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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 $11.50. 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 drug deductible and offers highly competitive rates for generic medications. Under Tier 1 (Preferred Generic), you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail order, while standard locations charge a $5 copay for a 1-month supply. For Tier 2 (Generic) drugs, copays are as low as $5 for a 1-month supply at preferred locations, with no copay required for a 3-month supply. For brand-name and specialty medications, the plan transitions from copays to coinsurance costs across all pharmacy types. Tier 3 (Preferred Brand) drugs require a 20% coinsurance, while Tier 4 (Non-Preferred) drugs carry a 30% coinsurance for both 1-month and 3-month fills. Specialty medications in Tier 5 are subject to a 31% coinsurance for a 1-month supply through both standard and preferred pharmacies or mail-order services.
Additional Benefits
The BCN Advantage Prime Value (HMO-POS) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, home health services, and cardiac rehabilitation. Specialist visits and physical therapy require a $35 copay, while inpatient hospital stays cost a $300 daily copay for the first seven days and no copay for days eight through 90. Emergency room visits carry a $130 copay, which is waived if you are admitted, while urgently needed services range from no copay to $45. For specialty care, the plan features no copay for select dental services up to a $950 annual maximum, alongside eye exams with copays ranging from no copay to $35. While diagnostic hearing exams are covered with no copay, routine hearing exams and hearing aids are not covered under this plan. Additionally, durable medical equipment and diabetic supplies are available with no copay and a coinsurance ranging from 0% to 20%.
Inpatient Hospital See details
BCN Advantage Prime Value (HMO-POS) covers inpatient hospital services with no coinsurance, requiring a $300 copay per day for days 1-7 and no copay for days 8-90 per admission. Unlimited additional acute care days are covered with no copay, but 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 no copays for ambulatory surgical center and blood services. Medicare-covered outpatient hospital services require a copay of $150 to $375, observation services cost a $130 copay per stay, and outpatient substance abuse sessions have a $35 copay.
Partial Hospitalization See details
BCN Advantage Prime Value (HMO-POS) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under the BCN Advantage Prime Value (HMO-POS) plan, featuring a $310 copay and no coinsurance for ground and air ambulance services. While 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, which is waived if you are admitted to the hospital within 3 days, and no coinsurance. Urgently needed services require no coinsurance and a copay ranging from no copay to $45, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum benefit with no coinsurance and copays ranging from $45 to $310.
Primary Care See details
BCN Advantage Prime Value (HMO-POS) provides primary care visits, telehealth, and opioid treatment services with no copay and no coinsurance. Specialist visits, physical therapy, occupational therapy, and speech therapy require a $35 copay and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
BCN Advantage Prime Value (HMO-POS) partially covers preventive services with no copay and no coinsurance for covered benefits like annual physical exams, nutritional training, and kidney disease education. However, several services are not covered, including fitness benefits, health education, weight management programs, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
Hearing services through BCN Advantage Prime Value (HMO-POS) are partially covered, featuring hearing exams with no copay, no coinsurance, and no deductible. However, routine hearing exams, hearing aid fittings and evaluations, prescription hearing aids, and 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 deductibles, no coinsurance, and a copay of $0 to $35 for eye exams and no copay for eyewear. Although some services are covered, specific options like routine eye exams, contact lenses, and eyeglasses are not covered.
Dental Services See details
BCN Advantage Prime Value (HMO-POS) offers partially covered dental services with no coinsurance, featuring a $0 to $375 copay for Medicare-covered dental and no copay for other dental services up to a $950 annual maximum. Covered benefits include oral exams, cleanings, fluoride, restorative services, endodontics, periodontics, and oral surgery, while other diagnostic, other preventive, adjunctive general, prosthodontics, implants, and orthodontics are not covered.
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 and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
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
BCN Advantage Prime Value (HMO-POS) partially covers medical equipment with no copays, though prior authorization is required for all covered items. Durable medical equipment and diabetic supplies carry a coinsurance ranging from 0% to 20%, while prosthetic devices and medical supplies require a 20% coinsurance; however, diabetic therapeutic shoes and inserts are not covered.
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 and lab services are not covered. Covered services feature no copay to a $20 copay for diagnostic procedures, a $20 copay for outpatient X-rays, a $20 minimum copay for diagnostic radiology, and a $25 minimum copay for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by BCN Advantage Prime Value (HMO-POS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
BCN Advantage Prime Value (HMO-POS) offers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. Some services are covered, but cardiac, intensive cardiac, pulmonary, and supervised exercise therapy for peripheral artery disease services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BCN Advantage Prime Value (HMO-POS) with no coinsurance and do not require a prior three-day inpatient hospital stay, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the standard Medicare-covered limit.
Other Services See details
Other Services are partially covered by BCN Advantage Prime Value (HMO-POS), with acupuncture, over-the-counter (OTC) items, and meal benefits not being covered. Covered services include non-Medicare-covered mobile mental health with a $20.00 copay and no coinsurance, and ambulance no transport with a $90.00 copay and no coinsurance.
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