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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 2025, 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 2025.
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 $25.00. 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 $3500.00 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) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you may pay a $12 copay for preferred generic drugs at a standard pharmacy, or 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2,000, you will enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The McLaren Medicare Inspire Plus (HMO) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay of $225 for the first 7 days, and no copay for the remaining days. The plan also covers outpatient services, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, medical equipment, diagnostic and radiological services, home health, cardiac rehabilitation, and skilled nursing facility services. This plan includes copays for many services, such as emergency and urgently needed services, and outpatient services. The plan also offers additional benefits like transportation, OTC items, and coverage for hearing aids and eyewear.
Inpatient Hospital See details
Inpatient Hospital benefits, including acute and psychiatric, are covered under the McLaren Medicare Inspire Plus (HMO) plan. For inpatient hospital-acute stays, you will pay a $225 copay for days 1-7, and no copay for days 8-90; inpatient hospital-psychiatric stays also have a $225 copay for days 1-7, and no copay for days 8-90. Additional days for inpatient hospital-acute are covered, but non-Medicare-covered stays and upgrades for inpatient hospital-acute are not covered, and additional days and non-Medicare-covered stays for inpatient hospital-psychiatric are also not covered.
Outpatient Services See details
Outpatient Services are covered by the McLaren Medicare Inspire Plus (HMO) plan, including outpatient hospital services with a $200 copay, observation services with a $150 copay, ambulatory surgical center services with a $150 copay, outpatient substance abuse services with a $25 copay for both individual and group sessions, and outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered by the McLaren Medicare Inspire Plus (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 by the McLaren Medicare Inspire Plus (HMO) plan, with a $220 copay for both ground and air ambulance services. Transportation to plan-approved health-related locations is 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, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the McLaren Medicare Inspire Plus (HMO) plan. Emergency Services have a $100 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage has a $100 copay; all have no coinsurance. Worldwide Emergency Transportation is not covered under this plan.
Primary Care See details
The McLaren Medicare Inspire Plus (HMO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, while individual and group sessions for mental health specialty and psychiatric services have a $25 copay. Occupational therapy services have a $25 copay. Physician specialist services have a copay between $0 and $25. Physical therapy and speech-language pathology services have a $25 copay. Additional telehealth benefits have a 20% coinsurance and a copay between $0 and $25. Opioid treatment program services have a copay of $25. Routine chiropractic care is not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered services, annual physical exams, additional preventive services, kidney disease education, and other preventive services, though health education, in-home safety assessment, medical nutrition therapy, post discharge in-home medication reconciliation, wigs for hair loss related to chemotherapy, weight management programs, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers personal emergency response systems, re-admission prevention, alternative therapies, a nutritional/dietary benefit (6 visits), an enhanced disease management program, and a fitness benefit (memory fitness, $200 maximum benefit).
Hearing Services See details
Hearing Services, including hearing exams and routine hearing exams, are covered by the McLaren Medicare Inspire Plus (HMO) plan. Hearing exams have a $25 copay, and prescription hearing aids (all types) are covered with a copay between $699 and $999; however, prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including routine eye exams with a $25 copay. Eyewear is covered with a combined maximum benefit of $200 every year, and Contact Lenses and Eyeglasses (lenses and frames) are covered. However, Eyeglass lenses, Eyeglass frames, and Upgrades are not covered.
Dental Services See details
The McLaren Medicare Inspire Plus (HMO) plan covers dental services, including oral exams with a $25 copay, dental x-rays, and cleanings, each with limitations on the number of visits per year. Restorative Services have a 50% coinsurance, and Oral and Maxillofacial Surgery has a 0-50% coinsurance, while the plan does not cover Maxillofacial Prosthetics and Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the McLaren Medicare Inspire Plus (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment, is covered under the McLaren Medicare Inspire Plus (HMO) plan. DME and Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance; however, 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, including diagnostic procedures and tests with a copay between $20 and $225, and diagnostic radiological services with a copay between $150 and $225. Therapeutic radiological services have a 20% coinsurance, and outpatient X-ray services have a $25 copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the McLaren Medicare Inspire Plus (HMO) plan. However, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the McLaren Medicare Inspire Plus (HMO) plan, with a prior authorization required. You will have no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services offered by McLaren Medicare Inspire Plus (HMO) include Over-the-Counter (OTC) Items, with a maximum benefit of $145 every three months, and nicotine replacement therapy is available as a Part C OTC benefit. Acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, 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, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, 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.
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