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BCN Advantage Local (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BCN Advantage Local (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BCN Advantage Local (HMO) in 2025, please refer to our full plan details page.
BCN Advantage Local (HMO) is a HMO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2025 to people living in Macomb, Oakland, Wayne. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BCN Advantage Local (HMO) 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 Local (HMO).
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 Local (HMO), 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.
This plan does not come with a Part B Premium reduction. You must continue to pay your 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 Maximum Out-Of-Pocket cost of $4175.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 Local (HMO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, while preferred brand drugs have a 50% coinsurance. 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 Local (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have copays, with a $325 copay for the first 7 days for acute care and a $300 copay for psychiatric care. Outpatient services, including some substance abuse and blood services, have copays ranging from $0 to $275. Emergency, urgent, and worldwide emergency services are covered with copays, and primary care visits start at a $15 copay. Preventive services, routine hearing exams, and some vision services have no copays, while dental services include a $1,500 annual maximum benefit. Home health services and durable medical equipment also have no copay. This plan also offers additional benefits like over-the-counter items and meal benefits for chronic illnesses.
Inpatient Hospital See details
The BCN Advantage Local (HMO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you will pay a $325 copay for days 1-7 and no copay for days 8-90, while for Inpatient Hospital Psychiatric, you will pay 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. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $275 copay, observation services, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services are covered with a $35 copay for both individual and group sessions, and outpatient blood services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the BCN Advantage Local (HMO) plan, with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for ground and air ambulance services, each with a $275 copay, and plan-approved health-related transportation with no copay or coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BCN Advantage Local (HMO) plan. Emergency Services have a $125 copay and no coinsurance, Urgently Needed Services have a copay between $0 and $45 and no coinsurance, and Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, a $45 copay for Worldwide Urgent Coverage, and a $275 copay for Worldwide Emergency Transportation, with a maximum plan benefit of $50,000.
Primary Care See details
The BCN Advantage Local (HMO) 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
Preventive services, including those covered by Medicare, are covered with no copay. Additional services like Health Education, Nutritional/Dietary Benefit (up to 6 visits), Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit (Memory Fitness), Remote Access Technologies, Home and Bathroom Safety Devices and Modifications (up to $100 per year), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered. However, services like In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, and several others are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, routine hearing exams (1 per year, $0-$35 copay), and fitting/evaluation for hearing aids (1 per three years). Prescription hearing aids are covered, with a maximum benefit of $600 per ear every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services include routine eye exams with a copay of $0 - $35, and eyewear benefits. Eyewear includes contact lenses with no copay, eyeglass lenses, and eyeglass frames. Eyeglasses (lenses and frames) and upgrades are not covered. The plan has a maximum benefit of $150 per year for frames or elective contact lenses.
Dental Services See details
Dental services include a maximum plan benefit of $1,500 per year, and cover oral exams with no copay for 2 visits per year, dental x-rays, prophylaxis (cleaning) for 2 visits per year, and fluoride treatment for 1 visit per year. Restorative services, endodontics, periodontics, and oral and maxillofacial surgery are also covered. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BCN Advantage Local (HMO) plan. You will pay a 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered by BCN Advantage Local (HMO), with no copay for Durable Medical Equipment, but coinsurance of 0-20% may apply; Prosthetic Devices and Medical Supplies have a 20% coinsurance. Diabetic Equipment is covered, but 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 and outpatient X-ray services. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $20, while Diagnostic Radiological Services have a copay of at most $100 and Therapeutic Radiological Services have a copay of at most $25; Outpatient X-Ray Services have a copay of $20. Lab Services are not covered.
Home Health Services See details
Home Health Services are covered by the BCN Advantage Local (HMO) plan 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 covered by the BCN Advantage Local (HMO) plan, but the specific services of 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 are not covered. The plan has a copay, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BCN Advantage Local (HMO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Under the BCN Advantage Local (HMO) plan, acupuncture, 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, 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. Over-the-counter items are covered up to $75 every three months, and meal benefits for a chronic illness are available. Other services include Mobile Mental Health with a $20 copay and Ambulance No Transport with a $90 copay.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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