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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 $7.00. 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 an "Enhanced Alternative" drug benefit. The plan has no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for Tier 1 and Tier 2 drugs, and coinsurance for Tier 3 and Tier 4 drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you'll pay nothing for covered Part D drugs.
Additional Benefits
The BCN Advantage HMO-POS Prime Value (HMO-POS) plan offers a range of benefits, including inpatient hospital stays with a $300 copay for days 1-7, and no copay for days 8-90, and outpatient services. The plan also covers primary care with copays ranging from $15 to $35, hearing exams with no copay, and vision services, including eye exams with a copay between $0 and $35, and eyewear benefits with a maximum of $150 per year. Additional benefits include ambulance services with a $310 copay, dental services with no copay for oral exams, and home health services with no copay, and Skilled Nursing Facility (SNF) services with a $0 copay for days 1-20, and a $214 copay for days 21-100. The plan also offers coverage for over-the-counter items with a maximum benefit of $95 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered. For acute care, you'll pay a $300 copay for days 1-7, and no copay for days 8-90; psychiatric care also has a $300 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient services include outpatient hospital services with a $275 copay, observation services, ambulatory surgical center services with no copay, outpatient substance abuse services with a $35 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. Ground and air ambulance services have a $310 copay, with no coinsurance. 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. 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 $310 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic Services have a $15 copay, and Routine Chiropractic Care has a $35 copay, and Other Chiropractic Services has a $20 copay, both with a limit of one visit per year. Occupational Therapy Services have a $30 copay. Physician Specialist Services have a $35 copay. Individual and Group Sessions for Mental Health and Psychiatric Services each have a $20 copay. Physical Therapy and Speech-Language Pathology Services have a $30 copay. Other Health Care Professional has a copay between $0 and $35.
Preventive Services See details
Preventive Services are covered, including Medicare-covered services and an annual physical exam, and the plan also covers Health Education, Nutritional/Dietary Benefit with 6 visits, Additional Sessions of Smoking and Tobacco Cessation Counseling with 999 visits, Fitness Benefit, Remote Access Technologies. However, In-Home Safety Assessment, Personal Emergency Response System, 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 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 coverage for hearing exams with no copay and routine hearing exams with a copay between $0 and $35 per visit, with one visit allowed per year, and fitting/evaluation for hearing aids with one visit every three years. Prescription hearing aids are covered up to $600 every three years, but 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 - $35, and eyewear benefits, including contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 per year. 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 up to 2 visits per year, and dental x-rays with no copay for 1 x-ray every two years. Other services include prophylaxis (cleaning), fluoride treatment, restorative services, endodontics, periodontics, and oral and maxillofacial surgery, but the plan does not cover Maxillofacial Prosthetics or Orthodontics. Some dental services are offered as optional, supplemental benefits.
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, but prior authorization is required. Medicare Part B Insulin Drugs have a $35 copay and coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. You are responsible for 20% coinsurance.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. DME has a coinsurance between 0% and 20%, while Prosthetic Devices, and Medical Supplies have a 20% coinsurance; however, DME 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 include coverage for all diagnostic services 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 of at most $100, Therapeutic Radiological Services have a copay of $25 or more, and Outpatient X-Ray Services have a $20 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
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
Other Services with the BCN Advantage HMO-POS Prime Value (HMO-POS) plan includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $95.00 every three months, and other services such as Mobile Mental Health with a $20 copay, and Ambulance No Transport with a $90 copay. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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.
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