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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 $49.00. 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. In the initial coverage phase, you will pay varying copays or coinsurance amounts depending on the drug tier and pharmacy used. For example, you may pay a $12 copay for a preferred generic drug at a standard pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, your monthly Part D premium will be reduced to $22.40.
Additional Benefits
The McLaren Medicare Inspire Flex (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital care with varying copays. It covers ambulance services with a $220 copay for ground and air, and offers transportation to health-related locations with limits. The plan also provides coverage for primary care, preventive services, hearing exams, and vision services. Additional benefits include dental coverage, home infusion, dialysis, and medical equipment with coinsurance requirements. The plan also covers diagnostic and radiological services with copays, home health services, and skilled nursing facility stays. There is a benefit for over-the-counter items, and there is a fitness benefit.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $200 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you pay a $200 copay for days 1-7, and no copay for days 8-60.
Outpatient Services See details
Outpatient Services, offered by McLaren Medicare Inspire Flex (HMO-POS), covers all outpatient hospital services with a $200 copay, observation services with a $150 copay, and ambulatory surgical center services with a $150 copay. Outpatient substance abuse services include individual and group sessions, each with a copay between $25 and $25, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the McLaren Medicare Inspire Flex (HMO-POS) plan, with a copay of $80.00 and prior authorization required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with no coinsurance for all services. Ground and air ambulance services have a $220 copay. Transportation services to a plan-approved health-related location are covered for up to 20 one-way trips per year, using rideshares, buses, vans, medical transport, and other methods; transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage all have a copay, with copays of $100, $50, and $100 respectively, and no coinsurance. 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 $25 copay, physician specialist services with a $0-$25 copay, mental health specialty services with a $25 copay, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a 20% coinsurance and a $0-$30 copay, and opioid treatment program services with a $25 copay. Podiatry services are not covered. 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 and additional preventive services, with no copay. The plan also covers Personal Emergency Response System (PERS), Re-admission Prevention, Alternative Therapies, Nutritional/Dietary Benefit (6 visits), Enhanced Disease Management, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. 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 are not covered. The plan also covers a Fitness Benefit with a maximum plan benefit coverage amount of $200.00 per year.
Hearing Services See details
Hearing Services include routine hearing exams with a $30 copay, fitting/evaluation for hearing aids, and prescription hearing aids. Prescription hearing aids (all types) are covered with a copay between $699 and $999, and are limited to 2 every two years. However, prescription hearing aids for the 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 include coverage for eye exams with a $30 copay, and eyewear with a combined maximum benefit of $200 every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for oral exams with a $30 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), and fluoride treatments. Restorative Services have a 50% coinsurance, while Oral and Maxillofacial Surgery has 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 insulin with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the McLaren Medicare Inspire Flex (HMO-POS) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical equipment benefits are covered, with Durable Medical Equipment (DME) requiring 20% coinsurance, and Prosthetic Devices, and Medical Supplies requiring 20% coinsurance. Diabetic Therapeutic Shoes/Inserts also requires 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, with a minimum copay of $20 and a maximum copay of $225 for Diagnostic Procedures/Tests, and a minimum copay of $125 and a maximum copay of $225 for Diagnostic Radiological Services. Therapeutic Radiological Services have a minimum copay of $25, and Outpatient X-Ray Services have a $25 copay. 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. 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. While some services are covered, 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 are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by 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 coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services for McLaren Medicare Inspire Flex (HMO-POS) includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $135 every three months, and does not cover 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.
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