A non-government entity
McLaren Medicare Inspire (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for McLaren Medicare Inspire (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on McLaren Medicare Inspire (HMO) in 2026, please refer to our full plan details page.
McLaren Medicare Inspire (HMO) is a HMO plan offered by McLaren Health Care Corporation available for enrollment in 2025 to people living in Lower Peninsula of Michigan. This plan received an overall rating of 3 out of 5 stars in 2026.
It's important to know that McLaren Medicare Inspire (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 McLaren Medicare Inspire (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 McLaren Medicare Inspire (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 a $615.00 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 Maximum Out-Of-Pocket cost of $6300.00 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 McLaren Medicare Inspire (HMO) plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 6 select care drugs, members pay no copay for one, two, or three-month supplies at standard pharmacies, as well as for three-month standard mail orders. Tier 2 generics are available at standard pharmacies with a $12 copay for a one-month supply, up to a $36 copay for a three-month supply, or a discounted $27 copay for a three-month standard mail order. Higher-tier prescription drugs require coinsurance instead of flat copays during the initial coverage phase. Tier 3 preferred brands and Tier 5 specialty drugs both carry a 25% coinsurance, while Tier 4 non-preferred brands require a 40% coinsurance at standard pharmacies and through standard mail order. These percentage-based costs apply to all available supply durations, helping you plan your prescription medication expenses.
Additional Benefits
The McLaren Medicare Inspire (HMO) plan offers robust core medical coverage with predictable out-of-pocket costs, including no copays for primary care visits, home health services, and preventive care. For emergency care, members pay a $115 copay, which is waived if admitted, while urgent care visits require a $40 copay. Inpatient hospital stays require a daily copay of $550 for the first five days of acute care, after which there is no copay, and standard outpatient hospital services carry a $200 copay. Specialty care and supplemental benefits are also covered, featuring dental benefits with up to a $1,500 annual maximum and no copay for preventive cleanings. Routine vision and hearing exams both carry a $45 copay, though covered eyewear is provided with no copay. Additionally, skilled nursing facility stays have no copay for the first 20 days, while durable medical equipment and dialysis services require a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services under McLaren Medicare Inspire (HMO) are partially covered with no coinsurance, requiring prior authorization and a daily copay of $550 for days 1 to 5 (no copay for days 6 to 90) for acute care, and $465 for days 1 to 5 (no copay for days 6 to 90) for psychiatric care. Hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by McLaren Medicare Inspire (HMO) with no coinsurance, featuring a $200 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse sessions require a $45 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
McLaren Medicare Inspire (HMO) covers partial hospitalization services with an $80 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
McLaren Medicare Inspire (HMO) covers ground and air ambulance services with a $220 copay and no coinsurance, with prior authorization required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
McLaren Medicare Inspire (HMO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital, and urgently needed services with a $40 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $50,000 maximum with no coinsurance and matching copays of $115 and $40, though worldwide emergency transportation is not covered.
Primary Care See details
McLaren Medicare Inspire (HMO) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $45 copay and no coinsurance. Other covered benefits, including physical, occupational, mental health, and psychiatric therapies, carry copays up to $45 with no coinsurance, while podiatry is not covered and chiropractic care is only partially covered because routine and other chiropractic services are excluded.
Preventive Services See details
Preventive services are covered by McLaren Medicare Inspire (HMO) with no copay and no coinsurance. While the plan covers annual exams and kidney disease education, additional preventive services are only partially covered, excluding health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, wigs, weight management, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, remote access technologies, home safety devices, and counseling.
Hearing Services See details
McLaren Medicare Inspire (HMO) covers hearing exams with a $45 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699 to $999, but OTC hearing aids and prescription aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
McLaren Medicare Inspire (HMO) partially covers vision services, offering routine eye exams for a $45 copay and no coinsurance, and eyewear including contact lenses and eyeglasses with no copay and no coinsurance. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
McLaren Medicare Inspire (HMO) dental services are partially covered, offering up to a $1,500 annual maximum for preventive care like exams and cleanings with no copay and no coinsurance, while Medicare-covered dental has a $45 copay and no coinsurance. Comprehensive services feature no copay and 0% to 50% coinsurance, though orthodontics, maxillofacial prosthetics, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by McLaren Medicare Inspire (HMO) with no copay, though prior authorization is required. Under this benefit, Medicare Part B insulin drugs have a $35 copay and no coinsurance, while chemotherapy and other Part B drugs feature no copay and a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the McLaren Medicare Inspire (HMO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
McLaren Medicare Inspire (HMO) provides coverage for durable medical equipment, prosthetics, and diabetic therapeutic shoes and inserts with no copay and a 20% coinsurance, subject to prior authorization. This medical equipment benefit is partially covered, as diabetic supplies are not covered.
Diagnostic and Radiological Services See details
McLaren Medicare Inspire (HMO) partially covers diagnostic and radiological services with prior authorization required, though lab services are not covered. Covered diagnostic tests have no coinsurance and a $20 to $200 copay, while outpatient X-rays require a $25 copay, diagnostic radiological services require a minimum $200 copay, and therapeutic radiological services carry a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by McLaren Medicare Inspire (HMO) with no copay and no coinsurance. This benefit ensures you receive essential in-home medical care with zero out-of-pocket costs.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by McLaren Medicare Inspire (HMO) with no coinsurance and no copay, though only some services are covered. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered, carrying copays ranging from $20.00 to $30.00.
Skilled Nursing Facility (SNF) See details
McLaren Medicare Inspire (HMO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
McLaren Medicare Inspire (HMO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture, meal benefits, and Naloxone are not covered under this plan.
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