A non-government entity
McLaren Medicare Inspire Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for McLaren Medicare Inspire Plus (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 Plus (HMO) in 2026, please refer to our full plan details page.
McLaren Medicare Inspire Plus (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 Plus (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 Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $8.80. 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 $500.00 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 $5900.00 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 Plus (HMO) prescription drug plan features an annual drug deductible of $500. Enrollees benefit from no copay on Tier 1 preferred generic and Tier 6 select care drugs at standard pharmacies and through standard mail order. Tier 2 generic medications are available for a $12 copay for a one-month supply at standard pharmacies, or a $27 copay for a three-month standard mail-order supply. For brand-name and specialty medications, costs are based on coinsurance. Tier 3 preferred brand drugs and Tier 5 specialty drugs both require a 25% coinsurance at standard pharmacies. Tier 4 non-preferred brand drugs have a 40% coinsurance, which applies to both standard retail and mail-order fills.
Additional Benefits
The McLaren Medicare Inspire Plus (HMO) plan offers comprehensive medical coverage with no copay or coinsurance for primary care visits and routine preventive services. Specialist visits require up to a $35 copay, while inpatient hospital stays are covered with a $550 daily copay for the first five days and no copay for unlimited additional days. Emergency room visits carry a $115 copay, which is waived if you are admitted, and urgent care services require a $40 copay. This plan also features valuable additional benefits, including no copay for home health services, over-the-counter items, and preventive dental care. Routine vision and hearing exams are available for a $35 copay, and the plan covers up to 20 one-way transportation trips to approved locations with no copay. Comprehensive dental services are covered up to a $1,500 annual limit with no copay and coinsurance ranging from 0% to 50%.
Inpatient Hospital See details
McLaren Medicare Inspire Plus (HMO) covers inpatient acute hospital stays with no coinsurance and a $550 daily copay for days 1 to 5, followed by no copay for unlimited additional days, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric hospital stays are also covered with no coinsurance and a $465 daily copay for days 1 to 5, then no copay for days 6 to 90, while additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
McLaren Medicare Inspire Plus (HMO) covers outpatient services with no coinsurance, featuring a $150 copay for outpatient hospital, observation, and ambulatory surgical center services. Outpatient substance abuse sessions require a $35 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
McLaren Medicare Inspire Plus (HMO) covers partial hospitalization services with an $80 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
McLaren Medicare Inspire Plus (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance per trip. Transportation services are partially covered, providing up to 20 one-way trips per year to plan-approved locations with no copay or coinsurance, while transportation to any other health-related location is not covered.
Emergency Services See details
McLaren Medicare Inspire Plus (HMO) covers emergency services with a $115 copay (waived if admitted) and no coinsurance, 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 similar copays and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
McLaren Medicare Inspire Plus (HMO) covers primary care provider services with no copay and no coinsurance, and specialist visits with a $0 to $35 copay and no coinsurance. Outpatient therapies and mental health services require a $25 to $35 copay and no coinsurance, while podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not covered.
Preventive Services See details
McLaren Medicare Inspire Plus (HMO) covers preventive services, including annual physicals and kidney disease education, with no copay and no coinsurance. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, chemotherapy wigs, weight management, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, remote access, home/bathroom safety modifications, and counseling.
Hearing Services See details
Hearing services are partially covered by McLaren Medicare Inspire Plus (HMO), featuring routine annual exams for a $35 copay and no coinsurance, and up to two prescription hearing aids every two years for a $699 to $999 copay and no coinsurance. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription hearing aids, are not covered.
Vision Services See details
McLaren Medicare Inspire Plus (HMO) provides partially covered vision services with no deductibles, offering routine eye exams for a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is also partially covered with no copay and no coinsurance for contact lenses and complete eyeglasses, but individual eyeglass lenses, frames, and upgrades are excluded.
Dental Services See details
McLaren Medicare Inspire Plus (HMO) partially covers dental services up to a $1,500 annual limit, though other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered. Medicare-covered dental has a $35 copay and no coinsurance, while covered preventive care like exams, cleanings, and x-rays has no copay and no coinsurance. Comprehensive services such as restorative care, periodontics, and oral surgery are covered with no copay and 0% to 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by McLaren Medicare Inspire Plus (HMO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from no coinsurance up to 20%, while Medicare Part B insulin drugs require a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered by McLaren Medicare Inspire Plus (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
McLaren Medicare Inspire Plus (HMO) partially covers medical equipment with no copay and a 20% coinsurance, subject to prior authorization. Under this plan, durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts are covered, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
McLaren Medicare Inspire Plus (HMO) covers diagnostic and radiological services with prior authorization, though lab services are not covered. Diagnostic tests require a $20 to $150 copay with no coinsurance, diagnostic radiology has a minimum $300 copay with no coinsurance, outpatient x-rays cost a $25 copay plus coinsurance, and therapeutic radiology requires a copay and a minimum 20% coinsurance.
Home Health Services See details
McLaren Medicare Inspire Plus (HMO) covers home health services with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by McLaren Medicare Inspire Plus (HMO) with no coinsurance and a $20 copay. This copayment applies to cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by McLaren Medicare Inspire Plus (HMO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard 100 days are not covered.
Other Services See details
McLaren Medicare Inspire Plus (HMO) partially covers Other Services, which includes over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture and meal benefits are not covered under this plan.
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