5

5 out of 5 stars* for plan year 2024

Plan ID: H5883-014

What You Need to Know:

  • BCN Advantage Prime Value (HMO-POS) is a Medicare Advantage Health Maintenance Organization Local HMO plan.
  • It must provide all of the same hospital and medical benefits as Medicare Part A and Part B, however, costs may be different.
  • It has additional benefits not included in Medicare Part A and Part B, including prescription drug coverage.
  • The plan's monthly premium is $0, which does not include your monthly Medicare Part B premium.
  • The annual deductible for this health plan is $50 (Tier 1 and 2 excluded from the Deductible.).
  • The plan includes an out-of-pocket maximum of $4,500 per year (in-network).
  • BCN Advantage Prime Value (HMO-POS) includes a Part D prescription drug plan for prescription medication coverage. The annual deductible is $50 (Tier 1 and 2 excluded from the Deductible.).
  • This plan's Part D Initial Coverage Limit is $0.

* Every year, the Centers for Medicare & Medicaid Services (CMS) evaluates plans based on a 5-star rating system.

$0

Monthly Premium

Medicare Plan Features
Monthly Premium: $0
Part C Premium: $0
Monthly Premium: Part C Premium: Part D Drug Premium: Part D Supplemental Premium: Total Part D Premium: Drug Deductible: Tiers with No Deductible:
$0 $0 $0 $0 $0 $50.00 1.0
Gap Coverage: Yes
Benchmark: not below the regional benchmark
Type of Medicare Health: Enhanced Alternative
Health Plan Type: Local HMO
Similar Plan: H5883-001
Special Needs Type: NULL
Chronic Condition: NULL
Additional Gap Coverage: Yes, some additional gap coverage.
Maximum Out-of-Pocket Limit for Parts A & B (Moop): $4,500
Annual Deductible: $50 (Tier 1 and 2 excluded from the Deductible.)
Annual Initial Coverage Limit ICL: $4,130
Number of Members enrolled in this plan in Wexford, Michigan: Plans Summary Star Rating: Customer Service Rating: Drug Cost Rating:
243 members 4 out of 5 Stars. 5 out of 5 Stars. 4 out of 5 Stars.
Plan Offers Mail Order: Yes
Plan Health Benefits
Total # of Formulary Drugs: 3,516 drugs
Number of Members Enrolled in this Plan in Wexford, Michigan: NULL
Number of Drugs Per Tier: NULL
Preferred Pharmacy Cost Sharing During Initial Coverage Phase: NULL
Special Needs Plan SNP Eligibility Requirement: NULL
Monthly Premium Split as Follows:
Part C Premium Part D Base Premium Part D Supplemental Premium Total Premium
$0.00 $0.00 $0.00 $0.00
Monthly Premium with Extra Help Low Income Subsidy:
LIS100 Subsidy Total Monthly Premium with LIS Parts CD LIS25 Subsidy Monthly PartD Premium with LIS LIS25 Subsidy Total Monthly Premium with LIS Parts CD LIS50 Monthly PartD Premium with LIS LIS50 Subsidy Total Monthly Premium with LIS Parts CD LIS75 Monthly PartD Premium with LIS LIS75 Subsidy Total Monthly Premium with LIS Parts CD
$0.00 $0.00 $0.00 $0.00 $0.00 $0.00 $0.00
Formulary Drug Details:
Tier 1 # of Drugs per Tier Tier 1 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 2 # of Drugs per Tier Tier 2 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 3 # of Drugs per Tier Tier 3 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 4 # of Drugs per Tier Tier 4 Preferred Pharmacy Cost Sharing (initial coverage phase) Tier 5 # of Drugs per Tier Tier 6 Preferred Pharmacy Cost Sharing (initial coverage phase)
419 $3.00 1241 $11.00 352 $42.00 617 50% 685 32%

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Aetna Medicare Premier (PPO) (2023)Local PPO$4,800$0
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Aetna Medicare Value (PPO) (2023)Local PPO$5,500$0
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BCN Advantage HMO-POS Prestige (HMO-POS) (2023)Local HMO$3,400$0
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Humana Value Plus H8087-002 (PPO) (2023)Local PPO$7,550$260
5
Aetna Medicare Eagle (PPO) (2023)Local PPO *$5,900$-
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PriorityMedicare Select (PPO) (2023)Local PPO$3,500$0
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PriorityMedicare Ideal (PPO) (2023)Local PPO$5,800$125
5
PriorityMedicare Vital (PPO) (2023)Local PPO$6,000$350
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Humana Gold Choice H8145-006 (PFFS) (2023)PFFS$-$445
4
HumanaChoice R3887-001 (Regional PPO) (2023)Regional PPO *$5,500$-
5
Humana Gold Choice H8145-121 (PFFS) (2023)PFFS *$-$-
4
PriorityMedicare Value (HMO-POS) (2023)Local HMO$4,900$75
3
HumanaChoice R3887-002 (Regional PPO) (2023)Regional PPO$5,300$380
5
Medicare Plus Blue PPO Assure (PPO) (2023)Local PPO$3,425$0
5
Medicare Plus Blue PPO Signature (PPO) (2023)Local PPO$4,700$0
5
PriorityMedicare Key (HMO-POS) (2023)Local HMO$5,500$100
3
Medicare Plus Blue PPO Essential (PPO) (2023)Local PPO$6,000$100
5
Medicare Plus Blue PPO Vitality (PPO) (2023)Local PPO$5,000$100
5
PriorityMedicare (HMO-POS) (2023)Local HMO$4,500$0
3
PriorityMedicare Edge (PPO) (2023)Local PPO$5,300$0
5
BCN Advantage HMO-POS Elements (HMO-POS) (2023)Local HMO *$4,500$-
5
PriorityMedicare Merit (PPO) (2023)Local PPO$4,100$0
5
Medicare Advantage Plans by Blue Care Network
BCN Advantage HMO-POS Classic (HMO-POS) (2023)Local HMO$3,800$0
5
BCN Advantage HMO-POS Prestige (HMO-POS) (2023)Local HMO$3,400$0
5
BCN Advantage HMO-POS Elements (HMO-POS) (2023)Local HMO *$4,500$-
5

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