2027 Medicare Advantage plan

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

Blue Care Network HMO-POS

CMS plan ID: H5883-003-4 · Plan year: 2027

BCN Advantage Prestige (HMO-POS) is a 2027 Medicare Advantage plan offered by Blue Care Network. It is listed in Michigan. Use this summary to compare plan costs, medical care and extra benefits. Check the service area and official plan documents before choosing a plan.

2027 plan costs at a glance

Monthly plan premium$241.00
Drug deductible$100.00
In-network medical out-of-pocket maximum$4,400.00
Organization
Blue Care Network
Plan type
HMO-POS
Part C premium
$223.90
Part D premium
$17.10
Prescription drug coverage
Yes
Combined in-network and out-of-network medical maximum
$4,400.00

2027 benefit summary

Compare the care and benefits below. A copay is a fixed dollar amount; coinsurance is a percentage of the covered cost. When both are listed, check when each applies. A range depends on the service or provider.

Doctor visits and medical care

Costs below keep in-network and out-of-network care separate. An unlisted network price does not establish coverage. Approval means the plan must authorize the service; a referral is a doctor’s direction to another provider.

Common medical services and member costs
ServiceIn-networkPoint-of-serviceWhat to know
Primary care doctor

$0

Deductible applies
No

$0.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Specialist visit

$25.00 copay

Deductible applies
No

$0.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Telehealth

$0

Deductible applies
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 $35.00 copay

Not summarized. Check coverage with the plan.

Home health

$0

Deductible applies
No

$0

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Dialysis

20% coinsurance

Deductible applies
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
Medicare-covered acupuncture

$0

Deductible applies
No

Not summarized. Check coverage with the plan.

Approval required
No
Referral required
No
Medicare-covered chiropractic

$15.00 copay

Deductible applies
No

$10.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Medicare-covered foot care

$25.00 copay

Deductible applies
No

$0.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Other health professionals

$0.00 to $25.00 copay

Deductible applies
No

$0.00 to $25.00 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.
CareYour share of the costWhat to know
Inpatient hospital stay

$0.00 copay per stay

Days 1–7: $200.00 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: $200.00 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

Out-of-network hospital and skilled nursing charges are not included here. Confirm them before arranging care.

Hospital, outpatient surgery and observation care and member costs
ServiceIn-networkPoint-of-serviceWhat to know
Outpatient hospital care

$200.00 copay

Deductible applies
No

$0.00 to $200.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Hospital observation services

$130.00 copay

Deductible applies
No

$0.00 to $200.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Ambulatory surgical center

$0.00 to $70.00 copay

Deductible applies
No

$0.00 to $200.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Outpatient blood

$0

Deductible applies
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
ServiceIn-networkPoint-of-serviceWhat to know
Diagnostic procedures and tests

$0.00 to $10.00 copay

Deductible applies
No

$0.00 to $50.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Laboratory services

$0

Deductible applies
No

$0.00 to $50.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Diagnostic radiology (CT, MRI)

$10.00 to $50.00 copay

Deductible applies
No

$0.00 to $50.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Therapeutic radiology

$0

Deductible applies
No

$0.00 to $50.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
X-rays

$10.00 to $50.00 copay

Deductible applies
No

$0.00 to $50.00 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
ServiceIn-networkPoint-of-serviceWhat to know
Partial hospitalization

$55.00 copay

Deductible applies
No

$55.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Intensive outpatient program

$55.00 copay

Deductible applies
No

$55.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Substance use treatment, individual sessions

$25.00 copay

Deductible applies
No

$20.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Substance use treatment, group sessions

$25.00 copay

Deductible applies
No

$20.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Opioid treatment program

$0

Deductible applies
No

$0

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Mental health, individual sessions

$20.00 copay

Deductible applies
No

$20.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Mental health, group sessions

$20.00 copay

Deductible applies
No

$20.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Psychiatry, individual sessions

$20.00 copay

Deductible applies
No

$20.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Psychiatry, group sessions

$20.00 copay

Deductible applies
No

$20.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No

Therapy and rehabilitation

Therapy and rehabilitation and member costs
ServiceIn-networkPoint-of-serviceWhat to know
Occupational therapy

$25.00 copay

Deductible applies
No

$25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Physical and speech therapy

$25.00 copay

Deductible applies
No

$25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
Yes
Cardiac rehabilitation

$15.00 copay

Deductible applies
No

$35.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Intensive cardiac rehabilitation

$15.00 copay

Deductible applies
No

$35.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Pulmonary rehabilitation

$10.00 copay

Deductible applies
No

$35.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Referral required
No
Supervised exercise for peripheral artery disease

$15.00 copay

Deductible applies
No

$35.00 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
ServiceIn-networkPoint-of-serviceWhat to know
Ground ambulance

$250.00 copay

Deductible applies
No

$90.00 to $250.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Air ambulance

$250.00 copay

Deductible applies
No

$90.00 to $250.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Durable medical equipment

0% to 20% coinsurance

Deductible applies
No

0% to 40% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Prosthetic devices

20% coinsurance

Deductible applies
No

0% to 40% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Medical supplies

20% coinsurance

Deductible applies
No

0% to 40% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Diabetic supplies

0% to 20% coinsurance

Deductible applies
No

0% to 40% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Diabetic shoes and inserts

$0

Deductible applies
No

0% to 40% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes
Diabetic monitors

0% to 20% coinsurance

Deductible applies
No

0% to 40% coinsurance

Deductible applies
No
Dollar benefit limit applies
No
Approval required
Yes

Dental benefits

Dental benefits and member costs
ServiceIn-networkPoint-of-serviceWhat to know
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
Plan benefit limit
$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
Plan benefit limit
$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
Plan benefit limit
$1,500.00
How often this limit applies
Every year
FluorideAdditional plan benefit

$0

50% coinsurance

Deductible applies
No
Dollar benefit limit applies
Yes
Plan benefit limit
$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
Plan benefit limit
$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
Plan benefit limit
$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
Plan benefit limit
$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
Plan benefit limit
$1,500.00
How often this limit applies
Every year

Vision benefits

Vision benefits and member costs
ServiceIn-networkPoint-of-serviceWhat to know
Medicare-covered eye exams

$0.00 to $25.00 copay

Deductible applies
No

$0.00 to $25.00 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

Deductible applies
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
ServiceIn-networkPoint-of-serviceWhat to know
Medicare-covered hearing exams

$0.00 to $25.00 copay

Deductible applies
No

$0.00 to $25.00 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

Deductible applies
No

Not summarized. Check coverage with the plan.

Approval required
No
Referral required
No

Extra benefits

Extra benefits and member costs
ServiceIn-networkPoint-of-serviceWhat to know
Over-the-counter health itemsAdditional plan benefit

$0

Deductible applies
No

Not summarized. Check coverage with the plan.

Limited-duration mealsAdditional plan benefit

$0

Deductible applies
No

Not summarized. Check coverage with the plan.

Approval required
No
Referral required
No
Annual physical examAdditional plan benefit

$0

Deductible applies
No

$0

Deductible applies
No
Dollar benefit limit applies
No
Approval required
No
Referral required
No
Fitness benefitAdditional plan benefit

$0

Deductible applies
No

Not summarized. Check coverage with the plan.

Approval required
No
Referral required
No

Additional services and network costs

Additional network details

These prices describe a broader category or a service without a matching in-network price in this summary. They do not establish the price for every related service. Confirm the applicable benefit and network with the plan.

Additional out-of-network or point-of-service benefits
ServiceNetworkYour share of the costWhat to know
Medicare-covered preventive servicesMedicare-covered carePoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
Kidney disease educationMedicare-covered carePoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
Glaucoma ScreeningMedicare-covered carePoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
Diabetes Self-Management TrainingMedicare-covered carePoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
Digital Rectal ExamsMedicare-covered carePoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
EKG after a Welcome to Medicare visitMedicare-covered carePoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
Additional Sessions of Smoking and Tobacco Cessation CounselingAdditional plan benefitPoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefitPoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
Personal emergency alert systemAdditional plan benefitPoint-of-service

$0

Deductible applies
No
Dollar benefit limit applies
No
Routine Chiropractic CareAdditional plan benefitPoint-of-service

$10.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Other Chiropractic ServicesAdditional plan benefitPoint-of-service

$10.00 to $25.00 copay

Deductible applies
No
Dollar benefit limit applies
No
Medicare Part B insulinMedicare-covered carePoint-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 applies across the listed services. It is 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

These benefits are not available to every member. The plan must confirm that you meet its qualifying rules.

Package 1

A qualifying condition alone may not establish eligibility. The requirements and shared limits below apply to this package, not to every plan member.

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

These packages are separate from the benefits included in your monthly plan premium.

Supplemental Dental, Vision Package 1 $26.60 extra per month

Supplemental Dental, Vision Package 1

The limits below apply only to this optional package.

Plan benefit limit
$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

Your drug cost depends on the medication, its tier, the pharmacy and how many days you fill. These are initial-coverage costs, not a quote for a particular prescription.

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

Retail pharmacy costs. Actual supply lengths are shown, including 100-day fills where offered.
Drug tierPharmacySupplyYour cost
Tier 1: Preferred GenericStandard retail31 days$5.00
Tier 1: Preferred GenericStandard retail100 days$15.00
Tier 1: Preferred GenericPreferred retail31 days$0.00
Tier 1: Preferred GenericPreferred retail100 days$0.00
Tier 2: GenericStandard retail31 days$12.00
Tier 2: GenericStandard retail90 days$36.00
Tier 2: GenericPreferred retail31 days$5.00
Tier 2: GenericPreferred retail90 days$0.00
Tier 3: Preferred BrandStandard retail31 days24%
Tier 3: Preferred BrandStandard retail90 days24%
Tier 3: Preferred BrandPreferred retail31 days20%
Tier 3: Preferred BrandPreferred retail90 days20%
Tier 4: Non-Preferred DrugStandard retail31 days30%
Tier 4: Non-Preferred DrugStandard retail90 days30%
Tier 4: Non-Preferred DrugPreferred retail31 days30%
Tier 4: Non-Preferred DrugPreferred retail90 days30%
Tier 5: Specialty TierStandard retail31 days32%
Tier 5: Specialty TierPreferred retail31 days32%

Mail-order and other pharmacy costs

Out-of-network pharmacy use is subject to the plan’s coverage rules and can cost more than the amounts listed below.

Out-of-network pricing: Standard Retail Copay/Coinsurance (no differential)*.

Mail-order, long-term care and out-of-network pharmacy costs
Drug tierPharmacySupplyYour cost
Tier 1: Preferred GenericStandard mail order31 days$5.00
Tier 1: Preferred GenericStandard mail order100 days$15.00
Tier 1: Preferred GenericPreferred mail order31 days$0.00
Tier 1: Preferred GenericPreferred mail order100 days$0.00
Tier 1: Preferred GenericOut-of-network pharmacy31 days$5.00
Tier 1: Preferred GenericLong-term care pharmacy31 days$5.00
Tier 2: GenericStandard mail order31 days$12.00
Tier 2: GenericStandard mail order90 days$36.00
Tier 2: GenericPreferred mail order31 days$5.00
Tier 2: GenericPreferred mail order90 days$0.00
Tier 2: GenericOut-of-network pharmacy31 days$12.00
Tier 2: GenericLong-term care pharmacy31 days$12.00
Tier 3: Preferred BrandStandard mail order31 days24%
Tier 3: Preferred BrandStandard mail order90 days24%
Tier 3: Preferred BrandPreferred mail order31 days20%
Tier 3: Preferred BrandPreferred mail order90 days20%
Tier 3: Preferred BrandOut-of-network pharmacy31 days24%
Tier 3: Preferred BrandLong-term care pharmacy31 days24%
Tier 4: Non-Preferred DrugStandard mail order31 days30%
Tier 4: Non-Preferred DrugStandard mail order90 days30%
Tier 4: Non-Preferred DrugPreferred mail order31 days30%
Tier 4: Non-Preferred DrugPreferred mail order90 days30%
Tier 4: Non-Preferred DrugOut-of-network pharmacy31 days30%
Tier 4: Non-Preferred DrugLong-term care pharmacy31 days30%
Tier 5: Specialty TierStandard mail order31 days32%
Tier 5: Specialty TierPreferred mail order31 days32%
Tier 5: Specialty TierOut-of-network pharmacy31 days32%
Tier 5: Specialty TierLong-term care pharmacy31 days32%

Drug coverage rules and exceptions

Check that your medicine is on the plan’s list of covered drugs (formulary). Quantity limits, step therapy, approval requirements and Extra Help can affect your costs.

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

Covered insulin and certain recommended adult vaccines have special cost protections. Confirm how those rules apply to your prescription with Medicare or the plan.

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 20 county listings across 1 state or territory

Michigan