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McLaren Medicare Inspire Flex (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for McLaren Medicare Inspire Flex (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on McLaren Medicare Inspire Flex (HMO-POS) in 2025, please refer to our full plan details page.
McLaren Medicare Inspire Flex (HMO-POS) is a HMO-POS 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 Flex (HMO-POS) 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 Flex (HMO-POS).
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 Flex (HMO-POS), 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 combined Maximum Out-Of-Pocket cost of $10000.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
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 Flex (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays depending on the drug tier and pharmacy. For example, you'll pay $12 for preferred generic drugs at a standard pharmacy and $100 for preferred brand drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The McLaren Medicare Inspire Flex (HMO-POS) plan offers a range of benefits with varying costs. You'll pay a copay for inpatient hospital stays, outpatient services, and ambulance services, with no copay for home health services. The plan also covers preventive services with no copay, as well as hearing, vision, and dental services with copays and coinsurance for some services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $200 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will pay a $200 copay for days 1-7, and no copay for days 8-60. Additional Days for Inpatient Hospital Psychiatric, Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, and Upgrades for Inpatient Hospital-Acute are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, Ambulatory Surgical Center (ASC) Services, Outpatient Substance Abuse Services, and Outpatient Blood Services, are covered. Outpatient Hospital Services, Observation Services, and ASC Services each have a $150 copay, while Individual and Group Sessions for Outpatient Substance Abuse have a copay between $30 and $30.
Partial Hospitalization See details
Partial Hospitalization is covered by the McLaren Medicare Inspire Flex (HMO-POS) plan, with a $80 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $200 copay for both ground and air ambulance services. Transportation Services to plan-approved health-related locations are covered for up to 20 one-way trips per year, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the McLaren Medicare Inspire Flex (HMO-POS) plan with a $100 copay, and no coinsurance. Urgently Needed Services have a $50 copay, and no coinsurance. Worldwide Emergency Coverage has a $100 copay, with no coinsurance, while Worldwide Urgent Coverage has a $50 copay, and no coinsurance; however, Worldwide Emergency Transportation is not covered.
Primary Care See details
The McLaren Medicare Inspire Flex (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $30 copay, physician specialist services with a copay between $0 and $30, and mental health specialty services with a $30 copay for individual and group sessions. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a $0-$30 copay and 20% coinsurance. The plan also covers opioid treatment program services with a $30 copay. Podiatry services are not covered, and routine chiropractic care is not covered.
Preventive Services See details
The McLaren Medicare Inspire Flex (HMO-POS) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services, such as Personal Emergency Response System (PERS), Alternative Therapies, Nutritional/Dietary Benefit (6 visits), Enhanced Disease Management, and Fitness Benefit (Memory Fitness, $200 maximum), are also covered. However, the plan does not cover Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), 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.
Hearing Services See details
Hearing Services include routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $699 and $999 every two years, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes eye exams with a $30 copay, and eyewear with a combined maximum benefit of $225 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $30 copay, as well as other services like Oral Exams (2 visits per year) and Dental X-Rays (1 per year) with no copay. Restorative Services have a 50% coinsurance, while Periodontics and Oral and Maxillofacial Surgery have a coinsurance between 0% and 50%. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered by the McLaren Medicare Inspire Flex (HMO-POS) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical equipment is covered, with 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, and Medical Supplies. Diabetic Therapeutic Shoes/Inserts are covered with a 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for diagnostic procedures/tests, with a copay ranging from $10 to $175, and diagnostic radiological services with a maximum copay of $175. Therapeutic radiological services have a minimum copay of $25, and outpatient X-ray services have a copay of $35. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the McLaren Medicare Inspire Flex (HMO-POS) plan 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 not covered by the McLaren Medicare Inspire Flex (HMO-POS) plan. This includes 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the McLaren Medicare Inspire Flex (HMO-POS) plan, but require prior authorization. There is 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 include coverage for over-the-counter (OTC) items with a maximum benefit of $140 every three months, and nicotine replacement therapy (NRT) is covered. However, acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, private duty nursing services, and other services are not covered.
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