BCN Advantage Classic (HMO-POS) Medicare Advantage Plan H5883-002-3 • 2027 • Charlevoix County, MI
- Monthly Premium
- $138.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $4800.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $200.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Charlevoix County, MI
- Local Enrollment
- 0 beneficiaries in Charlevoix County
BCN Advantage Classic (HMO-POS) Introduction
BCN Advantage Classic is a Medicare Advantage HMO-POS plan offered by Blue Care Network. It uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $138.00 monthly premium, $0.00 medical deductible, and $4800.00 in-network maximum out-of-pocket. CMS Plan ID H5883-002-3 identifies this plan. The 2027 Part D prescription drug deductible is $200.00.
You must live in Charlevoix County, Michigan to enroll in this plan. CMS reports 0 beneficiaries enrolled in this plan in Charlevoix County. For assistance with this plan, new members can call (855)425-7720 (TTY 711).
Compare Similar Plans in Charlevoix County
Compare this plan with the two most-enrolled HMO-POS plans available in Charlevoix County, Michigan. Enrollment is based on CMS local enrollment data.
| Plan Detail | BCN Advantage Classic | PriorityMedicare Value | Aetna Medicare Signature |
|---|---|---|---|
| CMS Plan ID | H5883-002-3 |
H2320-029-3 |
H3192-010-0 |
| Local Enrollment | 0 | 31 | 26 |
| Monthly Premium | $138.00 | $111.00 | $0.00 |
| Medical Deductible | $0.00 | $1,000 | $0.00 |
| Maximum Out-of-Pocket | $4,800.00 | $6,000.00 | $6,350.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $30 copay | $0-$35 copay | $45 copay |
| Part D Deductible | $200.00 | $225.00 | $400.00 |
| CMS Star Rating | Not yet rated | Not yet rated | Not yet rated |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Plan Benefits
BCN Advantage Classic has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5883-002-3.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H5883-002-3 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: $0-$30 copay - Specialist
- In-network: $30 copay
Out-of-network: $0-$30 copay
Preventive and Wellness Services
- Annual wellness exam
- In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance - Telehealth benefit
- In-network: $0 copay
- Routine chiropractic
- In-network: $30 copay
Out-of-network: $15-$30 copay - Fitness benefits
- Coming soon
- Health education
- Not covered
- Counseling services
- Not covered
- Over-the-counter drug benefits
- In-network: $0 copay
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $20-$75 copay
Out-of-network: $0-$75 copay - Lab services
- In-network: $0 copay
Out-of-network: $0-$75 copay - Outpatient x-rays
- In-network: $20-$75 copay
Out-of-network: $0-$75 copay - Diagnostic tests and procedures
- In-network: $0-$20 copay
Out-of-network: $0-$75 copay
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $0-$40 copay
- Inpatient hospital care
- In-network:
Tier 1
$250 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$250 per day for days 1-7
$0 per day for days 8-90
$0 per stay - Skilled Nursing Facility
- In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
$0 per day for days 1-20
$221 per day for days 21-100
$0 per stay - Ground ambulance
- In-network: $250 copay
Out-of-network: $90-$250 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $20 copay
Out-of-network: $30-$35 copay - Outpatient group therapy
- In-network: $20 copay
Out-of-network: $30-$35 copay - Inpatient psychiatric hospital care
- In-network:
Tier 1
$250 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
$250 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $35 copay
Out-of-network: $35 copay - Occupational therapy
- In-network: $35 copay
Out-of-network: $35 copay
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance - Durable medical equipment
- In-network: 0%-20% coinsurance
Out-of-network: 0%-40% coinsurance - Prosthetics
- In-network: 20% coinsurance
Out-of-network: 0%-40% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: $0-$35 copay, 0%-20% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: $0-$35 copay, 0%-20% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
Out-of-network: 50% coinsurance - Dental x-rays
- In-network: $0 copay
Out-of-network: 50% coinsurance - Cleaning
- In-network: $0 copay
Out-of-network: 50% coinsurance - Periodontics
- In-network: $0 copay
Out-of-network: 50% coinsurance - Endodontics
- In-network: $0 copay
Out-of-network: 50% coinsurance - Restorative services
- In-network: $0 copay
Out-of-network: 50% coinsurance - Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- In-network: $0 copay
Out-of-network: 50% coinsurance
Vision Services
- Routine eye exam
- In-network: $0 copay
- Contact lenses
- In-network: $0 copay
- Eyeglass frames only
- In-network: $0 copay
- Eyeglass lenses only
- In-network: $0 copay
- Eyeglasses (frames & lenses)
- Not covered
- Upgrades
- Not covered
Hearing Services
- Hearing exam
- In-network: $0 copay
- Fitting/evaluation
- In-network: $0 copay
- Prescription hearing aids
- In-network: $495-$1695 copay
- OTC hearing aids
- Not covered
Additional and Special Needs Services
- Adult day health services
- Not covered
- Home-based palliative care
- Not covered
- Personal emergency response system
- Coming soon
- Weight management programs
- Not covered
- Wigs for chemotherapy-related hair loss
- Coming soon
- Alternative therapies
- Not covered
- Massage therapy
- Not covered
- Home/bathroom safety devices
- Not covered
Certain preventive services are covered 100% by BCN Advantage Classic as a Part B benefit.
Prescription Drug Coverage
BCN Advantage Classic includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $27.80 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $27.80 |
| Low-Income Premium Subsidy: | $6.28 |
| Low-Income Premium Subsidy Paid by CMS: | $6.30 |
| Low-Income Subsidy Premium: | $21.50 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $200.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Blue Care Network starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, BCN Advantage Classic may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $7.00 copay | Coming soon |
| Preferred Brand | 20% coinsurance | Coming soon |
| Non-Preferred Drug | 30% coinsurance | Coming soon |
| Specialty Tier | 31% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H5883)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| CMS Measure | Star Rating |
|---|---|
| 2027 Overall Rating | |
| Staying Healthy: Screenings, Tests, Vaccines | |
| Managing Chronic (Long Term) Conditions | |
| Member Experience with Health Plan | |
| Complaints and Changes in Plans Performance | |
| Health Plan Customer Service | |
| Drug Plan Customer Service | |
| Complaints and Changes in the Drug Plan | |
| Member Experience with the Drug Plan | |
| Drug Safety and Accuracy of Drug Pricing |
Contact Information for Blue Care Network
- Website
- Blue Care Network Plan Page
- Providers
- Blue Care Network Providers Page
- Formulary
- Blue Care Network Formulary Page
- Pharmacy
- Blue Care Network Pharmacy Page
- New Member Health Plan Help
- (855)425-7720
- New Member Health Plan TTY
- 711
- New Member Part D Help
- (855)425-7720
- New Member Part D TTY Users
- 711
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.
Medicare Plan Data Sources and Methodology
| Data Source | Publisher | Last Accessed |
|---|---|---|
| Landscape Source Files | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Medicare Part C & D Performance | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Plan Benefits Package | Centers for Medicare & Medicaid Services | October 5, 2026 |
| Monthly Enrollment by Contract/Plan/State/County | Centers for Medicare & Medicaid Services | October 5, 2026 |
Data sources and methodology documentation.
| Publisher | Reference | Last Accessed |
|---|---|---|
| Blue Care Network (official source) | http://www.bcbsm.com/medicare | October 4, 2026 |
| Medicare.gov | Understanding Medicare Advantage Plans | 25 May, 2025 |
| NCOA.org | 5 Steps to Choosing the Right Medicare Plan for You | 25 May, 2025 |
| Medicare.gov | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
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