Michigan health plan · 2025

Blue Cross® Preferred HMO Silver Saver · 98185MI0180015

Blue Care Network of Michigan offers this marketplace health insurance plan (Plan ID 98185MI0180015) so you can compare premiums, coverage levels, and provider access against other health plan insurance options. Use the modules below to decide whether this is the best health insurance plan for your household or if another insurance health plan fits better.

Metal level: Silver Plan type: HMO CSR: 73% AV Level Silver Plan Issuer: Blue Care Network of Michigan
Telehealth Data pending HSA eligible No Dental Not listed Vision Child
Pay / Manage Plan View issuer site

Issuer actuarial value: 73.08%. Expect to pay roughly 26.92% of covered costs out of pocket, based on issuer reporting.

CMS AV Calculator output: 73.10% (26.90% member share on average). Learn about AV methodology.

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 02 Dec 2025 06:13 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$285 – $1505

Before subsidies

Estimate after subsidies

Deductible

$3,700

$7400 per group

See deductible details

Max out-of-pocket

$6,300

$12600 per group

Review MOOP rules

Office visits

Primary care $45.00
Specialist $90.00
HSA Not eligible

Drug tiers

Generic $4.00 Copay after deductible
Preferred brand $100.00 Copay after deductible

View formulary tiers

$449 / mo before subsidies

≈ $5392 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$1273 / mo before subsidies

≈ $15276 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$1562 / mo before subsidies

≈ $18748 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • This Silver tier qualifies for CSR if household income is ≤250% FPL.

$960 / mo before subsidies

≈ $11515 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$250.00 Copay after deductible, 20.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Michigan). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • 73% AV Level Silver Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Top covered benefits

How this plan handles key care scenarios

Preventive Care/Screening/Immunization

No Charge

Emergency Room Services

$250.00 Copay after deductible, 20.00% Coinsurance after deductible

Durable Medical Equipment

50.00% Coinsurance after deductible

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 98185MI0180015
Coverage year 2025
State Michigan
Issuer Blue Care Network of Michigan
Formulary document Download formulary
Marketing materials View marketing kit
Variant ID 98185MI0180015-04
Available variants

Standard Off Exchange Plan · 98185MI0180015-00

Standard On Exchange Plan · 98185MI0180015-01

Open to Indians below 300% FPL · 98185MI0180015-02

Open to Indians above 300% FPL · 98185MI0180015-03

73% AV Silver Plan · 98185MI0180015-04

87% AV Silver Plan · 98185MI0180015-05

94% AV Silver Plan · 98185MI0180015-06
Last plan update Wed, 14 Aug 2024 00:00 GMT
Last HealthPorta import Tue, 02 Dec 2025 06:13 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 02 Dec 2025 06:13 GMT).

All providers in Michigan 40
PCPs in Michigan 4
Telehealth support Data pending
Nationwide providers 41
40 doctors statewide 4 PCPs

Provider network(s)

Providers Michigan All US states
All 40 41
PCP 4 4
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

4,789 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Tier Covered drugs
NON-PREFERRED-BRANDS 3,782
NON-PREFERRED-SPECIALTY 1,007
Prior authorization Drugs
Required 0
Not Required 4,789
Step therapy Drugs
Required 0
Not Required 4,789
Quantity limits Drugs
Has Limit 0
No Limit 4,789

Customer highlights

What stands out for members

  • Issuer: Blue Care Network of Michigan · Plan ID 98185MI0180015 · 2025 filing.
  • Disease management programs available: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.
  • Download the latest formulary directly from the issuer here.
  • Review marketing brochures and SBC PDFs via the issuer marketing repository.
  • Variant 98185MI0180015-04 (73% AV Silver Plan) currently displayed.
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Benefits

Covered services & limitations

Everyday care

Office visits, preventive care, labs, imaging, and home health.

Chiropractic Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Spinal manipulation limit is not combined with Occupational Therapy and Physical Therapy; limit includes services provided by an osteopathic provider.

Exclusions: nan

Diabetes Education

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Follow Medicare guidelines.

Exclusions: nan

Home Health Care Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

BCN approved providers only.

Exclusions: Housekeeping Services. Services for the purposes of custodial care.

Laboratory Outpatient and Professional Services

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

May require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Other Practitioner Office Visit (Nurse, Physician Assistant)

$45.00
Tier 1 in-network $45.00
Out-of-network 100.00%

Includes virtual, retail health clinic and medical evaluation at an affiliated immunization pharmacy visits. No charge for 24/7 medical virtual visits when performed through the BCN selected vendor app. Diagnostic services are not included in the office visit copayment. These services are subject to the plan's deductible and coinsurance, if applicable.

Exclusions: nan

Preventive Care/Screening/Immunization

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

May require prior authorization. The penalty for not having prior authorization is denial of payment. You may have to pay for services that arent preventive. Ask your provider if the services needed are preventive. Then check what your plan will pay for.

Exclusions: Care and services not defined as preventive under PPACA.

Primary Care Visit to Treat an Injury or Illness

$45.00
Tier 1 in-network $45.00
Out-of-network 100.00%

Includes virtual, retail health clinic and medical evaluation at an affiliated immunization pharmacy visits. No charge for 24/7 medical virtual visits when performed through the BCN selected vendor app. Diagnostic services are not included in the office visit copayment. These services are subject to the plan's deductible and coinsurance, if applicable.

Exclusions: nan

Rehabilitative Occupational and Rehabilitative Physical Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Physical Therapy/Occupational Therapy- combined 30 visits per calendar year; 30 visits for Speech Therapy per calendar year.

Exclusions: nan

Rehabilitative Speech Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Physical Therapy/Occupational Therapy- combined 30 visits per calendar year; 30 visits for Speech Therapy per calendar year.

Exclusions: nan

Specialist Visit

$90.00
Tier 1 in-network $90.00
Out-of-network 100.00%

Referral required. The penalty for not having a referral is denial of payment. Diagnostic services are not included in the office visit copayment. These services are subject to the plan's deductible and coinsurance, if applicable. No charge for 24/7 medical virtual visits when performed through the BCN selected vendor app.

Exclusions: nan

Urgent Care Centers or Facilities

$45.00
Tier 1 in-network $45.00
Out-of-network $45.00

Urgent Care visits will be covered at non-participating providers for medical emergencies and accidental injuries only.

Exclusions: nan

X-rays and Diagnostic Imaging

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

May require prior authorization. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Hospital & urgent

Emergency room, inpatient stays, ambulance, and surgeries.

Chemotherapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Delivery and All Inpatient Services for Maternity Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authoriztion required. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Dialysis

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Durable Medical Equipment

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Breast pumps are covered in full when preauthorized.

Exclusions: Excludes bath, exercise and deluxe equipment and comfort and convenience items. Prescription is required. Rental and purchase limited to basic equipment.

Emergency Room Services

$250.00 Copay after deductible, 20.00% Coinsurance after deductible
Tier 1 in-network $250.00 Copay after deductible, 20.00% Coinsurance after deductible
Out-of-network $250.00 Copay after deductible, 20.00% Coinsurance after deductible

Emergency room visits will be covered at non-participating facilities for medical emergencies and accidental injuries only. Copayment waived if admitted inpatient into the hospital.

Exclusions: nan

Emergency Transportation/Ambulance

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 20.00% Coinsurance after deductible

Includes air and ground transportation.

Exclusions: Transportation for convenience.

Hospice Services

No Charge after deductible
Tier 1 in-network No Charge after deductible
Out-of-network 100.00%

Prior authorization required. The penalty for not having prior authorization is denial of payment. BCN participating hospice programs only. Coverage includes inpatient and outpatient hospice care.

Exclusions: Housekeeping services. Room and board at an extended care facility or hospice facility for the purposes of delivering Custodial Care.

Inpatient Hospital Services (e.g., Hospital Stay)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authorization required. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Inpatient Physician and Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authorization required. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Mental/Behavioral Health Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authoriztion required. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Mental/Behavioral Health Outpatient Services

$45.00
Tier 1 in-network $45.00
Out-of-network 100.00%

Copayment applies to providers office, virtual visit and applied behavior analysis (ABA) treatment by participating BCN provider and Blue Cross online visit from BCN selected vendor only. Additional services are subject to the plan's deductible and coinsurance. Prior authorization is not required for outpatient, office and online visits. Prior authorization is required for other outpatient services.

Exclusions: nan

Outpatient Facility Fee (e.g., Ambulatory Surgery Center)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

May require prior authorization.

Exclusions: Cosmetic surgery, corrective eye surgery, investigational and experimental procedures.

Outpatient Rehabilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Physical Therapy/Occupational Therapy- combined 30 visits per calendar year; 30 visits for Speech Therapy per calendar year.

Exclusions: nan

Outpatient Surgery Physician/Surgical Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

May require prior authorization.

Exclusions: Cosmetic surgery, corrective eye surgery, investigational and experimental procedures.

Radiation

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

nan

Exclusions: nan

Skilled Nursing Facility

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 45.0 Days per Year

Prior authoriztion required. The penalty for not having prior authorization is denial of payment. BCN participating facilities only.

Exclusions: Custodial Care.

Substance Abuse Disorder Inpatient Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authoriztion required. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Substance Abuse Disorder Outpatient Services

$45.00
Tier 1 in-network $45.00
Out-of-network 100.00%

Copayment applies to providers office and virtual visit by participating BCN provider and Blue Cross online visit from BCN selected vendor only. Additional services are subject to the plan's deductible and coinsurance. Prior authorization is not required for outpatient, office and online visits. Prior authorization is required for other outpatient services.

Exclusions: nan

Transplant

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Subject to BCN medical criteria. BCN designated facility only.

Exclusions: nan

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Hearing Aids

Coverage details pending

nan

Exclusions: nan

Major Dental Care - Child

Coverage details pending

nan

Exclusions: nan

Prenatal and Postnatal Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Cost sharing does not apply for preventive services. Depending on the type of services, a copayment, coinsurance, or deductible may apply.

Exclusions: nan

Routine Eye Exam for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Exam(s) per Year

Out of network is paid up to the allowed amount. A child is defined as a member up to age 19.

Exclusions: nan

Well Baby Visits and Care

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Quantity limits based on PPACA.

Exclusions: nan

Pharmacy & drugs

Generic, brand, specialty, and mail order tiers.

Generic Drugs

$4.00 Copay after deductible
Tier 1 in-network $4.00 Copay after deductible
Out-of-network 100.00%

Refer to drug list for quantity limits and other exclusions. May require prior authorization & step therapy. The penalty for not having prior authorization is denial of payment. No charge for Tier 1A contraceptives. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumers deductible, cost-sharing or out of pocket maximum

Exclusions: Quantity limits per fill may apply for 30-day retail, 90-day retail, and 90-day mail order. Opioid containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply.

Non-Preferred Brand Drugs

$150.00 Copay after deductible
Tier 1 in-network $150.00 Copay after deductible
Out-of-network 100.00%

Refer to drug list for quantity limits and other exclusions. May require prior authorization & step therapy. The penalty for not having prior authorization is denial of payment. No charge for Tier 1A contraceptives. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumers deductible, cost-sharing or out of pocket maximum

Exclusions: Quantity limits per fill may apply for 30-day retail, 90-day retail, and 90-day mail order. Opioid containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply.

Non-Preferred Generic Drugs

$20.00 Copay after deductible
Tier 1 in-network $20.00 Copay after deductible
Out-of-network 100.00%

Refer to drug list for quantity limits and other exclusions. May require prior authorization & step therapy. The penalty for not having prior authorization is denial of payment. No charge for Tier 1A contraceptives. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumers deductible, cost-sharing or out of pocket maximum

Exclusions: Quantity limits per fill may apply for 30-day retail, 90-day retail, and 90-day mail order. Opioid containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply.

Non-Preferred Specialty Drugs

45.00% Coinsurance after deductible
Tier 1 in-network 45.00% Coinsurance after deductible
Out-of-network 100.00%

Refer to drug list for quantity limits and other exclusions. BCN has contracted with an exclusive pharmacy network for specialty drugs. Call the customer service phone number on the back of your ID card for the pharmacys phone number or location nearest to you. If you obtain your specialty drugs from any other pharmacy, you are responsible for the total cost. Prior authorization, step therapy and quantity limits may apply to select drugs. The penalty for not having prior authorization is denial of payment. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumers deductible, cost-sharing or out of pocket maximum

Exclusions: Specialty drugs are limited to a 30-day supply per fill, however some may be limited to a 15-day supply fill, depending on the medication

Preferred Brand Drugs

$100.00 Copay after deductible
Tier 1 in-network $100.00 Copay after deductible
Out-of-network 100.00%

Refer to drug list for quantity limits and other exclusions. May require prior authorization & step therapy. The penalty for not having prior authorization is denial of payment. No charge for Tier 1A contraceptives. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumers deductible, cost-sharing or out of pocket maximum

Exclusions: Quantity limits per fill may apply for 30-day retail, 90-day retail, and 90-day mail order. Opioid containing medications are limited to no more than a 30-day supply per fill and first fills of select opioid containing medications will be limited to a 5-day supply.

Specialty Drugs

40.00% Coinsurance after deductible
Tier 1 in-network 40.00% Coinsurance after deductible
Out-of-network 100.00%

Refer to drug list for quantity limits and other exclusions. BCN has contracted with an exclusive pharmacy network for specialty drugs. Call the customer service phone number on the back of your ID card for the pharmacys phone number or location nearest to you. If you obtain your specialty drugs from any other pharmacy, you are responsible for the total cost. Prior authorization, step therapy and quantity limits may apply to select drugs. The penalty for not having prior authorization is denial of payment. Any coupon, rebate, or other credits received directly or indirectly from an assistance program or the drug manufacturer may not be applied to a consumers deductible, cost-sharing or out of pocket maximum

Exclusions: Specialty drugs are limited to a 30-day supply per fill, however some may be limited to a 15-day supply fill, depending on the medication

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Accidental injury and emergency only.

Exclusions: nan

Basic Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Dental Check-Up for Children

Coverage details pending

nan

Exclusions: nan

Infusion Therapy

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

BCN approved providers only.

Exclusions: nan

Major Dental Care - Adult

Coverage details pending

nan

Exclusions: nan

Nutritional Counseling

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Dietician Services.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Prosthetic Devices

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

BCN approved providers only. Limited to the basic items; replacement is limited to items that cannot be repaired or modified

Exclusions: nan

Routine Dental Services (Adult)

Coverage details pending

nan

Exclusions: nan

Weight Loss Programs

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Obesity screening at physician's office only.

Exclusions: nan

Additional benefits

Other plan-specific services and limitations.

Abortion for Which Public Funding is Prohibited

Coverage details pending

nan

Exclusions: nan

Acupuncture

Coverage details pending

nan

Exclusions: nan

Allergy Testing

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

In network only if at a physican's office.

Exclusions: nan

Bariatric Surgery

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 1.0 Procedure(s) per Lifetime

Subject to BCN medical criteria.

Exclusions: nan

Cosmetic Surgery

Coverage details pending

nan

Exclusions: nan

Eye Glasses for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 100.00%

Limit: 1.0 Item(s) per Year

Out of network is paid up to the allowed amount. A child is defined as a member up to age 19.

Exclusions: nan

Gender Affirming Care

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

May require prior authorization.

Exclusions: Cosmetic surgery, investigational and experimental procedures.

Habilitation Services

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Limit: 30.0 Visit(s) per Year

Prior authoriztion required. The penalty for not having prior authorization is denial of payment. Physical Therapy/Occupational Therapy- combined 30 visits per calendar year; 30 visits for Speech Therapy per calendar year.

Exclusions: nan

Imaging (CT/PET Scans, MRIs)

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authoriztion required. The penalty for not having prior authorization is denial of payment.

Exclusions: nan

Infertility Treatment

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authorization required. The penalty for not having prior authorization is denial of payment.

Exclusions: Artificial Insemination and In-Vitro Fertilization.

Long-Term/Custodial Nursing Home Care

Coverage details pending

nan

Exclusions: nan

Private-Duty Nursing

Coverage details pending

nan

Exclusions: nan

Reconstructive Surgery

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 100.00%

Covered only when medically necessary.

Exclusions: nan

Routine Eye Exam (Adult)

Coverage details pending

nan

Exclusions: nan

Routine Foot Care

Coverage details pending

nan

Exclusions: nan

Treatment for Temporomandibular Joint Disorders

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 100.00%

Prior authorization required. The penalty for not having prior authorization is denial of payment. Coverage includes medical care or services to treat dysfunction or TMJ resulting from a medical cause or Injury, Office visits for medical evaluation and treatment, X-rays of the temporomandibular joint including contrast studies, but not dental x-rays, Myofunctional therapy and Surgery to the temporomandibular joint, such as condylectomy, meniscectomy, arthrotomy, and arthrocentesis.

Exclusions: Dental and orthodontic services, treatment, prosthesis and appliances related to TMJ.

Variant attributes

Blue Cross® Preferred HMO Silver Saver · Variant 98185MI0180015-04

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

73% AV Level Silver Plan

HIOS Product ID

98185MI018

Metal Level

Silver

Plan ID (Standard Component ID with Variant)

98185MI0180015-04

Plan Marketing Name

Blue Cross® Preferred HMO Silver Saver

Plan Variant Marketing Name

Blue Cross® Preferred HMO Silver Saver

Issuer & service area

Issuer-provided metadata for this variant.

Issuer Actuarial Value

73.08%

Issuer ID

98185

Issuer Marketplace Marketing Name

Blue Care Network of Michigan

Market Coverage

Individual

Multiple In Network Tiers

No

National Network

No

Network ID

MIN005

Out of Country Coverage

Yes

Out of Country Coverage Description

Accidential Injury and Emergency Only

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Accidential Injury and Emergency Only

Service Area ID

MIS012

State Code

MI

URL for Summary of Benefits & Coverage

Open link

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

AV Calculator Output Number

0.73104368116124

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Medical Drug Deductibles Integrated

Yes

Medical Drug Maximum Out of Pocket Integrated

Yes

SBC Scenario, Having a Baby, Coinsurance

$1,500

SBC Scenario, Having a Baby, Copayment

$10

SBC Scenario, Having a Baby, Deductible

$3,700

SBC Scenario, Having Diabetes, Coinsurance

$20

SBC Scenario, Having Diabetes, Copayment

$600

SBC Scenario, Having Diabetes, Deductible

$3,700

SBC Scenario, Treatment of a Simple Fracture, Coinsurance

$0

SBC Scenario, Treatment of a Simple Fracture, Copayment

$300

SBC Scenario, Treatment of a Simple Fracture, Deductible

$2,500

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Combined In/Out Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Default Coinsurance

20.00%

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Group

$12600 per group

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Family Per Person

$6300 per person

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), In Network (Tier 1), Individual

$6,300

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical and Drug EHB Benefits (Total), Out of Network, Individual

Not Applicable

Enrollment & documents

Issuer-provided metadata for this variant.

Formulary ID

MIF230

Formulary URL

Open link

Plan Brochure

Open link

SBC Scenario, Having a Baby, Limit

$60

SBC Scenario, Having Diabetes, Limit

$20

SBC Scenario, Treatment of a Simple Fracture, Limit

$0

URL for Enrollment Payment

Open link

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

No

Design Type

Not Applicable

Disease Management Programs Offered

Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs

EHB Percent of Total Premium

1.0

First Tier Utilization

100%

Import Date

2024-08-14 20:01:41

Limited Cost Sharing Plan Variation - Estimated Advanced Payment

$0.00

HSA Eligible

No

New/Existing Plan

Existing

Notice Required for Pregnancy

No

Is a Referral Required for Specialist?

Yes

Plan Effective Date

2025-01-01

Plan Expiration Date

2025-12-31

Plan Type

HMO

QHP/Non QHP

Both

Source Name

SERFF

Specialist Requiring a Referral

All except routine OB/GYN & pediatric visits

Plan ID

98185MI0180015

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Combined In/Out of Network, Individual

Not Applicable

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Group

$7400 per group

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Family Per Person

$3700 per person

Combined Medical and Drug EHB Deductible, In Network (Tier 1), Individual

$3,700

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Group

per group not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Family Per Person

per person not applicable

Combined Medical and Drug EHB Deductible, Out of Network, Individual

Not Applicable

Unique Plan Design

Yes

Wellness Program Offered

No

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Michigan?

Blue Cross® Preferred HMO Silver Saver (98185MI0180015) is a Silver HMO from Blue Care Network of Michigan in Michigan for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Blue Cross® Preferred HMO Silver Saver support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Blue Cross® Preferred HMO Silver Saver HSA-eligible and does it include dental or vision coverage?

It is not marked as HSA-eligible, so confirm with the issuer before relying on tax-advantaged savings.

Dental coverage is not listed for this plan.

Vision add-ons: Child.

Does Blue Cross® Preferred HMO Silver Saver support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Which disease management programs come with Blue Cross® Preferred HMO Silver Saver?

The issuer lists disease management resources for: Asthma, Depression, Diabetes, Heart Disease, High Blood Pressure & High Cholesterol, Low Back Pain, Pain Management, Pregnancy, Weight Loss Programs.

Is there out-of-country coverage for Blue Cross® Preferred HMO Silver Saver?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Accidential Injury and Emergency Only

Does Blue Cross® Preferred HMO Silver Saver cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Accidential Injury and Emergency Only

Disclaimer: Based on the Tue, 02 Dec 2025 06:13 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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