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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 $21.40. 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) prescription drug plan features a $150 annual deductible. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail-order services. Tier 2 generic drugs cost a $5 copay for a 1-month supply at preferred locations, but you will pay no copay for a 3-month supply. For higher-tier medications, this plan transitions from flat copays to coinsurance. 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 at both preferred and standard locations.
Additional Benefits
The BCN Advantage Prime Value (HMO-POS) plan offers affordable essential healthcare coverage, featuring no copays and no coinsurance for primary care, preventive care, and home health services. For more specialized medical needs, members will pay a $35 copay for specialist visits and a $300 daily copay for days 1 through 7 of inpatient hospital stays, with no coinsurance. Emergency services are available with a $130 copay, which is waived if you are admitted to the hospital. Ancillary care under this plan includes dental services covered up to a $950 annual limit with no copay and no coinsurance for covered preventive and comprehensive treatments. While diagnostic hearing and select vision services are covered with no coinsurance, please note that routine eye exams, glasses, and hearing aids are not covered. Additionally, members can access covered home infusion, cardiac rehabilitation, and diagnostic services with no copays.
Inpatient Hospital See details
BCN Advantage Prime Value (HMO-POS) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $300 daily copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and while unlimited additional acute care days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BCN Advantage Prime Value (HMO-POS) covers outpatient hospital services with a $150 to $375 copay, observation services at a $130 copay per stay, and outpatient substance abuse sessions with a $35 copay, all with no coinsurance. Ambulatory surgical center services and outpatient blood services are also covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by BCN Advantage Prime Value (HMO-POS) with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
BCN Advantage Prime Value (HMO-POS) covers ground and air ambulance services with a $310 copay and no coinsurance, which is not waived if admitted to the hospital. Although some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
BCN Advantage Prime Value (HMO-POS) covers emergency services with a $130 copay and no coinsurance, with the copay waived if you are admitted to the hospital within three days. Urgently needed services range from no copay to a $45 copay with no coinsurance, and worldwide emergency 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) provides primary care, telehealth, and opioid treatment services with no copay and no coinsurance. Specialist visits, physical, occupational, and speech therapies require a $35 copay and no coinsurance, while mental health sessions have a $20 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
BCN Advantage Prime Value (HMO-POS) offers partially covered preventive services with no copay and no coinsurance, which includes annual physical exams, select nutritional benefits, and smoking cessation counseling. However, several supplemental preventive services, such as fitness benefits, health education, and personal emergency response systems, are not covered.
Hearing Services See details
BCN Advantage Prime Value (HMO-POS) covers diagnostic hearing exams with no copay and no coinsurance. Routine hearing exams, fitting and evaluations for hearing aids, and all prescription or over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
Vision Services are covered by BCN Advantage Prime Value (HMO-POS) with no coinsurance and copays ranging from no copay to $35, though only some services are covered in practice. Routine eye exams, other eye exam services, contact lenses, and eyeglasses are not covered under this plan.
Dental Services See details
Dental services are partially covered by BCN Advantage Prime Value (HMO-POS) up to a $950 annual limit, offering no copay and no coinsurance for covered preventive and comprehensive services, while Medicare-covered dental has a $0 to $375 copay and no coinsurance. Non-covered services include other diagnostic, other preventive, adjunctive general, fixed and removable prosthodontics, maxillofacial prosthetics, implants, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BCN Advantage Prime Value (HMO-POS) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other Part B drugs feature no coinsurance to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by BCN Advantage Prime Value (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by BCN Advantage Prime Value (HMO-POS) with no copays and coinsurance ranging from no coinsurance up to 20%, depending on the item. While durable medical equipment, prosthetics, and diabetic supplies are covered under this plan with prior authorization, diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services under BCN Advantage Prime Value (HMO-POS) are partially covered with no coinsurance, though lab services are not covered and prior authorization is required. Covered diagnostic procedures range from no copay to a $20 copay, while 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
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
Cardiac rehabilitation services are covered by BCN Advantage Prime Value (HMO-POS) with no copay, no coinsurance, and prior authorization required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, 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 and requires prior authorization, with no prior three-day hospital stay required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and no coverage for additional days.
Other Services See details
BCN Advantage Prime Value (HMO-POS) partially covers other services, providing non-Medicare-covered mobile mental health with a $20 copay and no coinsurance, and ambulance no transport with a $90 copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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