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Blue Medicare Advantage Enhanced PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Advantage Enhanced PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Advantage Enhanced PPO (PPO) in 2025, please refer to our full plan details page.
Blue Medicare Advantage Enhanced PPO (PPO) is a PPO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2025 to people living in Iowa. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Blue Medicare Advantage Enhanced PPO (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about Blue Medicare Advantage Enhanced PPO (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For Blue Medicare Advantage Enhanced PPO (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $63.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5450.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5450.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The Blue Medicare Advantage Enhanced PPO (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, you will pay a $10 copay for preferred generic drugs at a standard or mail pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Blue Medicare Advantage Enhanced PPO (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a $300 copay for the first six days, but no copay thereafter. Outpatient services and emergency services have copays ranging from $30 to $300. This plan includes coverage for primary care with no copay, and preventive services with no copay. The plan also covers hearing exams, vision services, and dental services. Additionally, the plan covers ambulance services, diagnostic services, home health services, and skilled nursing facility services.
Inpatient Hospital See details
Inpatient Hospital services are covered. For Inpatient Hospital-Acute, there is a $300 copay for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Inpatient Hospital Psychiatric services are covered with a $300 copay for days 1-6, and no copay for days 7-90, but additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered under the Blue Medicare Advantage Enhanced PPO (PPO) plan, including all outpatient hospital services, with a copay ranging from $30 to $300 depending on the service, and observation services with a $225 copay. Ambulatory Surgical Center (ASC) Services have a $200 copay, and Outpatient Substance Abuse Services, including individual and group sessions, have a copay of $25. Outpatient Blood Services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Medicare Advantage Enhanced PPO (PPO) plan, but requires prior authorization. The copay for this benefit is $130.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Blue Medicare Advantage Enhanced PPO (PPO) plan. Ground and air ambulance services have a $300 copay, and there is no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Blue Medicare Advantage Enhanced PPO (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $35 copay, and Worldwide Emergency Services has a $120 copay for Worldwide Emergency and Urgent Coverage, and a $300 copay for Worldwide Emergency Transportation.
Primary Care See details
The Blue Medicare Advantage Enhanced PPO (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Routine chiropractic care has a $25 copay for up to 14 visits per year, and other chiropractic services have no copay for up to 1 visit per year. Occupational therapy services have a $30 copay, while physician specialist services and physical therapy/speech-language pathology services both have a $30 copay. Mental health and psychiatric services have a $30 copay for individual and group sessions. Other health care professional services have a $0-$30 copay. Additional telehealth benefits have a $0-$40 copay, and opioid treatment program services have no copay. Podiatry services are not covered.
Preventive Services See details
The Blue Medicare Advantage Enhanced PPO (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional services like the Personal Emergency Response System (PERS), Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.
Hearing Services See details
The Blue Medicare Advantage Enhanced PPO (PPO) plan covers hearing exams with no copay, and also covers routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $500 per ear every year, and OTC hearing aids are covered up to $50 per ear every three months. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered.
Vision Services See details
The Blue Medicare Advantage Enhanced PPO (PPO) plan covers vision services, including eye exams with a copay of $0-$30, contact lenses, eyeglass lenses, eyeglass frames, and upgrades. Eyeglasses (lenses and frames) are not covered. Contact lenses are limited to 1 pair per year, and eyeglass frames are limited to 1 frame per year, with a maximum benefit coverage amount of $100.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay, and other dental services such as oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatment. Orthodontic Services are covered up to a maximum of $2000 per year, while restorative services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with varying coinsurance, and adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B insulin drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Blue Medicare Advantage Enhanced PPO (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance between 0% and 20% and requiring authorization, Prosthetics/Medical Supplies with a coinsurance for some services, and Diabetic Equipment with no copay and a coinsurance for some services. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, have a copay of $30, while lab services have no copay. Diagnostic Radiological Services have a copay of at least $75, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray services have a $10 copay.
Home Health Services See details
Home Health Services are covered by the Blue Medicare Advantage Enhanced PPO (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Blue Medicare Advantage Enhanced PPO (PPO), but the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. There is a copay for some services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Advantage Enhanced PPO (PPO) plan. There is no copay for days 1-20, but a $190 copay applies for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays are not covered.
Other Services See details
The Blue Medicare Advantage Enhanced PPO (PPO) plan's "Other Services" benefit covers over-the-counter items with a maximum benefit of $50 every three months, and meal benefits with no copay. Acupuncture and several other services are not covered.
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