BCN Advantage Prime Value (HMO-POS) Medicare Advantage Plan H5883-014-4 • 2026 • Lenawee County, MI

BCN Advantage Prime Value Overview

Coverage Overview for BCN Advantage Prime Value

This Medicare Advantage MAPD HMO-POS plan includes hospital, medical, and prescription drug coverage under Medicare Parts A and B. The monthly premium is $35.00, and the plan provides coverage through a network of participating providers, with limited access to out-of-network services in certain situations. The annual Part D deductible is $150.00.

Primary care visits have a $0 copay | Out-of-network: $0 copay, 0% coinsurance, specialist visits come with a $35 copay | Out-of-network: $0-$35 copay, urgent care services carry a $0-$45 copay, and ambulance transportation is $310 copay | Out-of-network: $90-$310 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $5000.00. After this limit is reached, in-network services are fully covered.

This plan is registered with CMS under Plan ID H5883-014-4. A summary of cost sharing is provided below.

Cost-Sharing Overview

BCN Advantage Prime Value has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The table below details the most common in-network out-of-pocket expenses for plan H5883-014-4.

Certain preventive services are covered 100% by BCN Advantage Prime Value as a Part B benefit.

Prescription Drug Coverage

BCN Advantage Prime Value 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 Special Needs 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.

For more details, visit the Social Security Extra Help program .

Prescription Drug Plan Deductible

This plan has a $150.00 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 Prime Value may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.

Medicare Plan Star Ratings

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.