2027 Medicare Advantage plan

BCN Advantage Elements (HMO-POS): 2027 benefits and costs

Blue Care Network HMO-POS

CMS plan ID: H5883-017-0 · Plan year: 2027

BCN Advantage Elements (HMO-POS) 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$0.00

In-network medical out-of-pocket maximum$4,500.00

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-POS
Part C premium: $0.00
Prescription drug coverage: No
2027 CMS Star Rating

Standard monthly Medicare Part B premium: $209.50 (estimated)
Monthly Part B premium after plan reduction: $189.50 (estimated)$209.50 standard premium less $20.00 plan reduction.

You must continue to pay your Medicare Part B premium.

In-network medical deductible: None
Combined in/out-of-network medical deductible: None
Out-of-network medical deductible: None
In-network medical maximum: $4,500.00
Combined in/out-of-network medical maximum: $4,500.00
Out-of-network medical maximum: Not applicable

Part B premium reduction: $20.00

2027 benefit summary

Doctor visits and medical care

Common medical services and member costs
Service	In-network	Point-of-service	What to know
Primary care doctor	$0 Service-specific deductible No	$0.00 to $35.00 copay Deductible applies No Dollar benefit limit applies No
Specialist visit	$35.00 copay Service-specific deductible No	$0.00 to $35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Telehealth	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Emergency care	$130.00 copay	Not summarized. Check coverage with the plan.
Urgent care	$0.00 to $45.00 copay	Not summarized. Check coverage with the plan.
Home health	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Dialysis	20% coinsurance Service-specific deductible No	0% to 40% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Part B chemotherapy and radiation drugs	0% to 20% coinsurance Deductible applies No	$0.00 to $35.00 copay; 0% to 20% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Other Part B drugs	0% to 20% coinsurance Deductible applies No	$0.00 to $35.00 copay; 0% to 20% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Kidney disease education services	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Medicare-covered chiropractic	$15.00 copay Service-specific deductible No	$15.00 to $35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Medicare-covered foot care	$35.00 copay Service-specific deductible No	$0.00 to $35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Other health professionals	$0.00 to $35.00 copay Service-specific deductible No	$0.00 to $35.00 copay Deductible applies No Dollar benefit limit applies 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: $250.00 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: $250.00 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	Point-of-service	What to know
Outpatient hospital care	$200.00 copay Service-specific deductible No	$0.00 to $200.00 copay Deductible applies No Dollar benefit limit applies No
Hospital observation services	$130.00 copay Service-specific deductible No	$0.00 to $200.00 copay Deductible applies No Dollar benefit limit applies No
Ambulatory surgical center	$0.00 to $100.00 copay Service-specific deductible No	$0.00 to $200.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Outpatient blood	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No

Tests, imaging and laboratory services

Tests, imaging and laboratory services and member costs
Service	In-network	Point-of-service	What to know
Diagnostic procedures and tests	$0.00 to $20.00 copay Service-specific deductible No	$0.00 to $100.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Laboratory services	$0 Service-specific deductible No	$0.00 to $100.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Diagnostic radiology (CT, MRI)	$20.00 to $100.00 copay Service-specific deductible No	$0.00 to $100.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Therapeutic radiology	$25.00 copay Service-specific deductible No	$0.00 to $100.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
X-rays	$20.00 to $100.00 copay Service-specific deductible No	$0.00 to $100.00 copay Deductible applies No Dollar benefit limit applies 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	Point-of-service	What to know
Partial hospitalization	$55.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Intensive outpatient program	$55.00 copay Service-specific deductible No	$55.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Substance use treatment, individual sessions	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Substance use treatment, group sessions	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Opioid treatment program	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Mental health, individual sessions	$20.00 copay Service-specific deductible No	$35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Mental health, group sessions	$20.00 copay Service-specific deductible No	$35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Psychiatry, individual sessions	$20.00 copay Service-specific deductible No	$35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Psychiatry, group sessions	$20.00 copay Service-specific deductible No	$35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
Service	In-network	Point-of-service	What to know
Occupational therapy	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Physical and speech therapy	$35.00 copay Service-specific deductible No	$35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required Yes
Cardiac rehabilitation	$15.00 copay Service-specific deductible No	$45.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Intensive cardiac rehabilitation	$15.00 copay Service-specific deductible No	$45.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Pulmonary rehabilitation	$10.00 copay Service-specific deductible No	$45.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No
Supervised exercise for peripheral artery disease	$15.00 copay Service-specific deductible No	$45.00 copay Deductible applies No Dollar benefit limit applies No	Approval required Yes Referral required No

Ambulance, medical equipment and supplies

Ambulance, medical equipment and supplies and member costs
Service	In-network	Point-of-service	What to know
Ground ambulance	$300.00 copay Service-specific deductible No	$90.00 to $300.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No
Air ambulance	$300.00 copay Service-specific deductible No	$90.00 to $300.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No
Durable medical equipment	0% to 20% coinsurance Service-specific deductible No	0% to 40% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Prosthetic devices	20% coinsurance Service-specific deductible No	0% to 40% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Medical supplies	20% coinsurance Service-specific deductible No	0% to 40% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Diabetic supplies	0% to 20% coinsurance Service-specific deductible No	0% to 40% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Diabetic shoes and inserts	$0 Service-specific deductible No	0% to 40% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes
Diabetic monitors	0% to 20% coinsurance Service-specific deductible No	0% to 40% coinsurance Deductible applies No Dollar benefit limit applies No	Approval required Yes

Dental benefits

Dental benefits and member costs
Service	In-network	Point-of-service
Medicare-covered dental	$0.00 to $200.00 copay	$0.00 to $200.00 copay Deductible applies No Dollar benefit limit applies No
Oral examsAdditional plan benefit	$0	50% coinsurance Deductible applies No Dollar benefit limit applies Yes Benefit allowance $1,500.00 How often this limit applies Every year
Dental X-raysAdditional plan benefit	$0	50% coinsurance Deductible applies No Dollar benefit limit applies Yes Benefit allowance $1,500.00 How often this limit applies Every year
Dental cleaningAdditional plan benefit	$0	50% coinsurance Deductible applies No Dollar benefit limit applies Yes Benefit allowance $1,500.00 How often this limit applies Every year
FluorideAdditional plan benefit	$0	50% coinsurance Deductible applies No Dollar benefit limit applies Yes Benefit allowance $1,500.00 How often this limit applies Every year
Restorative dental careAdditional plan benefit	$0	50% coinsurance Deductible applies No Dollar benefit limit applies Yes Benefit allowance $1,500.00 How often this limit applies Every year
Root canal treatment (endodontics)Additional plan benefit	$0	50% coinsurance Deductible applies No Dollar benefit limit applies Yes Benefit allowance $1,500.00 How often this limit applies Every year
Gum treatment (periodontics)Additional plan benefit	$0	50% coinsurance Deductible applies No Dollar benefit limit applies Yes Benefit allowance $1,500.00 How often this limit applies Every year
Oral surgeryAdditional plan benefit	$0	50% coinsurance Deductible applies No Dollar benefit limit applies Yes Benefit allowance $1,500.00 How often this limit applies Every year

Vision benefits

Vision benefits and member costs
Service	In-network	Point-of-service	What to know
Medicare-covered eye exams	$0.00 to $35.00 copay Service-specific deductible No	$0.00 to $35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Routine eye examsAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Medicare-covered eyewear	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Contact lensesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Eyeglass lensesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Eyeglass framesAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No

Hearing benefits

Hearing benefits and member costs
Service	In-network	Point-of-service	What to know
Medicare-covered hearing exams	$0.00 to $35.00 copay Service-specific deductible No	$0.00 to $35.00 copay Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Routine hearing examsAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	Approval required No Referral required No
Hearing aid fitting and evaluationAdditional plan benefit	$0	Not summarized. Check coverage with the plan.	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	Not summarized. Check coverage with the plan.	Approval required No Referral required No

Extra benefits

Extra benefits and member costs
Service	In-network	Point-of-service	What to know
Over-the-counter health itemsAdditional plan benefit	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.
Annual physical examAdditional plan benefit	$0 Service-specific deductible No	$0 Deductible applies No Dollar benefit limit applies No	Approval required No Referral required No
Fitness benefitAdditional plan benefit	$0 Service-specific deductible No	Not summarized. Check coverage with the plan.	Approval required No Referral required No

Additional services and network costs

Additional network details

These costs apply to the listed service categories and networks.

Additional medical services: additional out-of-network or point-of-service benefits
Service	Network	Your share of the cost	What to know
Medicare-covered preventive servicesMedicare-covered care	Point-of-service	$0 Deductible applies No	Dollar benefit limit applies No
Glaucoma ScreeningMedicare-covered care	Point-of-service	$0 Deductible applies No	Dollar benefit limit applies No
Diabetes Self-Management TrainingMedicare-covered care	Point-of-service	$0 Deductible applies No	Dollar benefit limit applies No
Digital Rectal ExamsMedicare-covered care	Point-of-service	$0 Deductible applies No	Dollar benefit limit applies No
EKG after a Welcome to Medicare visitMedicare-covered care	Point-of-service	$0 Deductible applies No	Dollar benefit limit applies No
Additional Sessions of Smoking and Tobacco Cessation CounselingAdditional plan benefit	Point-of-service	$0 Deductible applies No	Dollar benefit limit applies No
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit	Point-of-service	$0 Deductible applies No	Dollar benefit limit applies No
Routine Chiropractic CareAdditional plan benefit	Point-of-service	$15.00 to $35.00 copay Deductible applies No	Dollar benefit limit applies No
Other Chiropractic ServicesAdditional plan benefit	Point-of-service	$15.00 to $35.00 copay Deductible applies No	Dollar benefit limit applies No
Medicare Part B insulinMedicare-covered care	Point-of-service	$0.00 to $35.00 copay; 0% to 20% coinsurance Deductible applies No	Dollar benefit limit applies 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: $50.00
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
Applies to out-of-network or point-of-service care: No
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

This plan does not include a Part D prescription drug benefit.

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 70 county listings across 1 state or territory