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University of Michigan Health Advantage Plus (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for University of Michigan Health Advantage Plus (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 Plus (HMO-POS) in 2025, please refer to our full plan details page.
University of Michigan Health Advantage Plus (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 Plus (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 Plus (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 Plus (HMO-POS), 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 $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 Plus (HMO-POS) plan has an "Enhanced Alternative" drug benefit. This plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, you'll pay a $10 copay at a preferred pharmacy and a $20 copay at a standard pharmacy. For non-preferred drugs, you'll pay 33% coinsurance. Once your total drug costs reach $2000, you will enter the next coverage phase.
Additional Benefits
The University of Michigan Health Advantage Plus (HMO-POS) plan provides comprehensive coverage for various healthcare services. This plan covers inpatient hospital stays with a copay of $200 for days 1-7 and no copay for days 8-90, along with outpatient services, including primary care, specialist visits, and mental health services, with copays ranging from $20 to $30. Additional benefits include coverage for ambulance services, emergency services, hearing and vision services, and dental services, each with specific copays or annual maximums. The plan also covers home health services with no copay, skilled nursing facility stays with a copay after 20 days, and offers an over-the-counter allowance of $115 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For days 1-7, there is a $200 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services with the University of Michigan Health Advantage Plus (HMO-POS) plan covers outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital and Observation Services have a $150 copay, while Ambulatory Surgical Center Services have a $100 copay. Individual and Group Sessions for Outpatient Substance Abuse have copays of $30 and $25 respectively.
Partial Hospitalization See details
Partial Hospitalization is covered under the University of Michigan Health Advantage Plus (HMO-POS) plan with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and air ambulance services have a $200 copay, while transportation services to a plan-approved health-related location are covered for up to 30 one-way taxi trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage have a copay of $140, $60, and $140 respectively, with no coinsurance. Worldwide Urgent Coverage also has a $140 copay and no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The University of Michigan Health Advantage Plus (HMO-POS) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, and physician specialist services with a $30 copay. The plan also covers mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits with a copay between $0 and $30, and opioid treatment program services with a $30 copay. However, routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive services include coverage for Medicare-covered preventive services with no copay, annual physical exams with no copay, and other preventive services with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $25 copay, and fitting/evaluation for a hearing aid, with a limit of 1 visit every two years. Prescription hearing aids are covered, with a maximum benefit of $1500 every two years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $30 copay, and other eye exam services with a $39 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, are covered, with a combined maximum benefit of $400 per year. Upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $30 copay, and other dental services with a $2,000 annual maximum. Oral exams, dental x-rays, cleaning, and fluoride treatments are covered, with limitations on the number of visits per year. Orthodontic Services are covered, subject to a $75 deductible. Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), and Oral and Maxillofacial Surgery are covered with varying coinsurance. 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 a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetics/Medical Supplies with 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $10, Diagnostic Radiological Services with a maximum copay of $100, Therapeutic Radiological Services with a $25 copay, and Outpatient X-Ray Services with a $35 copay, while Lab Services are not covered. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered 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 Plus (HMO-POS) plan, but 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, and Additional Cardiac Rehabilitation Services are not covered. There is a copay for these services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the University of Michigan Health Advantage Plus (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, but there is a $150 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and Non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $115 every three months, and it also includes other services that are not covered. 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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