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 2025, 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 2025.
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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $4200.00 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:
Sign up for McLaren Medicare Inspire (HMO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The McLaren Medicare Inspire (HMO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay a $12 copay for preferred generic drugs at a standard pharmacy. For non-preferred drugs, you will pay 33% coinsurance. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for Part D covered drugs.
Additional Benefits
The McLaren Medicare Inspire (HMO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $275 copay for the first seven days, with no copay for the remainder of the stay, while outpatient services have copays ranging from $40 to $200. Emergency services have a $100 copay, and ambulance services have a $220 copay. The plan includes no copay for primary care, and offers dental, vision, and hearing benefits with copays for exams and services. It also covers home health services with no copay, and offers an over-the-counter (OTC) benefit with a $140 allowance every three months. Skilled nursing facility (SNF) services have no copay for the first 20 days, and a $214 copay for days 21-100.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-7, the copay is $275, and for days 8-90, there is no copay. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center (ASC) services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services and ASC services have a $200 copay, while observation services have a $150 copay. Individual and group sessions for outpatient substance abuse have a copay between $40 and $40.
Partial Hospitalization See details
Partial Hospitalization is covered by the McLaren Medicare Inspire (HMO) plan, but requires prior authorization. You will have an $80 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $220 copay for both ground and air ambulance services, and no coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 20 one-way trips per year, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered under the McLaren Medicare Inspire (HMO) plan. Emergency Services have a $100 copay, and Urgently Needed Services have a $50 copay, while Worldwide Emergency Services, Worldwide Urgent Coverage and Worldwide Emergency Transportation are not covered.
Primary Care See details
The McLaren Medicare Inspire (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a copay between $0 and $40, and physical therapy and speech-language pathology services with a $25 copay. The plan also covers mental health and psychiatric services, as well as additional telehealth benefits, with various copays depending on the service.
Preventive Services See details
Preventive Services, including annual physical exams, are covered. Additional services such as Health Education, In-Home Safety Assessment, and others are not covered. Some services like Fitness Benefit and Nutritional/Dietary Benefit are covered, but have specific limitations.
Hearing Services See details
Hearing Services are covered by the McLaren Medicare Inspire (HMO) plan, including routine hearing exams with a $40 copay. Prescription hearing aids are covered with a copay between $699 and $999, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services are covered, including routine eye exams with a $40 copay. Eyewear is covered with a combined maximum of $100 per year, while contact lenses and eyeglasses (lenses and frames) are also covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services include coverage for Medicare dental services with a $40 copay, oral exams (2 per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), and fluoride treatment (1 per year). Restorative services have a 50% coinsurance, while oral and maxillofacial surgery has a 0-50% coinsurance; other services such as endodontics, implant services, and prosthodontics are offered as optional supplemental benefits. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the McLaren Medicare Inspire (HMO) plan. The coinsurance for these services is between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies with 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the McLaren Medicare Inspire (HMO) plan, with all diagnostic services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $20.00 and $225.00, while Lab Services are not covered. Diagnostic Radiological Services have a copay between $200.00 and $225.00, Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $25 copay.
Home Health Services See details
Home Health Services are covered by the McLaren Medicare Inspire (HMO) plan with no copay or coinsurance. However, Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the McLaren Medicare Inspire (HMO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by McLaren Medicare Inspire (HMO). For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, as well as non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The McLaren Medicare Inspire (HMO) plan covers over-the-counter (OTC) items with a maximum benefit of $140.00 every three months, including nicotine replacement therapy, but does not cover acupuncture, meal benefits, or several other services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
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.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved