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NextBlue Discover PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for NextBlue Discover PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on NextBlue Discover PPO (PPO) in 2026, please refer to our full plan details page.
NextBlue Discover PPO (PPO) is a PPO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2026 to people living in North Dakota. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that NextBlue Discover 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 Discover 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 Discover PPO (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $59.00. 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 has a $200.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $300.00 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 $8000.00 (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 $8000.00 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 Discover PPO (PPO)
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Drug Coverage
The NextBlue Discover PPO (PPO) Medicare plan features a $300 annual drug deductible. Under this plan, Tier 1 preferred generic drugs are highly affordable, requiring no copay for one-month, two-month, or three-month supplies at standard pharmacies and mail-order services. Tier 2 generic drugs require a small copay, ranging from $3 for a one-month supply up to $9 for a three-month supply at standard pharmacies, or up to $7.50 for a three-month mail-order supply. For brand-name and specialty medications, members pay a percentage of the drug cost through coinsurance. Tier 3 preferred brand drugs carry a 20% coinsurance, and Tier 4 non-preferred drugs require a 25% coinsurance for standard pharmacy and mail-order fills. Tier 5 specialty drugs are restricted to a one-month supply and incur a 29% coinsurance.
Additional Benefits
The NextBlue Discover PPO (PPO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs and no coinsurance for many key benefits. Primary care visits, annual physicals, routine hearing exams, and home health services are available with no copay, while specialist visits and urgent care require low copays ranging from $15 to $55. For major medical events, inpatient hospital stays require a $450 daily copay for the first four days followed by no copay, and emergency room visits feature a $115 copay that is waived if you are admitted. This plan also includes valuable dental, vision, and hearing benefits to help manage your everyday health costs. Routine dental services and eyewear are covered with no copay up to a $500 annual maximum respectively, while prescription hearing aids are also covered up to $500 per ear. Additionally, diagnostic radiology services and home infusion therapies are offered with no copay, though other services like dialysis and durable medical equipment carry a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital care under the NextBlue Discover PPO (PPO) is partially covered with no coinsurance, requiring a daily copay of $450 for days 1 to 4 and no copay for days 5 to 90. Prior authorization is required, and while unlimited additional acute care days are covered at no cost, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services are covered by NextBlue Discover PPO (PPO) with no coinsurance, featuring copays of $450 to $550 for outpatient hospital services, $450 per stay for observation services, and $250 for ambulatory surgical center services. Outpatient substance abuse sessions require a $55 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
NextBlue Discover PPO (PPO) covers partial hospitalization services with a $105.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
NextBlue Discover PPO (PPO) covers ambulance services with a $350 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport, with prior authorization required. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
NextBlue Discover PPO (PPO) covers emergency services with a $115 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $40 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with copays ranging from $40 to $115 and no coinsurance.
Primary Care See details
NextBlue Discover PPO (PPO) covers primary care physician services and opioid treatment with no copay and no coinsurance, while specialist visits, physical therapy, and mental health services require copays ranging from $15 to $55 and no coinsurance. Podiatry services are not covered under this plan.
Preventive Services See details
NextBlue Discover PPO (PPO) covers preventive services, including annual physical exams, kidney disease education, and remote access technologies, with no copay and no coinsurance. Additional preventive benefits are only partially covered, with services such as fitness programs, health education, weight management, and in-home safety assessments not covered under this plan.
Hearing Services See details
NextBlue Discover PPO (PPO) covers hearing exams and fitting evaluations with no copay and no coinsurance, including one routine exam annually. Prescription hearing aids are partially covered with no copay or coinsurance up to a $500 maximum per ear each year, though OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
NextBlue Discover PPO (PPO) partially covers vision services, as other eye exam services are not covered, but includes one routine eye exam per year with a $0 to $55 copay and no coinsurance. Eyewear is covered with no copay, no coinsurance, and no deductible, offering a $500 combined annual maximum for contacts, lenses, frames, and upgrades.
Dental Services See details
NextBlue Discover PPO (PPO) dental services are partially covered, offering Medicare-covered dental care for a $55 copay and no coinsurance, and other dental services with no copay and no coinsurance up to a $500 annual maximum. However, other preventive dental services and adjunctive general services are not covered under this plan.
Home Infusion bundled Services See details
Home infusion bundled services are covered under NextBlue Discover PPO (PPO) with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other drugs carry a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis services are covered under the NextBlue Discover PPO (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
NextBlue Discover PPO (PPO) partially covers medical equipment, with diabetic supplies excluded from coverage. Covered items—including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes—feature no copay and a coinsurance ranging from 0% to 20%.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by NextBlue Discover PPO (PPO) with prior authorization required, offering diagnostic tests with no coinsurance and copays ranging from no copay up to $200, plus a $20 copay for lab services. Radiological benefits include a $25 copay for X-rays, no copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by NextBlue Discover PPO (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under the NextBlue Discover PPO (PPO) plan, but in practice some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD services are not. Copayments for these rehabilitation services range from $20 to $40.
Skilled Nursing Facility (SNF) See details
NextBlue Discover PPO (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 to 20 and days 56 to 100, a $200 daily copay for days 21 to 55, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the NextBlue Discover PPO (PPO) plan, which does not provide coverage for acupuncture, over-the-counter (OTC) items, or meal benefits.
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