2023 BCN AdvantageSM HMO-POS Classic
This Blue Care Network plan provides great coverage at a reasonable price. It offers lower out-of-pocket costs for things like office visits and prescriptions.
NETWORK SIZE
MONTHLY PREMIUM
$$
MEDICAL DEDUCTIBLE
In network: $0
Point of service: $500
$0.00 monthly payment for 48002
In-network services: $0
Point of service: $500
$0
$3,800
Optional supplemental benefits don't count toward your out-of-pocket maximum.
You pay $0.
You pay $35.
You pay $0-$40.
Starts at $0 for certain generic drugs filled at a preferred pharmacy. Certain drugs may cost more if you choose a pharmacy in our standard network.
See if this plan covers your medication. Find your prescription (PDF).
All benefits required by Original Medicare and more, including:
• $0 telehealth visits for primary care and behavioral health
• Advantage Dollars quarterly allowance for over-the-counter drugs and health products with rollover within the calendar year
• Hearing aid allowance every three years
• Annual allowance for preventive and comprehensive dental
• Annual allowance for vision items
• Worldwide emergency, urgent care and transportation coverage
• Meals benefit following hospital discharge for qualifying members
• One round trip per calendar year to an Annual Wellness Visit within the state of Michigan
• Transportation benefit for certain counties following hospital discharge
• SilverSneakers® fitness program
• MyBlueSM Concierge program
• Coverage while traveling outside of Michigan with the nationwide network of Blue Plan Providers.
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.
Specialist: You pay a $35 copay.
Primary care physician: You pay a $0 copay.
Behavioral health: You pay a $0 copay.
Ambulatory surgical center: You pay a $0-$95 copay.
Hospital: You pay a $0- $225 copay.
Days 1-6: You pay a $225 copay per day.
Days 7-90: You pay $0.
Days 90 & beyond: You pay $0.
You're covered for up to 100 days each benefit period at a Medicare-certified facility.
Days 1-20: You pay $0.
Days 21-100: You pay a $188 copay per day.
You pay a $0-$40 copay.
You pay a $90 copay.
You pay a $40 copay.
There's a combined $50,000 lifetime limit for emergency, urgent care services and worldwide transportation received outside the U.S. and its territories.
You pay a $90 copay.
There's a combined $50,000 lifetime limit for emergency, urgent care services and worldwide transportation received outside the U.S. and its territories.
You pay a $250 copay.
There's a combined $50,000 lifetime limit for emergency, urgent care services and worldwide transportation received outside the U.S. and its territories.
You pay 20% of the cost.
You pay a $250 copay.
Spinal manipulation: You pay a $15copay.
Annual exam: You pay a $35 copay.
Annual X-ray: You pay a $20 copay.
You pay a $35 copay.
Includes individual and group therapy visits.
You pay a $20 copay.
You pay a $30 copay.
You pay 20% of the cost.
Commonly prescribed generic versions of brand medications. You’ll pay the least for these drugs at the pharmacy.
Preferred pharmacy: You pay $0.
Standard pharmacy: You pay $5.
Although you’ll pay more at the pharmacy for these generic drugs, they're more cost-effective than brand medications.
Preferred pharmacy: You pay $7.
Standard pharmacy: You pay $12.
Brand drugs that aren’t available yet as a generic.
Preferred pharmacy: You pay $38.
Standard pharmacy: You pay $43.
Because there are alternatives for the drugs in this tier, you’ll pay more for them at the pharmacy.
Preferred pharmacy: You pay 45% of the cost.
Standard pharmacy: You pay 45% of the cost.
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 33% of the cost.
Standard pharmacy: You pay 33% of the cost.
Tier 1: You also receive some coverage for generic drugs. You pay no more than 25% of the cost for generic drugs and the plan pays the rest.
All other drugs: You pay 25% of the cost.
Generic drugs: You pay a $4.15 copay or 5% of the cost, whichever is greater.
Other drugs: You pay a $10.35 copay or 5% of the cost, whichever is greater.
The benefit provides a $1,500 annual maximum for combined in-network and out-of-network dental services per calendar year.
This plan covers the following dental services for $0 copay in-network and 50% coinsurance out-of-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
• Fluoride treatments
• Brush biopsies
• Resin and amalgam fillings
• Crowns
• Crown repairs
• Root canals
• Deep cleanings
• Extractions
• Oral surgery
• 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 dentures, onlays and implants
Add more dental and vision coverage for an additional cost.
This plan covers these benefits for $0 copay:
• One routine eye exam every year.
• If you have cataract surgery, you're covered for one pair of eyeglasses (lenses and frames) or contact lenses.
• Diabetic retinopathy eye exam
• We'll pay up to $150 every 12 months for elective contacts or one frame with no copay.
• Standard eyeglass lenses are covered in full every 12 months.
• Limitations may apply.
• You can choose any provider from the VSP Choice network.
This plan also covers Medicare-covered exams. You'll just have a $35 copay.
• Diabetic Retinopathy Eye Exam has a $0 copay.
What's not covered:
• LASIK or RK (radial keratotomy) surgery
Add more dental and vision coverage for an additional cost.
You pay:
• $0 for one hearing aid fitting and evaluation every three years
• $0 to $35 copay for one routine hearing exam each year depending on place of service
• $0 to $35 copay for Medicare-covered diagnostic hearing exams
• New standard hearing aids every three years. We'll cover up to $600 per ear.
How this compares:
• This plan offers more hearing coverage than Original Medicare.
Add more dental and vision 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.
This brochure gives you an overview of all our Medicare Advantage plans to help you compare.
Find a doctor or hospital in this plan's network:
Find a pharmacy in this plan's network:
This map shows you the counties where BCN Advantage plans are available.
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:
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.
In-network services: $0
Point of service: $500
$0
$3,800
Optional supplemental benefits don't count toward your out-of-pocket maximum.
You pay $0.
You pay $35.
You pay $0-$40.
Starts at $0 for certain generic drugs filled at a preferred pharmacy. Certain drugs may cost more if you choose a pharmacy in our standard network.
See if this plan covers your medication. Find your prescription (PDF).
All benefits required by Original Medicare and more, including:
• $0 telehealth visits for primary care and behavioral health
• Advantage Dollars quarterly allowance for over-the-counter drugs and health products with rollover within the calendar year
• Hearing aid allowance every three years
• Annual allowance for preventive and comprehensive dental
• Annual allowance for vision items
• Worldwide emergency, urgent care and transportation coverage
• Meals benefit following hospital discharge for qualifying members
• One round trip per calendar year to an Annual Wellness Visit within the state of Michigan
• Transportation benefit for certain counties following hospital discharge
• SilverSneakers® fitness program
• MyBlueSM Concierge program
• Coverage while traveling outside of Michigan with the nationwide network of Blue Plan Providers.
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.
Specialist: You pay a $35 copay.
Primary care physician: You pay a $0 copay.
Behavioral health: You pay a $0 copay.
Ambulatory surgical center: You pay a $0-$95 copay.
Hospital: You pay a $0- $225 copay.
Days 1-6: You pay a $225 copay per day.
Days 7-90: You pay $0.
Days 90 & beyond: You pay $0.
You're covered for up to 100 days each benefit period at a Medicare-certified facility.
Days 1-20: You pay $0.
Days 21-100: You pay a $188 copay per day.
You pay a $0-$40 copay.
You pay a $90 copay.
You pay a $40 copay.
There's a combined $50,000 lifetime limit for emergency, urgent care services and worldwide transportation received outside the U.S. and its territories.
You pay a $90 copay.
There's a combined $50,000 lifetime limit for emergency, urgent care services and worldwide transportation received outside the U.S. and its territories.
You pay a $250 copay.
There's a combined $50,000 lifetime limit for emergency, urgent care services and worldwide transportation received outside the U.S. and its territories.
You pay 20% of the cost.
You pay a $250 copay.
Spinal manipulation: You pay a $15copay.
Annual exam: You pay a $35 copay.
Annual X-ray: You pay a $20 copay.
You pay a $35 copay.
Includes individual and group therapy visits.
You pay a $20 copay.
You pay a $30 copay.
You pay 20% of the cost.
Commonly prescribed generic versions of brand medications. You’ll pay the least for these drugs at the pharmacy.
Preferred pharmacy: You pay $0.
Standard pharmacy: You pay $5.
Although you’ll pay more at the pharmacy for these generic drugs, they're more cost-effective than brand medications.
Preferred pharmacy: You pay $7.
Standard pharmacy: You pay $12.
Brand drugs that aren’t available yet as a generic.
Preferred pharmacy: You pay $38.
Standard pharmacy: You pay $43.
Because there are alternatives for the drugs in this tier, you’ll pay more for them at the pharmacy.
Preferred pharmacy: You pay 45% of the cost.
Standard pharmacy: You pay 45% of the cost.
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 33% of the cost.
Standard pharmacy: You pay 33% of the cost.
Tier 1: You also receive some coverage for generic drugs. You pay no more than 25% of the cost for generic drugs and the plan pays the rest.
All other drugs: You pay 25% of the cost.
Generic drugs: You pay a $4.15 copay or 5% of the cost, whichever is greater.
Other drugs: You pay a $10.35 copay or 5% of the cost, whichever is greater.
The benefit provides a $1,500 annual maximum for combined in-network and out-of-network dental services per calendar year.
This plan covers the following dental services for $0 copay in-network and 50% coinsurance out-of-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
• Fluoride treatments
• Brush biopsies
• Resin and amalgam fillings
• Crowns
• Crown repairs
• Root canals
• Deep cleanings
• Extractions
• Oral surgery
• 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 dentures, onlays and implants
Add more dental and vision coverage for an additional cost.
This plan covers these benefits for $0 copay:
• One routine eye exam every year.
• If you have cataract surgery, you're covered for one pair of eyeglasses (lenses and frames) or contact lenses.
• Diabetic retinopathy eye exam
• We'll pay up to $150 every 12 months for elective contacts or one frame with no copay.
• Standard eyeglass lenses are covered in full every 12 months.
• Limitations may apply.
• You can choose any provider from the VSP Choice network.
This plan also covers Medicare-covered exams. You'll just have a $35 copay.
• Diabetic Retinopathy Eye Exam has a $0 copay.
What's not covered:
• LASIK or RK (radial keratotomy) surgery
Add more dental and vision coverage for an additional cost.
You pay:
• $0 for one hearing aid fitting and evaluation every three years
• $0 to $35 copay for one routine hearing exam each year depending on place of service
• $0 to $35 copay for Medicare-covered diagnostic hearing exams
• New standard hearing aids every three years. We'll cover up to $600 per ear.
How this compares:
• This plan offers more hearing coverage than Original Medicare.
Add more dental and vision 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.
This brochure gives you an overview of all our Medicare Advantage plans to help you compare.
Find a doctor or hospital in this plan's network:
Find a pharmacy in this plan's network:
This map shows you the counties where BCN Advantage plans are available.
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:
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.
You can add an optional supplemental package to your Medicare Advantage plan for an additional monthly cost.
This package will enhance your dental and vision benefits.