A non-government entity
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:
Sign up for BCN Advantage HMO-POS Prime Value (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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 copay at preferred pharmacies. For preferred brand drugs and non-preferred drugs, you will pay 50% and 33% coinsurance, respectively. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered 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 the first 7 days, outpatient services, and ambulance services. The plan also covers primary care, preventive services, and hearing services with no copay for hearing exams. Vision services include routine eye exams and eyewear benefits, and dental services are also covered. Other benefits include home infusion, dialysis, medical equipment, and diagnostic services. Additionally, the plan covers skilled nursing facility stays and offers an over-the-counter item benefit.
Inpatient Hospital See details
Inpatient Hospital benefits for BCN Advantage HMO-POS Prime Value (HMO-POS) include coverage for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both with 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, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, as are additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric.
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 include coverage for individual and group sessions with a copay between $35 and $35, and outpatient blood services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by BCN Advantage HMO-POS Prime Value (HMO-POS). Both ground and air ambulance services have a copay of $310, and transportation services to any health-related location are covered, limited to one round trip per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. 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
BCN Advantage HMO-POS Prime Value (HMO-POS) covers primary care physician services, chiropractic services with a $15 copay, occupational therapy, 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. Routine chiropractic care has a $35 copay.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, health education, kidney disease education services, and other preventive services, but does not cover 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 of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, or counseling services. The plan also covers nutritional/dietary benefits, additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit.
Hearing Services See details
Hearing Services include hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered. Prescription hearing aids (all types) are covered, but inner ear, outer ear, and over-the-ear hearing aids are not covered, and OTC hearing aids are not covered. Prescription hearing aids have a maximum plan benefit coverage of $600 every three years.
Vision Services See details
Vision services include routine eye exams with a copay of $0-$35, and eyewear benefits. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, and has 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 two visits per year, and dental x-rays with no copay for one visit every two years. The plan also covers prophylaxis (cleaning), fluoride treatment, restorative services, endodontics, periodontics, and oral and maxillofacial surgery, but some services are limited and may have a copay. Maxillofacial prosthetics and orthodontics are not covered, and some services are 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. Medicare Part B Insulin Drugs have a $35 copay, with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan with a coinsurance of 20%.
Medical Equipment See details
Medical equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment are covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. DME has a coinsurance between 0% and 20%, Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance. However, 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 include coverage for all diagnostic services, with a copay for Medicare-covered lab services and a maximum copay of $20 for diagnostic procedures and tests. Radiological services are also covered, with copays for diagnostic services (at most $100, with a minimum copay of $20), therapeutic services (at most $25, with a minimum copay of $25), and outpatient X-ray services ($20).
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. However, 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 under the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. There is no copay for days 1-20, but there is a $214 copay for days 21-100.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $95 every three months, and a Meal Benefit for chronic illness. 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved