This is an HMO-POS plan. HMO stands for health maintenance organization. It's a group of health care professionals that provide services to members. You choose a primary care physician from your network who coordinates all your care and refers you to specialists. In most cases, we don’t cover care you get outside our network except in an emergency.

POS stands for point of service. It means you can get care from doctors outside of Michigan under certain conditions. Find a doctor in this plan's network.

Includes services such as:
• Welcome to Medicare exam
• Personalized prevention plan services
• Bone mass measurement
• Screenings for cancer, glaucoma, depression, diabetes and sexually transmitted infections
• Immunizations (including flu, pneumonia and Hepatitis B vaccines)
• Screening mammograms
• Pap smears
• Behavioral counseling to reduce alcohol misuse
• Behavioral therapy for cardiovascular disease and obesity

You pay $0

Primary care physician: You pay a $0 copay after deductible.

Specialist: You pay a $45 copay after deductible.

Medical: You pay a $0 copay after deductible.
Behavioral health: You pay a $40 copay after deductible.

Ambulatory surgical center: You pay a $100 copay after deductible.

Hospital: You pay a $225 copay after deductible.

Doctor's office: You pay a $50 copay after deductible.

Days 1-6: You pay a $285 copay per day after deductible.

Days 7-90: You pay $0 after deductible.

You're covered for up to 100 days each benefit period at a Medicare-certified facility.

Days 1-20: You pay $0 after deductible.

Days 21-100: You pay a $178 copay per day after deductible.

You pay a $45 copay.

You pay a $90 copay.

You pay a $45 copay.

There's a combined $50,000 lifetime limit for emergency and urgent care services received outside the U.S. and its territories.

You pay a $90 copay.

There's a combined $50,000 lifetime limit for emergency and urgent care services received outside the U.S. and its territories.

You pay 20% of the cost after deductible.

Durable medical equipment must be received through a Northwood Inc. provider.

You pay a $230 copay after deductible.

Spinal manipulation: You pay a $20 copay after deductible.

Annual exam: You pay a $45 copay after deductible.

Annual X-ray: You pay a $20 copay after deductible.

You pay a $45 copay after deductible.

Includes individual and group therapy visits.

You pay a $40 copay after deductible.

You pay a $30 copay after deductible.

You pay 20% of the cost after deductible.

This plan has a $200 pharmacy deductible for Tiers 2-5. You pay full price for drugs before you meet the deductible, except for Tiers 1 and 6, which have no deductible. You can save by going to a preferred pharmacy in our network. Check out the example of what you'll pay for a one-month supply at a preferred pharmacy compared with a standard pharmacy.

Commonly prescribed generic versions of brand medications. You’ll pay the least for these drugs at the pharmacy.

Preferred pharmacy: You pay $3.

Standard pharmacy: You pay $9.

Although you’ll pay more at the pharmacy for these generic drugs, they're more cost-effective than brand medications.

Preferred pharmacy: You pay $11 after deductible.

Standard pharmacy: You pay $20 after deductible.

Brand drugs that aren’t available yet as a generic.

Preferred pharmacy: You pay $42 after deductible.

Standard pharmacy: You pay $47 after deductible.

Because there are alternatives for the drugs in this tier, you’ll pay more for them at the pharmacy.

Preferred pharmacy: You pay 50% of the cost after deductible.

Standard pharmacy: You pay 50% of the cost after deductible.

Specialty drugs are used to treat complex conditions like cancer and multiple sclerosis. Although they can be generic or brand, they usually need special handling and approval. You may have to order them through a specialty pharmacy.

Preferred pharmacy: You pay 29% of the cost after deductible.

Standard pharmacy: You pay 29% of the cost after deductible.

Select care drugs are generic drugs used to treat diabetes and high cholesterol.

Preferred pharmacy: You pay $0.

Standard pharmacy: You pay $5.

Tier 6 generic drugs: $0 at a preferred pharmacy, $5 at a standard pharmacy
All other drugs: You pay 25% of the cost.

Generic drugs: You pay a $3.60 copay or 5% of the cost, whichever is greater.
Other drugs: You pay an $8.95 copay or 5% of the cost, whichever is greater.

This plan covers these preventive services for $0 copay in network:

• Two oral exams every year
• Two routine cleanings every year
• Up to four bitewing x-rays or up to six periapical films every other calendar year
• Original Medicare covered dental care services are covered with a copay of $0-$225 depending on place of service.

What's not covered:

• Dental procedures like fillings, crowns, root canals and simple extractions
• Fluoride treatments

Add more dental, vision and hearing coverage for an additional cost.

You can choose from any provider from the VSP Choice network.

This plan covers these benefits for $0 copay:
• One routine eye exam every year
• A diabetic retinopathy exam
• One pair of Medicare-covered glasses or contact lenses after cataract surgery.

This plan also covers:
• Medicare-covered exam for a $45 copay.

What's not covered:
• Glasses or contact lenses
• LASIK or RK (radial keratotomy) surgery

Add more dental, vision and hearing coverage for an additional cost.

You pay:

• $0 to $45 for Medicare-covered diagnostic only hearing exams. These are tests your doctor orders for you to see if you need medical treatment. Your primary care physician or specialist copay applies.

What's not covered:

• Routine hearing exams
• Hearing aids or exams for fitting hearing aids

Add more dental, vision and hearing coverage for an additional cost.

This document lists important features and rules for this plan.

• Summary of Benefits (PDF)

This booklet explains how to use this plan's benefits. It also lists some of the things this plan doesn't cover.

• Evidence of Coverage (PDF)

This brochure gives you an overview of all our Medicare Advantage plans to help you compare.

• 2020 Medicare Advantage Plans Comparison Guide (PDF)

Find a doctor or hospital in this plan's network:

• Find a doctor

Find a pharmacy in this plan's network:

• Find a pharmacy

This map shows you the counties where BCN Advantage plans are available.

• BCN Advantage Service Area (PDF)

If you meet certain income and resource limits, you may qualify for help paying for your prescription drug costs through the low-income subsidy.

If you're eligible, see what your monthly premium would be:

• BCN Advantage Low-Income Subsidy Table (PDF)

The easiest way to enroll in this plan is online. Or call us at 1-888-563-3307. TTY users call 711. You can also print, fill out and mail this paper application.

• Enrollment Application Form (PDF)

Visit our Help section.