Medicare Plan Lookup Official CMS data · Contract Year 2026
CMS 2026 data

2026 Medicare plan code

H5883-014

Medicare Plan

BCN Advantage Prime Value (HMO-POS) · Blue Care Network · HMOPOS · Region 4

Full CMS plan ID: H5883-014-004

H5883-014-004 is the full CMS identifier for the H5883-014 Medicare plan. Common searches include H5883 014 and H5883014.

Historical 2026 record. Benefits and service areas shown apply to that year.

2026

Spaces or dashes work: H5216-435-002 · S2135 802

● CMS 2026 plan record

BCN Advantage Prime Value (HMO-POS)

H5883-014-004 Region 4 HMOPOS

At-a-glance

Quick view

01

In-network

Inpatient hospital

Days 1–7 $300 / day
Days 8–90 $0 / day
Total of listed copays · 7 charged days $2,100
02

Emergency transport

Ambulance

Ground · in-network$310 copay
Air · in-network$310 copay

Ground ambulance: In-network: cost sharing varies by a CMS plan-defined group; Air ambulance: In-network: cost sharing varies by a CMS plan-defined group

03

Emergency services

Emergency room

$130 copay

Waived if admitted

04

Medical maximum

Maximum out-of-pocket

In-network$5,000
Combined in + out$5,000
05

Skilled care at home

Home health

In-networkVerify in plan documents
Out-of-networkNot separately reported
06

Monthly cost

Premium & giveback

Part C premium$25.40 / month
Consolidated C + D$35 / month

Plan details

All plan benefits

Medical care3 benefits

Primary care physician

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported

Specialist

Verify in plan documents
In-network$35 copay
Out-of-networkNot separately reported

Preventive care

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported
Diagnostics & imaging4 benefits

Diagnostic procedures & tests

Verify in plan documents
In-network$0–$20 copay
Out-of-networkNot separately reported

Laboratory services

Verify in plan documents
In-networkCost share not reported
Out-of-networkNot separately reported

X-rays & standard imaging

Verify in plan documents
In-network$20–$100 copay
Out-of-networkNot separately reported

MRI, CT & PET imaging

Verify in plan documents
In-network$25 copay
Out-of-networkNot separately reported
Urgent & hospital care6 benefits

Urgent care

In-networkCost share not reported
Out-of-networkNot separately reported

Emergency room

In-network$130 copay
Out-of-networkNot separately reported

Ground ambulance

Verify in plan documents
In-network$310 copay
Out-of-networkNot separately reported

Air ambulance

Verify in plan documents
In-network$310 copay
Out-of-networkNot separately reported

Outpatient hospital

Verify in plan documents
In-network$150–$375 copay
Out-of-networkNot separately reported

Outpatient surgery / ASC

Verify in plan documents
In-network$0–$240 copay
Out-of-networkNot separately reported
Recovery & therapy5 benefits

Home health

Verify in plan documents
In-networkVerify in plan documents
Out-of-networkNot separately reported

Skilled nursing facility

In-networkCost share not reported
Out-of-networkNot separately reported

Cardiac & pulmonary rehabilitation

Verify in plan documents
In-network$0 copay
Out-of-networkNot separately reported

Occupational therapy

Verify in plan documents
In-network$35 copay
Out-of-networkNot separately reported

Physical & speech therapy

Verify in plan documents
In-network$35 copay
Out-of-networkNot separately reported
Behavioral health2 benefits

Mental health services

Verify in plan documents
In-network$55 copay
Out-of-networkNot separately reported

Substance use treatment

Verify in plan documents
In-network$55 copay
Out-of-networkNot separately reported
Specialty care2 benefits

Podiatry

Verify in plan documents
In-network$35 copay
Out-of-networkNot separately reported

Chiropractic

Verify in plan documents
In-network$15 copay
Out-of-networkNot separately reported
Supplemental benefits7 benefits

Dental

Verify in plan documents
In-network$0–$375 copay
Out-of-networkNot separately reported

Vision

Verify in plan documents
In-network$0–$35 copay
Out-of-networkNot separately reported

Hearing

Verify in plan documents
In-network$0–$35 copay
Out-of-networkNot separately reported

Transportation

Not reported in this CMS export

Not reported in this CMS export

Fitness & wellness

Not reported in this CMS export

Not reported in this CMS export

Over-the-counter allowance

Not reported in this CMS export

Not reported in this CMS export

Meals

Not reported in this CMS export

Not reported in this CMS export

Plan costs & rulesCoverage overview

Premium & Part B giveback

$25.40 Part C premium / month · Part B giveback not separately reported

Maximum out-of-pocket (MOOP)

In-network$5,000
Combined in + out$5,000

Medical deductibles

In-networkNot reported
Out-of-networkNot reported

Network & referrals

HMOPOS · Referrals: Required for some services · Out-of-network coverage: Not reported

Prescription drugs5 tiers

Part D deductible

Not reported

Drug tier 1

$5 retail copay · 31-day supply

Drug tier 2

$10 retail copay · 31-day supply

Drug tier 3

20% retail coinsurance · 31-day supply

Drug tier 4

30% retail coinsurance · 31-day supply

Drug tier 5

31% retail coinsurance · 31-day supply

Using this plan

Understand H5883-014-004

Plain-language context built from this plan’s 2026 CMS record. It is a guide to the reported benefits, not a personalized cost estimate.

Plan at a glance

A quick read on this plan

BCN Advantage Prime Value (HMO-POS) is a 2026 HMOPOS offered by Blue Care Network in Region 4. Referrals are required for some services. Its listed inpatient copay stages total $2,100 across 7 charged days.

Common benefit costs

What you may pay

These are individual in-network benefit amounts. A real visit may involve more than one separately billed service.

Routine care

Primary care physician
Verify in plan documents
Specialist
$35 copay
Laboratory services
Cost share not reported

Separate visits or services; costs are not added together.

Tests & outpatient care

Diagnostic procedures & tests
$0–$20 copay
MRI, CT & PET imaging
$25 copay
Outpatient hospital
$150–$375 copay

The service setting and billing details can change what you pay.

Emergency & hospital care

Emergency room
$130 copay
Listed inpatient stages
$2,100 total

7 charged inpatient days are included in the calculated total. Actual costs depend on the care received and plan rules.

Helpful context

Terms worth knowing

Maximum out-of-pocket (MOOP)

This is the most you generally pay during the plan year for covered Part A and Part B medical services under the applicable network limit. Premiums and prescription drug costs generally do not count toward it.

Availability

Who can enroll

Service area
Region 4 (MI)
Plan type
HMOPOS
Contract / plan
H5883-014
Coverage year
2026

Enrollment generally requires Medicare eligibility and residence in the plan's service area. Confirm eligibility and the exact service area with the plan before enrolling.

Supplemental coverage

Extra benefits reported

Availability is summarized here; allowances, frequency limits, networks, and prior-authorization rules may apply.

Dental$0–$375 copay
Vision$0–$35 copay
Hearing$0–$35 copay

Plan-specific answers

Frequently asked questions

Where is H5883-014-004 available?

BCN Advantage Prime Value (HMO-POS) is listed for Region 4 (MI). Enrollment generally requires Medicare eligibility and residence in the plan's service area.

What is the in-network maximum out-of-pocket limit for H5883-014-004?

The 2026 CMS record lists an in-network medical maximum out-of-pocket limit of $5,000. Prescription drug spending generally does not count toward this medical limit.

What is the monthly plan premium for H5883-014-004?

The listed consolidated Part C and Part D premium is $35 per month. This does not replace the standard Medicare Part B premium.

What does an emergency room visit cost on H5883-014-004?

The plan record lists $130 copay, waived when an admission meets the plan's stated timing rule.

Does H5883-014-004 report extra benefits?

Yes. CMS reports dental, vision, hearing. See the detailed benefit rows and official plan documents for limits and conditions.

Source trail

Official CMS, Contract Year 2026

Plan identity and benefits come from CMS PBP data. Premium and MOOP figures are cross-checked against the August 2026 Landscape release; county identity is sourced from segment-level Landscape rows and stable codes are enriched from the aligned MA contract service-area release where matched. Quick-reference values should be confirmed in 2026 official plan documents.

PBP benefits ↗ Landscape data ↗ County service area ↗

Plan context

Where H5883-014-004 fits

Full CMS plan ID
H5883-014-004
Contract
H5883
Base plan code
H5883-014
Segment
004
Carrier
Blue Care Network
Plan type
HMOPOS
Service area
Region 4 (MI)

County/service-area foundation

CMS service-area entries

Named county entries are tied to this exact contract, plan, and segment in CMS Landscape data. County codes are enriched from the aligned CMS contract service-area release where a match exists.

  • Genesee, MI
  • Lenawee, MI
  • Livingston, MI
  • St. Clair, MI

Same CMS contract

H5883-014-001 BCN Advantage Prime Value (HMO-POS) Region 1 · HMOPOS H5883-014-002 BCN Advantage Prime Value (HMO-POS) Region 2 · HMOPOS H5883-014-005 BCN Advantage Prime Value (HMO-POS) Region 5 · HMOPOS H5883-001-001 BCN Advantage Elements (HMO-POS) Region 1 · HMOPOS H5883-001-002 BCN Advantage Elements (HMO-POS) Region 2 · HMOPOS H5883-001-003 BCN Advantage Elements (HMO-POS) Region 3 · HMOPOS H5883-001-004 BCN Advantage Elements (HMO-POS) Region 4 · HMOPOS H5883-001-005 BCN Advantage Elements (HMO-POS) Region 5 · HMOPOS

About this code

What H5883-014-004 identifies

H5883-014-004 is a Contract Year 2026 Medicare plan segment code. Searches written as H5883-014, H5883 014, or the compact full CMS ID H5883014004 refer to this plan or its base plan code.

Medicare Plan Lookup uses official CMS data as a quick reference. Benefit details, eligibility, service-area rules, and cost sharing should be confirmed in the current Summary of Benefits or Evidence of Coverage.