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University of Michigan Health Advantage (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for University of Michigan Health Advantage (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on University of Michigan Health Advantage (HMO-POS) in 2025, please refer to our full plan details page.
University of Michigan Health Advantage (HMO-POS) is a HMO-POS plan offered by University of Michigan Health available for enrollment in 2025 to people living in Central and Southern Michigan. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that University of Michigan Health Advantage (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 University of Michigan Health Advantage (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 University of Michigan Health Advantage (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 Maximum Out-Of-Pocket cost of $5000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $3900.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5000.00 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 University of Michigan Health Advantage (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions. For example, preferred generic drugs have a $10 copay at preferred pharmacies, while standard generic drugs have a $45 copay. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The University of Michigan Health Advantage (HMO-POS) plan offers a range of benefits beyond standard Medicare coverage. This plan includes coverage for inpatient hospital stays with a $200 copay for days 1-7, and no copay for days 8-90, along with various outpatient services like primary care with no copay, and specialist visits. You'll also find coverage for hearing and vision services, dental, and home health services. This plan also includes coverage for ambulance services with a $200 copay, and transportation services with 20 one-way taxi trips per year. Emergency services have a $140 copay. There's also coverage for medical equipment, dialysis, and home infusion bundled services.
Inpatient Hospital See details
Inpatient hospital stays are covered, including services not usually covered by Medicare, with a copay of $200 for days 1-7 and no copay for days 8-90. Additional days for inpatient hospital are covered with no copay, and non-Medicare-covered stays and upgrades are not covered. Inpatient hospital psychiatric stays are also covered with the same cost-sharing structure as inpatient hospital stays.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, have a $150 copay. Ambulatory Surgical Center (ASC) Services have a $100 copay, and outpatient substance abuse services have a $30 copay for individual sessions and a $25 copay for group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay, and prior authorization is required.
Ambulance and Transportation Services See details
The University of Michigan Health Advantage (HMO-POS) plan covers ambulance services with a $200 copay for both ground and air ambulance services, and covers transportation services to plan-approved health-related locations, with 20 one-way taxi trips per year. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Urgently Needed Services, are covered by the University of Michigan Health Advantage (HMO-POS) plan. Emergency Services and Worldwide Emergency Coverage have a $140 copay, while Urgently Needed Services have a $60 copay, and there is no coinsurance for any of these services; Worldwide Emergency Transportation is not covered.
Primary Care See details
The University of Michigan Health Advantage (HMO-POS) 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 $35 copay, mental health specialty services with a $30 copay for individual sessions and a $25 copay for group sessions, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $35, and opioid treatment program services with a $30 copay. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services and annual physical exams. Additional preventive services are partially covered, but do not include health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy (MNT), post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies (including web/phone-based technologies and nursing hotline), home and bathroom safety devices and modifications, and counseling services.
Hearing Services See details
Hearing Services includes coverage for hearing exams with a $25 copay, as well as coverage for routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a maximum plan benefit of $1,000 every two years, but 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
The University of Michigan Health Advantage (HMO-POS) plan covers vision services, including eye exams with a $35 copay, and other eye exam services with a $39 copay. The plan also covers eyewear, with a combined maximum benefit of $200 per year, and covers contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Upgrades are not covered.
Dental Services See details
Dental Services includes coverage for Medicare dental services with a $35 copay, as well as other dental services up to a $1,000 annual maximum. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, but have limits on the number of visits. Orthodontic services have a $100 deductible, while restorative services, adjunctive general services, endodontics, periodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with varying coinsurance, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B insulin drugs, there is a $35 copay and the coinsurance is between 0% and 20%. For Medicare Part B chemotherapy/radiation drugs and other Medicare Part B drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the University of Michigan Health Advantage (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, is covered by the University of Michigan Health Advantage (HMO-POS) plan. DME has a 20% coinsurance, and Prosthetic Devices and Medical Supplies also have a 20% coinsurance, with no copay for either. Diabetic Equipment coverage is available, but Diabetic Supplies are not covered, and a 20% coinsurance applies to Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services include coverage for all diagnostic procedures/tests with a copay between $0 and $10, and diagnostic radiological services with a copay up to $100. Therapeutic radiological services have a $25 copay, and outpatient X-ray services have a $35 copay. Lab services are not covered.
Home Health Services See details
Home Health Services are covered by the University of Michigan Health Advantage (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 covered by the University of Michigan Health Advantage (HMO-POS) plan, but the plan does not cover the specific services of 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. There is a copay for these services, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the University of Michigan Health Advantage (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, while days 21-100 have a $150 copay.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with an $85 maximum benefit every three months, including Nicotine Replacement Therapy and Naloxone coverage. Acupuncture, Meal Benefit, 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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