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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 a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for generic drugs, and coinsurance for brand-name and non-preferred drugs, which varies by pharmacy type. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. This plan may also reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The BCN Advantage HMO-POS Prime Value (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. It also provides coverage for emergency services, primary care, preventive services, hearing, vision, and dental services. The plan includes coverage for ambulance services, home health services, and skilled nursing facilities. Additional benefits include coverage for home infusion, dialysis, and medical equipment, as well as diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric care, are covered under the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is 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, and outpatient substance abuse services with a $35-$35 copay for individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan, and requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. Ambulance services have no coinsurance, but a $310 copay applies to both ground and air ambulance services. Transportation Services to any health-related location are covered for one round trip per year via medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by 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
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
The BCN Advantage HMO-POS Prime Value (HMO-POS) plan covers preventive services including Medicare-covered preventive services, annual physical exams, health education, kidney disease education services, and other preventive services like glaucoma screening, with no copay. The plan 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.
Hearing Services See details
Hearing Services include coverage for hearing exams with no copay, and prescription hearing aids with a maximum benefit of $600 every three years. Routine hearing exams have a copay between $0 and $35, and Fitting/Evaluation for Hearing Aids is covered once every three years. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The BCN Advantage HMO-POS Prime Value (HMO-POS) plan covers vision services, including routine eye exams with a copay of $0-$35, contact lenses, eyeglass lenses, and eyeglass frames. Eyeglass frames and elective contact lenses have a combined maximum benefit of $150 every year, but 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 up to 1 visit every two years. Other services include prophylaxis (cleaning) with no copay for up to 2 visits per year, fluoride treatment with no copay for up to 1 visit per year, and oral and maxillofacial surgery with no copay, with specific limits described in the details. The plan also offers a maximum benefit of $1500 per year for other dental services. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including insulin and Medicare Part B drugs. For Medicare Part B Insulin Drugs, there is a $35 copay with coinsurance between 0% and 20%. The coinsurance for other Medicare Part B drugs is 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 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, while 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 diagnostic procedures/tests with a copay between $0 and $20, while lab services are not covered. Diagnostic radiological services have a copay up to $100 with a minimum of $20, 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 by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BCN Advantage HMO-POS Prime Value (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and 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, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays 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 for a chronic illness meal benefit, but not for acupuncture. The plan also covers Mobile Mental Health with a $20 copay and Ambulance No Transport with a $90 copay, but does not cover several other services.
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