2022 BCN Advantage HMO-POS Elements (HMO-POS)

BCN Advantage HMO-POS Elements (HMO-POS) H5883-001 is a 2022 Medicare Advantage Plan or Part-C by Blue Care Network available to residents in Michigan. This plan does not provide additional prescription drug (Part-D) coverage. The BCN Advantage HMO-POS Elements (HMO-POS) has a monthly premium of $8.00 and has an in-network maximum out-of-pocket limit of $4,500 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,500 out-of-pocket. This can be a extremely nice safety net.

BCN Advantage HMO-POS Elements (HMO-POS) is a Local HMO *. With a health maintenance organization (HMO) you will be required to receive most of your health care from an in-network provider. Health maintenance organizations require that you select a primary care physician (PCP). Your PCP will serve as your personal doctor to provide all of your basic healthcare services. If you require specialized care or a physician specialist, your primary care physician will make the arrangements and inform you where you can go in the network. You will need your PCPs okay, called a referral. Services received from an out-of-network provider are not typically covered.

Blue Care Network works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BCN Advantage HMO-POS Elements (HMO-POS) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Care Network and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Blue Care Network except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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Sat 8am-8pm EST

2022 Blue Care Network Medicare Advantage Plan Costs

2021 BCN Advantage HMO-POS Elements (HMO-POS) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	Not covered
Extractions	Not covered
Non-routine services	Not covered
Periodontics	Not covered
Prosthodontics, other oral/maxillofacial surgery, other services	Not covered
Restorative services	Not covered

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Deductible

$160 In-network

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$20-100 copay (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$20-100 copay
Diagnostic tests and procedures	$0-20 copay
Diagnostic tests and procedures	$20 copay (Out-of-Network)
Lab services	$0 copay (Out-of-Network)
Lab services	$0 copay
Outpatient x-rays	$20-100 copay
Outpatient x-rays	$20-100 copay (Out-of-Network)

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Doctor Visits

Primary	$0 copay
Primary	$40 copay per visit (Out-of-Network)
Specialist	$40 copay per visit
Specialist	$40 copay per visit (Out-of-Network)

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$0-45 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$40 copay
Foot exams and treatment	$40 copay (Out-of-Network)
Routine foot care	Not covered

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Ground Ambulance

$250 copay
$250 copay (Out-of-Network)

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Hearing

Fitting/evaluation	$0 copay
Hearing aids	$0 copay
Hearing exam	$40 copay (Out-of-Network)
Hearing exam	$0-40 copay

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Inpatient Hospital Coverage

$205 per day for days 1 through 6 $0 per day for days 7 through 90 (Out-of-Network)
$205 per day for days 1 through 6 $0 per day for days 7 through 90

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Medical Equipment/Supplies

Diabetes supplies	$0 copay
Diabetes supplies	$0 copay (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item (Out-of-Network)
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item

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Medicare Part B Drugs

Chemotherapy	0-20% coinsurance (Out-of-Network)
Chemotherapy	0-20% coinsurance
Other Part B drugs	0-20% coinsurance
Other Part B drugs	0-20% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	$205 per day for days 1 through 6 $0 per day for days 7 through 90
Inpatient hospital - psychiatric	$205 per day for days 1 through 6 $0 per day for days 7 through 90 (Out-of-Network)
Outpatient group therapy visit	$40 copay
Outpatient group therapy visit	$40 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$40 copay
Outpatient individual therapy visit	$40 copay
Outpatient individual therapy visit	$40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist	$40 copay

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MOOP

$4,500 In and Out-of-network $4,500 In-network

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Option

No

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Optional supplemental benefits

Yes

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Outpatient Hospital Coverage

$0-200 copay per visit (Out-of-Network)
$0-200 copay per visit

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Package #1

Deductible
Monthly Premium	$20.40

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Package #2

Deductible
Monthly Premium	$37.40

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Preventive Care

$0 copay
$0 copay (Out-of-Network)

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Preventive Dental

Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Fluoride treatment	Not covered
Oral exam	$0 copay

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Rehabilitation Services

Occupational therapy visit	$30 copay (Out-of-Network)
Occupational therapy visit	$30 copay
Physical therapy and speech and language therapy visit	$30 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$30 copay

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Skilled Nursing Facility

$0 per day for days 1 through 20 $178 per day for days 21 through 100 (Out-of-Network)
$0 per day for days 1 through 20 $178 per day for days 21 through 100

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Transportation

Not covered

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Vision

Contact lenses	Not covered
Eyeglass frames	Not covered
Eyeglass lenses	Not covered
Eyeglasses (frames and lenses)	Not covered
Other	Not covered
Routine eye exam	$0 copay
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for BCN Advantage HMO-POS Elements (HMO-POS) H5883

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in BCN Advantage HMO-POS Elements (HMO-POS) Plans Performance

Health Plan Customer Service Rating for BCN Advantage HMO-POS Elements (HMO-POS)

BCN Advantage HMO-POS Elements (HMO-POS) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

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Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for BCN Advantage HMO-POS Elements (HMO-POS)

(Click county to compare all available Advantage plans)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.