mental health services cost a $20 copay with no coinsurance, and podiatry and routine chiropractic services are 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 care like annual physical exams, kidney disease education, and nutritional counseling. However, several supplemental services are not covered, including fitness benefits, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management programs, alternative therapies, and caregiver support.
Hearing Services See details
BCN Advantage Prime Value (HMO-POS) partially covers hearing exams with no copay and no coinsurance, excluding routine hearing exams and fitting or evaluation services. For prescription hearing aids, some services are covered, but all types—including inner ear, outer ear, and over the ear devices—along with over-the-counter hearing aids, are not covered.
Vision Services See details
Vision Services are covered under BCN Advantage Prime Value (HMO-POS) with no coinsurance, featuring exam copays ranging from no copay to $35 and no copay for eyewear. Although the plan states some services are covered, in practice, routine eye exams, other eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
BCN Advantage Prime Value (HMO-POS) dental services are partially covered, offering no coinsurance, a $0 to $375 copay for Medicare-covered dental, and no copay for other covered services up to a $950 annual limit. Preventive care, root canals, and extractions are covered, while implants, orthodontics, fixed or removable prosthodontics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
BCN Advantage Prime Value (HMO-POS) covers home infusion bundled services with no copay and no coinsurance, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs carry no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis Services are covered under the BCN Advantage Prime Value (HMO-POS) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by BCN Advantage Prime Value (HMO-POS) with no copays, though coinsurance ranges from no coinsurance up to 20% and prior authorization is required. This benefit is partially covered, as diabetic therapeutic shoes and inserts are not covered by the plan.
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. Outpatient diagnostic procedures and tests have a copay ranging from no copay to $20 while lab services are not covered, and radiological services require a $20 copay for X-rays, a minimum $20 copay for diagnostic radiology, and a minimum $25 copay for therapeutic radiology.
Home Health Services See details
BCN Advantage Prime Value (HMO-POS) provides coverage for home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under BCN Advantage Prime Value (HMO-POS), which does not provide coverage for standard cardiac, intensive cardiac, pulmonary, or supervised exercise therapy (SET) rehabilitation services.
Skilled Nursing Facility (SNF) See details
BCN Advantage Prime Value (HMO-POS) covers skilled nursing facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by BCN Advantage Prime Value (HMO-POS), as acupuncture, over-the-counter items, and meal benefits are not covered. Covered benefits include non-Medicare-covered mobile mental health with a $20 copay and no coinsurance, and ambulance no-transport services with a $90 copay and no coinsurance.
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