2027 Medicare Advantage plan

BCN Advantage ConnectedCare (HMO): 2027 benefits and costs

Blue Care Network HMO

CMS plan ID: H5883-007-0 · Plan year: 2027

BCN Advantage ConnectedCare (HMO) is a 2027 Medicare Advantage plan offered by Blue Care Network. It is listed in Michigan.

2027 plan costs at a glance

Monthly plan premium$50.00

Drug deductible$100.00

In-network medical out-of-pocket maximum$4,800.00

Organization: Blue Care Network
Plan organization: BLUE CARE NETWORK OF MICHIGAN
Parent company: Blue Cross Blue Shield of Michigan Mutual Ins. Co.
Plan type: HMO
Part C premium: $50.00
Part D premium: $0.00
Prescription drug coverage: Yes
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
In-network medical maximum: $4,800.00

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	What to know
Primary care doctor	$0 Service-specific deductible No
Specialist visit	$35.00 copay Service-specific deductible No	Approval required Yes Referral required No
Telehealth	$0 Service-specific deductible No	Approval required No Referral required No
Emergency care	$130.00 copay
Urgent care	$0.00 to $45.00 copay
Home health	$0 Service-specific deductible No	Approval required Yes Referral required No
Dialysis	20% coinsurance Service-specific deductible No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	Approval required Yes
Kidney disease education services	$0 Service-specific deductible No	Approval required No Referral required No
Medicare-covered chiropractic	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No
Medicare-covered foot care	$35.00 copay Service-specific deductible No	Approval required Yes Referral required No
Other health professionals	$0.00 to $35.00 copay Service-specific deductible No	Approval required Yes Referral required No

Hospital, outpatient surgery and observation care

Inpatient stays and skilled nursing care

In-network stays. Charges can depend on the number of days and the benefit period.
Care	Your share of the cost	What to know
Inpatient hospital stay	$0.00 copay per stay Days 1–7: $325.00 copay per day Days 8–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Inpatient mental health care	$0.00 copay per stay Days 1–7: $275.00 copay per day Days 8–90: $0.00 copay per day	Approval required Yes Referral required No Benefit period Per Admission or Per Stay
Skilled nursing facility	Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day	Approval required Yes Referral required No Benefit period Original Medicare

See plan documents for out-of-network hospital and skilled nursing costs.

Hospital, outpatient surgery and observation care and member costs
Service	In-network	What to know
Outpatient hospital care	$225.00 copay Service-specific deductible No
Hospital observation services	$130.00 copay Service-specific deductible No
Ambulatory surgical center	$0.00 to $100.00 copay Service-specific deductible No	Approval required Yes Referral required No
Outpatient blood	$0 Service-specific deductible No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	What to know
Diagnostic procedures and tests	$0.00 to $20.00 copay Service-specific deductible No	Approval required Yes Referral required No
Laboratory services	$0 Service-specific deductible No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	$20.00 to $100.00 copay Service-specific deductible No	Approval required Yes Referral required No
Therapeutic radiology	$25.00 copay Service-specific deductible No	Approval required Yes Referral required No
X-rays	$20.00 to $100.00 copay Service-specific deductible No	Approval required Yes Referral required No

Mental health and substance use treatment

Mental health and substance use treatment and member costs
Service	In-network	What to know
Partial hospitalization	$55.00 copay Service-specific deductible No	Approval required Yes Referral required No
Intensive outpatient program	$55.00 copay Service-specific deductible No	Approval required Yes Referral required No
Substance use treatment, individual sessions	$35.00 copay Service-specific deductible No	Approval required No Referral required No
Substance use treatment, group sessions	$35.00 copay Service-specific deductible No	Approval required No Referral required No
Opioid treatment program	$0 Service-specific deductible No	Approval required No Referral required No
Mental health, individual sessions	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Mental health, group sessions	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Psychiatry, individual sessions	$20.00 copay Service-specific deductible No	Approval required No Referral required No
Psychiatry, group sessions	$20.00 copay Service-specific deductible No	Approval required No Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	What to know
Occupational therapy	$40.00 copay Service-specific deductible No	Approval required Yes Referral required No
Physical and speech therapy	$40.00 copay Service-specific deductible No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No
Intensive cardiac rehabilitation	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No
Pulmonary rehabilitation	$10.00 copay Service-specific deductible No	Approval required Yes Referral required No
Supervised exercise for peripheral artery disease	$15.00 copay Service-specific deductible No	Approval required Yes Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	What to know
Ground ambulance	$230.00 copay Service-specific deductible No	Approval required No
Air ambulance	$230.00 copay Service-specific deductible No	Approval required No
Durable medical equipment	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic supplies	0% to 20% coinsurance Service-specific deductible No	Approval required Yes
Diabetic shoes and inserts	$0 Service-specific deductible No	Approval required Yes
Diabetic monitors	0% to 20% coinsurance Service-specific deductible No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	What to know
Medicare-covered dental	$0.00 to $225.00 copay
Oral examsAdditional plan benefit	$0
Dental X-raysAdditional plan benefit	$0
Dental cleaningAdditional plan benefit	$0
FluorideAdditional plan benefit	$0
Restorative dental careAdditional plan benefit	$0
Root canal treatment (endodontics)Additional plan benefit	$0
Gum treatment (periodontics)Additional plan benefit	$0
Oral surgeryAdditional plan benefit	$0

Vision benefits

Vision benefits and member costs
Service	In-network	What to know
Medicare-covered eye exams	$0.00 to $35.00 copay Service-specific deductible No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Approval required No Referral required No
Medicare-covered eyewear	$0 Service-specific deductible No	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	What to know
Medicare-covered hearing exams	$0.00 to $35.00 copay Service-specific deductible No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Approval required No Referral required No
Prescription hearing aids (all types)Additional plan benefit	$495.00 to $1,695.00 copay Service-specific deductible No	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	What to know
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No
Limited-duration mealsAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Annual physical examAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Approval required No Referral required No

Allowances and optional benefits

Combined Supplemental Benefits 1

One shared limit covers the listed services, not a separate allowance for each service.

Services sharing this allowance: Over-the-counter health items; Additional Benefits for SSBCI
Service categories that apply to the combined supplemental benefits group for Special Supplemental Benefits for Chronically Ill (SSBCI) package(s): Food and produce (SSBCI: Package 1)
How benefits are provided: Debit Card
Advance choice of benefits required: No
Shared benefit limit: $25.00
How often this limit applies: Every three months
Are the benefits combined such that a single benefit maximum available to all enrollees in the benefit details section is extended to an SSBCI or MA UF benefit for eligible enrollees?: No
Shared limit on visits or trips: No

Benefits for qualifying members

Package 1

The plan must confirm eligibility, including any qualifying condition.

Qualifying conditions: Chronic alcohol use disorder and other substance use disorders (SUDs); Autoimmune disorders; Cancer; Cardiovascular disorders; Chronic heart failure; Dementia; Diabetes mellitus; Chronic gastrointestinal disease; Chronic kidney disease (CKD); Severe hematologic disorders; HIV/AIDS; Chronic lung disorders; Chronic and disabling mental health conditions; Neurologic disorders; Conditions with functional challenges; Other 1; Other 2
Qualifying conditions: Chronic Hypertension
Qualifying conditions: Pre-diabetes
Included services: Food and produce
Some package benefits are exempt from the deductible: No
Package limit: $0.00
How often this limit applies: Every three months
How benefits are provided: Debit Card
Services sharing the package limit: Food and produce

Optional packages that cost extra

Supplemental Dental, Vision Package 1 $26.60 extra per month

Supplemental Dental, Vision Package 1

The limits below apply only to this optional package.

Benefit allowance: $1,750.00
How often this limit applies: Every year
Do the Optional Supplemental benefits in this package apply to the MOOP for this plan?: No
Deductible applies: No
Included services: Restorative dental care; Gum treatment (periodontics); Removable dentures (prosthodontics); Implant Services; Fixed dental restorations (prosthodontics); Adjunctive General Services; Contact Lenses; Eyeglass frames

Prescription drug coverage

Costs shown are for initial coverage.

Drug deductible exceptions: Tier 1; Tier 2 are exempt from the deductible.

Preferred retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred retail: initial-coverage cost per prescription fill
Drug tier	31 days	90 days	100 days
Tier 1Preferred Generic	$0.00	Not listed	$0.00
Tier 2Generic	$0.00	$0.00	Not listed
Tier 3Preferred Brand	16%	16%	Not listed
Tier 4Non-Preferred Drug	17%	17%	Not listed
Tier 5Specialty Tier	32%	Not listed	Not listed

Standard retail costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard retail: initial-coverage cost per prescription fill
Drug tier	31 days	90 days	100 days
Tier 1Preferred Generic	$5.00	Not listed	$15.00
Tier 2Generic	$8.00	$24.00	Not listed
Tier 3Preferred Brand	16%	16%	Not listed
Tier 4Non-Preferred Drug	17%	17%	Not listed
Tier 5Specialty Tier	32%	Not listed	Not listed

Mail-order and other pharmacies

Out-of-network pricing: The standard retail copay or coinsurance applies, without an added difference between the billed charge and the plan’s allowed amount. The plan’s out-of-network coverage rules still apply.

Preferred mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Preferred mail order: initial-coverage cost per prescription fill
Drug tier	31 days	90 days	100 days
Tier 1Preferred Generic	$0.00	Not listed	$0.00
Tier 2Generic	$0.00	$0.00	Not listed
Tier 3Preferred Brand	16%	16%	Not listed
Tier 4Non-Preferred Drug	17%	17%	Not listed
Tier 5Specialty Tier	32%	Not listed	Not listed

Standard mail order costs

On a small screen, scroll the table sideways to compare all fill lengths.

Standard mail order: initial-coverage cost per prescription fill
Drug tier	31 days	90 days	100 days
Tier 1Preferred Generic	$5.00	Not listed	$15.00
Tier 2Generic	$8.00	$24.00	Not listed
Tier 3Preferred Brand	16%	16%	Not listed
Tier 4Non-Preferred Drug	17%	17%	Not listed
Tier 5Specialty Tier	32%	Not listed	Not listed

Long-term care pharmacy costs

Long-term care pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$5.00
Tier 2Generic	$8.00
Tier 3Preferred Brand	16%
Tier 4Non-Preferred Drug	17%
Tier 5Specialty Tier	32%

Out-of-network pharmacy costs

Out-of-network pharmacy: initial-coverage cost per prescription fill
Drug tier	31 days
Tier 1Preferred Generic	$5.00
Tier 2Generic	$8.00
Tier 3Preferred Brand	16%
Tier 4Non-Preferred Drug	17%
Tier 5Specialty Tier	32%

Drug coverage rules and exceptions

Tier 1: Preferred Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 2: Generic

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 3: Preferred Brand

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 4: Non-Preferred Drug

Drugs included in this tier: Part D Drugs Only
Longer fills available for every covered drug: Yes
Some longer-fill prescriptions require a one-month first fill: No

Tier 5: Specialty Tier

Drugs included in this tier: Part D Drugs Only

Initial-coverage prices also apply to drugs exempt from the deductible: Yes

Special cost protections apply to covered insulin and recommended adult vaccines.

Where this plan is offered

CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.

View all locations 11 county listings across 1 state or territory