McLaren Medicare
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McLaren Medicare Inspire (HMO)

McLaren Medicare Inspire Plus (HMO)

McLaren Medicare Inspire Flex Region 1 * (HMO-POS)

* Available for people who reside in the following Michigan counties: Bay, Charlevoix, Cheboygan, Clinton, Emmet, Genesee, Ingham, Isabella, Lapeer, Macomb, Oakland, and St. Clair counties

McLaren Medicare Inspire Flex Region 2 ** (HMO-POS)

** Available for people who reside in the following Michigan counties: Alcona, Allegan, Alpena, Antrim, Arenac, Barry, Benzie, Berrien, Branch, Calhoun, Cass, Clare, Crawford, Eaton, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron, Ionia, Iosco, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Livingston, Manistee, Mecosta, Midland, Missaukee, Montcalm, Montmorency, Newaygo, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, St. Joseph, Sanilac, Shiawassee, Tuscola, Van Buren, Washtenaw, Wayne, and Wexford counties

McLaren Medicare Inspire Duals (HMO DSNP)

McLaren Medicare Inspire (HMO)

Health Maintenance Organization (HMO) plans give you great health care benefits. These Medicare Advantage plans in Michigan offer low monthly premiums to keep your health care affordable. Benefits include all the same coverage as Original Medicare Part A and Part B, as well as prescription drug coverage and dental and vision coverage.

When you enroll in the McLaren Medicare Inspire (HMO) plan, you’ll choose a primary doctor to be your care partner. This HMO plan covers in-network care and has a large network of care providers.

Plan Premiums and Other Costs
Monthly premium $0
Maximum out of pocket limit $4,200
Annual deductible $0

Benefits and Costs
Primary care physician visit $0 copay
Specialist visits $40 copay
Preventive care $0 copay
Inpatient hospital coverage $275 per day for days 1 - 7
$0 per day for days 8 and after
Outpatient surgery - hospital $200 copay
Outpatient surgery - ambulatory surgical center $200 copay
Emergency care $100 copay anywhere in the United States or its territories
Urgent care $50 copay in or out of network
Ambulance $220 copay
Lab services $0 copay
Diagnostic tests & procedures $20 copay
Diagnostic radiology services (MRI, CT scan) $200 copay
Standard X-rays $25 copay
OTC $100/quarter with no rollover
Meals after discharge $0 copay for 28 meals (2 meals per day for 14 days) delivered directly to your home after each discharge from an inpatient acute or a skilled nursing facility stay. Annual limit of 5 discharges for a total of 140 meals per year.
Preventive dental

$0 copay for:

  • 2 exams and 2 cleanings (regular or periodontal) each year
  • 1 fluoride treatment each year
  • One set of bitewing X-rays each year (not payable in the same calendar year as a full mouth X-ray)
  • Full mouth X-rays once every 5 years
  • Emergency palliative treatment
Comprehensive dental

50% coinsurance for:

  • Fillings and crown repair
  • Periodontal non-surgical procedures (covered once per quadrant per 24-month period)
  • Simple extractions

$0 copay for brush biopsies

$40 copay for Medicare-covered dental services
Vision

$40 copay for each Medicare-covered exam to diagnose and treat diseases or conditions of the eye.

$0 copay for a Medicare-covered glaucoma screening.

$0 copay for a Medicare-covered diabetic retinopathy screening.

$0 copay for Medicare-covered eyeglasses or contact lenses after cataract surgery.

$0 copay for a non-Medicare-covered routine eye exam
Eyewear $0 copay for up to a maximum of $100 each year for routine corrective eyeglasses (lenses and frames) or contact lenses.
Chiropractic services $20 copay
Acupuncture services $25 copay
Fitness membership Up to $100 annually
Virtual care with McLarenNow or McLaren Now+Clinic $0 copay
Hearing aid             

$699 copayment per aid for Advanced Aids

$999 copayment per aid for Premium Aids

$50 additional cost per aid for optional hearing aid rechargeability

Up to two TruHearing-branded hearing aids, one per ear every two years. Benefit is limited to TruHearing’s Advanced and Premium hearing aids. Must use TruHearing providers.
Transportation $0 copay for up to 20 one-way non-emergency trips per year to plan approved health-related locations. 50 mile limit one-way.

Part D Prescription Drug Coverage
Deductible Stage There is no Part D deductible
Initial Coverage Stage
Tier 1 (preferred generics) $0
Tier 2 (generics) $12  Insulin: $10
Tier 3 (preferred brand) $47  Insulin: $35
Tier 4 (non-preferred brand) $100
Tier 5 (specialty drugs) 33% of the cost
Tier 6 (select care drugs) $0
Coverage Gap Stage Once your total drug cost (what you pay plus what we pay) reaches $5,030, you will move into the Coverage Gap Stage where you will continue to pay your copay for drugs on Tier 1 and Tier 6. For all other generics, you will pay 25% of the price. For brand name drugs, you will pay 25% of the price plus a portion of the dispensing fee.
Catastrophic Coverage Stage Once your yearly out-of-pocket drug costs total $8,000, our plan will pay the full cost for your covered Part D drugs.
Enroll Here

McLaren Medicare Inspire Plus (HMO)

The McLaren Medicare Inspire Plus is another HMO Medicare plan in Michigan. When you enroll in this plan, you’ll find a primary care provider.

The Inspire Plus plan offers all the same benefits as the Inspire plan. It also includes extra benefits, worldwide emergency care and the option to receive a Personal Emergency Response System. This plan has no annual deductible, so your benefits start right away. The McLaren Medicare Inspire Plus also has a low out-of-pocket maximum, so you don’t need to worry about your health care budget.

Plan Premiums and Other Costs
Monthly premium $25
Maximum out of pocket limit $3,500
Annual deductible $0

Benefits and Costs
Primary care physician visit $0 copay
Specialist visits $25 copay
Preventive care $0 copay
Inpatient hospital coverage $225 per day for days 1 - 7
$0 per day for days 8 and after
Outpatient surgery - hospital $200 copay
Outpatient surgery - ambulatory surgical center $150 copay
Emergency care $100 copay anywhere in the United States or its territories
Urgent care $50 copay in or out of network
Ambulance $220 copay
Lab services $0 copay
Diagnostic tests & procedures $20 copay
Diagnostic radiology services (MRI, CT scan) $150 copay
Standard X-rays $25 copay
Over-the-counter allowance $105/quarter with no rollover
Preventative dental

$0 copay for:

  • 2 exams and 2 cleanings (regular or periodontal) each year
  • 1 fluoride treatment each year
  • One set of bitewing X-rays each year (not payable in the same calendar year as a full mouth X-ray)
  • Full mouth X-rays once every 5 years
  • Emergency palliative treatment
Comprehensive dental

50% coinsurance for:

  • Fillings and crown repair
  • Periodontal non-surgical procedures (covered once per quadrant per 24-month period)
  • Simple extractions

$0 copay for brush biopsies

$40 copay for Medicare-covered dental services
Eyewear $0 copay for up to a maximum of $200 each year for routine corrective eyeglasses (lenses and frames) or contact lenses
Chiropractic services $20 copay
Acupuncture services $25 copay
Fitness membership Up to $200 annually
Virtual care with McLarenNow or McLaren Now+Clinic $0 copay
Hearing aid             

$699 copayment per aid for Advanced Aids

$999 copayment per aid for Premium Aids

$50 additional cost per aid for optional hearing aid rechargeability

Up to two TruHearing-branded hearing aids, one per ear every two years. Benefit is limited to TruHearing’s Advanced and Premium hearing aids. Must use TruHearing providers.
Transportation

$0 copay for up to 20 one-way non-emergency trips per year to plan approved health-related locations. 50-mile limit one-way.
Worldwide emergency or urgent care

$100 emergency copay

$50 urgent care copay

You may receive covered emergency and urgent care services anywhere in the world. If you are outside of the United States or its territories, your worldwide emergency and urgent care coverage is limited to $50,000
Personal Emergency Response System (PERS) $0 copay for a Mobile PERS plus device equipped with two-way voice communication, GPS location technology, and the option of auto fall detection with 24/7 monitoring
Meals after discharge $0 copay for 28 meals (2 meals per day for 14 days) delivered directly to your home after each discharge from an inpatient acute or a skilled nursing facility stay. Annual limit of 5 discharges for a total of 140 meals per year.

Part D Prescription Drug Coverage
Deductible Stage There is no Part D deductible
Initial Coverage Stage
Tier 1 (preferred generics) $0
Tier 2 (generics) $12  Insulin: $10
Tier 3 (preferred brand) $47  Insulin: $35
Tier 4 (non-preferred brand) $100
Tier 5 (specialty drugs) 33% of the cost
Tier 6 (select care drugs) $0
Coverage Gap Stage Once your total drug cost (what you pay plus what we pay) reaches $5,030, you will move into the Coverage Gap Stage where you will continue to pay your copay for drugs on Tier 1 and Tier 6. For all other generics, you will pay 25% of the price. For brand name drugs, you will pay 25% of the price plus a portion of the dispensing fee.
Catastrophic Coverage Stage Once your yearly out-of-pocket drug costs total $8,000, our plan will pay the full cost for your covered Part D drugs.
Enroll Here

McLaren Medicare Inspire Flex Region 1 (HMO-POS) *

An HMO-POS plan gives you more flexibility to access the care you need. Like McLaren Medicare’s other HMO plans, you’ll choose a primary care physician when you enroll in the plan. This doctor will be your care partner. When you access in-network care, you’ll have low copays for all covered services.

The McLaren Medicare Inspire Flex plan in Michigan also covers out-of-network care. When you visit a health care provider who is not in your network, you’ll pay a Point of Service (POS) coinsurance, and your Inspire Flex plan will pay the rest.

* Available for people who reside in the following Michigan counties: Bay, Charlevoix, Cheboygan, Clinton, Emmet, Genesee, Ingham, Isabella, Lapeer, Macomb, Oakland, and St. Clair counties

Plan Premiums and Other Costs
Monthly premium $0
Maximum out of pocket limit $3,800
Annual deductible $0

Benefits and Costs
In-Network Point-of-Service
Primary care physician visit $0 copay 20% coinsurance
Specialist visits $30 copay 20% coinsurance
Preventive care $0 copay 20% coinsurance
Inpatient hospital coverage $200 per day for days 1 - 7
$0 per day for days 8 and after 		20% coinsurance
Outpatient surgery - hospital $150 copay 20% coinsurance
Outpatient surgery - ambulatory surgical center $150 copay 20% coinsurance
Emergency care $100 copay anywhere in the United States or its territories
Urgent care $50 copay in or out of network
Ambulance $200 copay
Lab services $0 copay 20% coinsurance
Diagnostic tests & procedures $10 copay 20% coinsurance
Diagnostic radiology services (MRI, CT scan) $100 copay 20% coinsurance
Standard X-rays $35 copay 20% coinsurance
Over-the-counter allowance $100/quarter with no rollover 
Preventive dental

$0 copay for:

  • 2 exams and 2 cleanings (regular or periodontal) each year
  • 1 fluoride treatment each year
  • One set of bitewing X-rays each year (not payable in the same calendar year as a full mouth X-ray)
  • Full mouth X-rays once every 5 years
  • Emergency palliative treatment
 Not covered
Comprehensive dental

50% coinsurance for:

  • Fillings and crown repair
  • Periodontal non-surgical procedures (covered once per quadrant per 24-month period)
  • Simple extractions

$0 copay for brush biopsies

$40 copay for Medicare-covered dental services

Not covered
Eyewear $0 copay for up to a maximum of $200 each year for routine corrective eyeglasses (lenses and frames) or contact lenses 20% coinsurance
Chiropractic services $20 copay 20% coinsurance
Acupuncture services $30 copay Not covered
Fitness membership Up to $200 annually
Virtual care with McLarenNow or McLaren Now+Clinic $0 copay Not covered
Hearing Aid

$699 copayment per aid for Advanced Aids

$999 copayment per aid for Premium Aids

$50 additional cost per aid for optional hearing aid rechargeability

Up to two TruHearing-branded hearing aids, one per ear every two years. Benefit is limited to TruHearing’s Advanced and Premium hearing aids. Must use TruHearing providers.

 Not covered
Worldwide emergency or urgent care

$100 emergency copay $50 urgent care copay

You may receive covered emergency and urgent care services anywhere in the world. If you are outside of the United States or its territories, your worldwide emergency and urgent care coverage is limited to $50,000
Personal Emergency Response System (PERS) $0 copay for a Mobile PERS plus device equipped with two-way voice communication, GPS location technology, and the option of auto fall detection with 24/7 monitoring
Transportation $0 copay for up to 20 one-way non-emergency trips per year to plan approved health-related locations. 50-mile limit one-way.
Meals after discharge $0 copay for 28 meals (2 meals per day for 14 days) delivered directly to your home after each discharge from an inpatient acute or a skilled nursing facility stay. Annual limit of 5 discharges for a total of 140 meals per year.

Part D Prescription Drug Coverage
Deductible Stage There is no Part D deductible
Initial Coverage Stage
Tier 1 (preferred generics) $0
Tier 2 (generics) $12  Insulin: $10
Tier 3 (preferred brand) $47  Insulin: $35
Tier 4 (non-preferred brand) $100
Tier 5 (specialty drugs) 33% of the cost
Tier 6 (select care drugs) $0
Coverage Gap Stage Once your total drug cost (what you pay plus what we pay) reaches $5,030, you will move into the Coverage Gap Stage where you will continue to pay your copay for drugs on Tier 1 and Tier 6. For all other generics, you will pay 25% of the price. For brand name drugs, you will pay 25% of the price plus a portion of the dispensing fee.
Catastrophic Coverage Stage Once your yearly out-of-pocket drug costs total $8,000, our plan will pay the full cost for your covered Part D drugs.
Enroll Here

McLaren Medicare Inspire Flex Region 2 (HMO-POS) **

An HMO-POS plan gives you more flexibility to access the care you need. Like McLaren Medicare’s other HMO plans, you’ll choose a primary care physician when you enroll in the plan. This doctor will be your care partner. When you access in-network care, you’ll have low copays for all covered services.

The McLaren Medicare Inspire Flex plan in Michigan also covers out-of-network care. When you visit a health care provider who is not in your network, you’ll pay a Point of Service (POS) coinsurance, and your Inspire Flex plan will pay the rest.

** Available for people who reside in the following Michigan counties: Alcona, Allegan, Alpena, Antrim, Arenac, Barry, Benzie, Berrien, Branch, Calhoun, Cass, Clare, Crawford, Eaton, Gladwin, Grand Traverse, Gratiot, Hillsdale, Huron, Ionia, Iosco, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Livingston, Manistee, Mecosta, Midland, Missaukee, Montcalm, Montmorency, Newaygo, Ogemaw, Osceola, Oscoda, Otsego, Ottawa, Presque Isle, Roscommon, Saginaw, St. Joseph, Sanilac, Shiawassee, Tuscola, Van Buren, Washtenaw, Wayne, and Wexford counties

Plan Premiums and Other Costs
Monthly premium $49
Maximum out of pocket limit $3,800
Annual deductible $0

Benefits and Costs
In-Network Point-of-Service
Primary care physician visit $0 copay 30% coinsurance
Specialist visits $30 copay 30% coinsurance
Preventive care $0 copay 30% coinsurance
Inpatient hospital coverage $200 per day for days 1 - 7
$0 per day for days 8 and after 		30% coinsurance
Outpatient surgery - hospital $200 copay 30% coinsurance
Outpatient surgery - ambulatory surgical center $150 copay 30% coinsurance
Emergency care $100 copay anywhere in the United States or its territories
Urgent care $50 copay in or out of network
Ambulance $220 copay
Lab services $0 copay 30% coinsurance
Diagnostic tests & procedures $20 copay 30% coinsurance
Diagnostic radiology services (MRI, CT scan) $125 copay 30% coinsurance
Standard X-rays $25 copay 30% coinsurance
Over-the-counter allowance $100/quarter with no rollover
Preventive dental

$0 copay for:

  • 2 exams and 2 cleanings (regular or periodontal) each year
  • 1 fluoride treatment each year
  • One set of bitewing X-rays each year (not payable in the same calendar year as a full mouth X-ray)
  • Full mouth X-rays once every 5 years
  • Emergency palliative treatment
 Not covered
Comprehensive dental

50% coinsurance for:

  • Fillings and crown repair
  • Periodontal non-surgical procedures (covered once per quadrant per 24-month period)
  • Simple extractions

$0 copay for brush biopsies

$40 copay for Medicare-covered dental services

 Not covered
Eyewear $0 copay for up to a maximum of $200 each year for routine corrective eyeglasses (lenses and frames) or contact lenses 30% coinsurance
Chiropractic services $20 copay 30% coinsurance
Acupuncture services $25 copay Not covered
Fitness membership Up to $200 annually
Virtual care with McLarenNow or McLaren Now+Clinic $0 copay Not covered
Hearing Aid

$699 copayment per aid for Advanced Aids

$999 copayment per aid for Premium Aids

$50 additional cost per aid for optional hearing aid rechargeability

Up to two TruHearing-branded hearing aids, one per ear every two years. Benefit is limited to TruHearing’s Advanced and Premium hearing aids. Must use TruHearing providers.

 Not covered
Worldwide emergency or urgent care

$100 emergency copay

$50 urgent care copay

You may receive covered emergency and urgent care services anywhere in the world. If you are outside of the United States or its territories, your worldwide emergency and urgent care coverage is limited to $50,000
Personal Emergency Response System (PERS) $0 copay for a Mobile PERS plus device equipped with two-way voice communication, GPS location technology, and the option of auto fall detection with 24/7 monitoring
Transportation $0 copay for up to 20 one-way non-emergency trips per year to plan approved health-related locations. 50-mile limit one-way.
Meals after discharge $0 copay for 28 meals (2 meals per day for 14 days) delivered directly to your home after each discharge from an inpatient acute or a skilled nursing facility stay. Annual limit of 5 discharges for a total of 140 meals per year.

Part D Prescription Drug Coverage
Deductible Stage There is no Part D deductible
 Initial Coverage Stage
Tier 1 (preferred generics) $0
Tier 2 (generics) $12  Insulin: $10
Tier 3 (preferred brand) $47  Insulin: $35
Tier 4 (non-preferred brand) $100
Tier 5 (specialty drugs) 33% of the cost
Tier 6 (select care drugs) $0
Coverage Gap Stage Once your total drug cost (what you pay plus what we pay) reaches $5,030, you will move into the Coverage Gap Stage where you will continue to pay your copay for drugs on Tier 1 and Tier 6. For all other generics, you will pay 25% of the price. For brand name drugs, you will pay 25% of the price plus a portion of the dispensing fee.
Catastrophic Coverage Stage Once your yearly out-of-pocket drug costs total $8,000, our plan will pay the full cost for your covered Part D drugs.
Enroll Here

McLaren Medicare Inspire Duals (HMO DSNP)

Are you eligible for both Medicare and Medicaid^? If you’re dual eligible, you can enroll in a Dual Eligible Special Needs Plan (DSNP) in Michigan. An HMO-DSNP plan bundles all your Medicaid benefits and Medicare Advantage plan benefits into one plan.

The McLaren Medicare Inspire Duals plan benefits include a $0 monthly premium and a $0 annual deductible. Medicare and Medicaid work together to cover your health care costs, so you can access benefits with low or no copays and coinsurance. Our HMO-DSNP plan also offers prescription drug coverage, dental and vision coverage, fitness membership allowance, hearing services and more.

^Must also qualify for Low Income Subsidy or "Extra Help"

Plan Premiums and Other Costs
Monthly premium $0
Maximum out of pocket limit $0
Annual deductible $0

Benefits and Costs
Primary care physician visit $0 copay
Specialist visits $0 copay
Preventive care $0 copay
Inpatient hospital coverage $0 copay per stay
Outpatient surgery - hospital $0 copay
Outpatient surgery - ambulatory surgical center $0 copay
Urgent care $0 copay
Ambulance $0 copay
Lab services $0 copay
Diagnostic tests & procedures $0 copay
Diagnostic radiology services (MRI, CT scan) $0 copay
Standard X-rays $0 copay
Over-the-counter allowance $50/quarter with no rollover
Preventive dental

$0 copay
Eyewear $0 copay for up to a maximum of $100 each year for routine corrective eyeglasses (lenses and frames) or contact lenses.
Chiropractic services $0 copay
Acupuncture services $0 copay
Fitness membership Up to $200 annually
Transportation $0 copay for up to 25 one-way non-emergency trips per year to plan approved health-related locations. 50-mile limit one-way.
Meals after discharge $0 copay for 28 meals (2 meals per day for 14 days) delivered directly to your home after each discharge from an inpatient acute or a skilled nursing facility stay. Annual limit of 5 discharges for a total of 140 meals per year.
Virtual care with McLarenNow or McLaren Now+Clinic $0 copay
Hearing aid

$0 copay per hearing aid

Benefit covers up to two TruHearing-branded hearing aids, one per ear, every two years. Benefit is limited to TruHearing’s Advanced hearing aids.

You must see a TruHearing providers.

Part D Prescription Drug Coverage
Deductible Stage There is no Part D deductible
 Initial Coverage Stage
Tier 1 (generics) $0 per prescription
 Tier 1 (brand) $0 per prescription
Catastrophic Coverage Stage Once your yearly out-of-pocket drug costs total $8,000 you will pay: $0 per prescription.
Enroll Here