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NextBlue Classic PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for NextBlue Classic PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on NextBlue Classic PPO (PPO) in 2025, please refer to our full plan details page.
NextBlue Classic 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 North Dakota. This plan received an overall rating of 4 out of 5 stars in 2025.
It's important to know that NextBlue Classic 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 NextBlue Classic 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 NextBlue Classic PPO (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 a $340.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5500.00 (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 $5500.00 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:
Sign up for NextBlue Classic PPO (PPO)
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Drug Coverage
The NextBlue Classic PPO (PPO) plan has a $340 deductible for prescription drugs. After meeting the deductible, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you will pay $8 for preferred generics at a standard pharmacy, and 29% coinsurance for non-preferred drugs. For specialty tier drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs.
Additional Benefits
The NextBlue Classic PPO (PPO) plan offers a wide range of benefits, including coverage for inpatient and outpatient services, with varying copays depending on the service. The plan includes no copay for primary care physician visits, and preventive services like an annual physical exam, and offers additional benefits for vision, hearing, and dental services. The plan also covers home health services with no copay, but does not cover cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital services, including Acute and Psychiatric, are covered, with a $425 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The NextBlue Classic PPO (PPO) plan covers outpatient services, including outpatient hospital services with a copay between $250 and $350, observation services with a $350 copay, and outpatient substance abuse services with copays of $40 for individual sessions and $45 for group sessions. Ambulatory Surgical Center (ASC) Services and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the NextBlue Classic PPO (PPO) plan, with a $55 copay, and requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the NextBlue Classic PPO (PPO) plan, which requires prior authorization for all ambulance services. Ground ambulance services have a $250 copay, while air ambulance services have a 20% coinsurance. 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 NextBlue Classic PPO (PPO) plan. Emergency Services have a $120 copay, and Urgently Needed Services have a $50 copay, while Worldwide Emergency Coverage and Worldwide Emergency Transportation have a $125 copay, and Worldwide Urgent Coverage has a $65 copay.
Primary Care See details
The NextBlue Classic PPO (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $20 copay, and Routine Chiropractic Care also has a $20 copay. Occupational therapy services have a $45 copay, while physical therapy and speech-language pathology services have a $40 copay. Physician specialist services have a $40 copay, and mental health specialty services have a $40 copay for both individual and group sessions. Other health care professional services have copays between $15 and $40, and psychiatric services have a $40 copay for both individual and group sessions. Additional telehealth benefits have copays between $0 and $50, and Opioid Treatment Program Services have no copay.
Preventive Services See details
The NextBlue Classic PPO (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, including Medicare-covered glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit, all with no copay. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services are not covered. The plan also covers fitness benefits and remote access technologies, both with no copay.
Hearing Services See details
Hearing services include hearing exams with a $15 copay, fitting/evaluation for hearing aids, prescription hearing aids (all types) with a maximum benefit of $800 per year, and OTC hearing aids with a maximum of $35 per ear every three months; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. Routine hearing exams are limited to 1 per year.
Vision Services See details
The NextBlue Classic PPO (PPO) plan covers vision services, including routine eye exams with a copay of $0 - $40. Eyewear, contact lenses, eyeglass lenses, eyeglass frames, and upgrades are also covered; contact lenses have a maximum benefit coverage amount of $100 per year, while eyeglass frames have a maximum benefit coverage amount of $100 per year. Eyeglasses (lenses and frames) are not covered.
Dental Services See details
The NextBlue Classic PPO (PPO) plan covers dental services, including oral exams with a $40 copay, dental x-rays with no coinsurance, and prophylaxis (cleaning) with no copay, and fluoride treatment with no copay. Orthodontic services have a maximum benefit of $750 per year, and restorative services, endodontics, prosthodontics (removable and fixed), and oral and maxillofacial surgery are covered with varying coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the NextBlue Classic PPO (PPO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the NextBlue Classic PPO (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
The NextBlue Classic PPO (PPO) plan covers medical equipment, including durable medical equipment with a 0% to 20% coinsurance and no copay, and prosthetic devices with a 20% coinsurance and no copay. The plan also covers medical supplies with a 20% coinsurance and no copay, while diabetic supplies have no coinsurance and no copay, and diabetic therapeutic shoes/inserts have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $150, Lab Services with a $15 copay, and Outpatient X-Ray Services with a $20 copay. Diagnostic Radiological Services have a copay of up to $350, while Therapeutic Radiological Services have a coinsurance of at least 20%.
Home Health Services See details
Home Health Services are covered by the NextBlue Classic 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 not covered by the NextBlue Classic PPO (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the NextBlue Classic PPO (PPO) plan, but require prior authorization. For days 1-20, there is no copay, for days 21-55 the copay is $150, and for days 56-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $35 every three months, but does not cover Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services.
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