BCN Advantage Elements (HMO-POS) Medicare Advantage Plan H5883-001-5 • 2026 • Washtenaw County, MI

BCN Advantage Elements Overview

Coverage Overview for BCN Advantage Elements

BCN Advantage Elements is a Medicare Advantage HMO-POS plan that includes Medicare Part A and Part B coverage, with limited access to out-of-network providers in certain situations. The monthly premium is $0.00, and costs are generally lower when services are received from in-network providers.

Primary care visits have a $0 copay | Out-of-network: $0-$35 copay, 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 $300 copay | Out-of-network: $90-$300 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $4500.00. After this limit is reached, in-network services are fully covered.

This plan is listed by CMS under Plan ID H5883-001-5. A summary of cost sharing is provided below.

Cost-Sharing Overview

Cost-sharing for BCN Advantage Elements includes out-of-pocket expenses for covered healthcare services. The table below provides a summary of typical in-network out-of-pocket costs for plan H5883-001-5.

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

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Ratings

CMS evaluates Medicare Advantage (Part C) and Part D plans annually using a 5-star rating system. Ratings reflect performance in preventive care, chronic condition management, and member experience.