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NextBlue Premium PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for NextBlue Premium PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on NextBlue Premium PPO (PPO) in 2025, please refer to our full plan details page.
NextBlue Premium 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 Premium 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 Premium 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 Premium PPO (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $73.00. 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 $240.00 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 $4500.00 (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 $4500.00 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 Premium PPO (PPO)
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Drug Coverage
The NextBlue Premium PPO (PPO) plan has a $240 deductible for prescription drugs. After the deductible, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, you will pay a $6 copay for preferred generic drugs at a standard pharmacy, and a $100 copay for preferred brand drugs at a standard pharmacy. Once your total yearly drug costs reach $2000, you will enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs.
Additional Benefits
The NextBlue Premium PPO (PPO) plan offers a range of benefits, including inpatient hospital stays with a $400 copay, and outpatient services with varying copays. The plan also covers primary care visits, preventive services, and hearing exams with no copay. Vision services, including routine eye exams, are covered with some copays and maximums. Additional benefits include dental services with copays or coinsurance, home infusion services, and dialysis services with coinsurance. The plan covers ambulance and emergency services with copays, and skilled nursing facility stays with no copay for some days, but excludes some services like cardiac rehabilitation and acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the NextBlue Premium PPO (PPO) plan. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, there is a $400 copay for a Medicare-covered stay, and additional days for Inpatient Hospital-Acute have no copay. Non-Medicare-covered Stay for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, offered by the NextBlue Premium PPO (PPO) plan, include coverage for all outpatient hospital services, with a copay between $225 and $250, and observation services with a $250 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $30 copay for both individual and group sessions. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the NextBlue Premium PPO (PPO) plan with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the NextBlue Premium PPO (PPO) plan. Ground ambulance services have a $150 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. Emergency Services has a $110 copay, Urgently Needed Services has a $40 copay, and Worldwide Emergency Coverage and Emergency Transportation have a $110 copay, while Worldwide Urgent Coverage has a $55 copay.
Primary Care See details
The NextBlue Premium PPO (PPO) plan covers primary care physician services with no copay, and chiropractic services with a $20 copay. Occupational therapy services have a $30 copay, and physician specialist services have a $30 copay. Mental health specialty services, psychiatric services, and other health care professionals services have a copay between $0 and $30. Physical therapy and speech-language pathology services have a $30 copay, and additional telehealth benefits have a copay between $0 and $40. Opioid treatment program services are covered with no copay.
Preventive Services See details
The NextBlue Premium PPO (PPO) plan covers preventive services, including an annual physical exam with no copay. The plan also covers additional preventive services, including Fitness Benefit, 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. However, Health Education, In-Home Safety Assessment, Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission 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.
Hearing Services See details
Hearing exams are covered with no copay, as is the fitting/evaluation for hearing aids. Prescription hearing aids are covered up to a maximum of $1,000 per year, per ear, and OTC hearing aids are covered up to $50 per ear every three months. Prescription hearing aids are not covered for inner ear, outer ear, or over the ear.
Vision Services See details
The NextBlue Premium PPO (PPO) plan covers vision services, including routine eye exams with a copay of $0-$30, contact lenses with a maximum of $200 per year, eyeglass lenses, eyeglass frames with a maximum of $200 per year, and upgrades. Eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $30 copay. Other dental services include oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services with 25% coinsurance, endodontics with 25% coinsurance, periodontics with 0% - 25% coinsurance, prosthodontics removable with 25% coinsurance, prosthodontics fixed with 25% coinsurance, and oral and maxillofacial surgery with 0% - 25% coinsurance. Orthodontic services are covered up to a $1000 yearly maximum, while 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. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are covered with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the NextBlue Premium PPO (PPO) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and Diabetic Supplies have no coinsurance, while Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with all services requiring prior authorization. Diagnostic Procedures/Tests have a copay between $0 and $150, and Lab Services have no copay. Diagnostic Radiological Services have a copay up to $325, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the NextBlue Premium PPO (PPO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the NextBlue Premium PPO (PPO) plan. While the plan covers some Cardiac Rehabilitation Services, the specific services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the NextBlue Premium PPO (PPO) plan, but require prior authorization. There is no copay for days 1-20 and days 49-100, but there is a $150 copay for days 21-48. Additional days beyond Medicare and non-Medicare stays are not covered.
Other Services See details
The NextBlue Premium PPO (PPO) plan does not cover acupuncture, meal benefits, 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, or Self-Directed Personal Assistance Services. The plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $50 every three months.
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