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NextBlue Summit PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for NextBlue Summit PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on NextBlue Summit PPO (PPO) in 2026, please refer to our full plan details page.
NextBlue Summit 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 Summit 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 Summit 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 Summit PPO (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $149.00. 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 $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 $6750.00 (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 $6750.00 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 NextBlue Summit PPO (PPO) Medicare prescription drug plan features an annual drug deductible of $300. For Tier 1 preferred generic drugs, members benefit from no copay for one-, two-, or three-month supplies at standard pharmacies and through standard mail order. Tier 2 generic drugs are also highly affordable, requiring only a $3 copay for a one-month supply at standard pharmacies or standard mail order. Higher-tier medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for both standard retail and mail-order fills. Specialty medications in Tier 5 require a 29% coinsurance for a one-month supply.
Additional Benefits
The NextBlue Summit PPO (PPO) plan offers robust coverage for essential medical services with predictable out-of-pocket costs and no coinsurance for many key benefits. Patients enjoy no copay for primary care visits, home health services, and routine preventive care, while specialist visits and outpatient services require copays ranging from $15 to $400. Inpatient hospital stays are covered with a $425 copay for the first four days and no copay for days five through ninety. The plan also features additional benefits like dental, vision, and hearing care, which provide up to $650 in annual coverage with no copay for routine services. While dialysis and durable medical equipment require up to a 20% coinsurance, other services like home infusion and diagnostic radiology are available with no copay. Please note that this plan does not cover non-Medicare transportation, cardiac rehabilitation, acupuncture, or over-the-counter items.
Inpatient Hospital See details
Inpatient hospital care is partially covered by NextBlue Summit PPO (PPO) with no coinsurance, requiring a $425 copay for days 1 to 4 and no copay for days 5 to 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by NextBlue Summit PPO (PPO) with no coinsurance, featuring a $350 to $400 copay for outpatient hospital services, a $300 copay per stay for observation services, and a $175 copay for ambulatory surgical center visits. Outpatient substance abuse sessions require a $45 copay, while outpatient blood services are provided with no copay and no deductible.
Partial Hospitalization See details
NextBlue Summit PPO (PPO) covers partial hospitalization services with a $95.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and transportation services under NextBlue Summit PPO (PPO) cover ground ambulance services with a $250 copay and air ambulance services with a 20% coinsurance, with prior authorization required for both. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
NextBlue Summit PPO (PPO) covers emergency services with a $125 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $50 copay with no coinsurance, and worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with no coinsurance and copays ranging from $50 to $125.
Primary Care See details
NextBlue Summit PPO (PPO) provides partially covered primary care benefits, offering primary care physician visits and opioid treatment with no copay and no coinsurance, while podiatry services are not covered. Other covered services, including specialist visits, physical therapy, and mental health care, require copays ranging from $15 to $45 with no coinsurance, and telehealth services have a $0 to $50 copay and no coinsurance.
Preventive Services See details
NextBlue Summit PPO (PPO) covers preventive services, including annual physical exams, kidney disease education, and screenings, with no copay and no coinsurance. Additional preventive services are partially covered, with personal emergency response systems and remote access technologies included, while fitness benefits, health education, and nutritional therapy are not covered.
Hearing Services See details
Hearing services are covered by NextBlue Summit PPO (PPO) with no copay and no coinsurance for routine exams and fitting evaluations. Prescription hearing aids are partially covered with no copay or coinsurance up to a $650 annual maximum per ear, though inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
NextBlue Summit PPO (PPO) covers vision services, although eye exams are only partially covered since other eye exam services are not covered. Covered routine exams have no copay to a $45 copay and no coinsurance, while eyewear is covered with no copay and no coinsurance up to a $650 yearly limit for contacts, frames, lenses, and upgrades.
Dental Services See details
NextBlue Summit PPO (PPO) provides partially covered dental services, featuring Medicare-covered dental for a $45.00 copay and no coinsurance, and other dental benefits with no copay and no coinsurance up to a $650 annual maximum. While diagnostic, preventive, restorative, and orthodontic treatments are covered, adjunctive general services are not covered.
Home Infusion bundled Services See details
NextBlue Summit PPO (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy and other Part B drugs require no copay and a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the NextBlue Summit PPO (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by NextBlue Summit PPO (PPO) with no copay for covered items, featuring coinsurance ranging from no coinsurance to 20% for durable medical equipment and a flat 20% coinsurance for prosthetics, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for durable medical equipment and prosthetics, and diabetic supplies are not covered.
Diagnostic and Radiological Services See details
NextBlue Summit PPO (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and lab services feature no coinsurance, with copays ranging from no copay up to $175 for tests and a $10 copay for labs. Outpatient X-rays require a $20 copay, diagnostic radiology has no copay, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
NextBlue Summit PPO (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the NextBlue Summit PPO (PPO), as all individual sub-services—including cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation—are excluded from coverage.
Skilled Nursing Facility (SNF) See details
NextBlue Summit PPO (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. 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 Summit PPO (PPO) plan, which does not provide coverage for acupuncture, over-the-counter (OTC) items, or meal benefits.
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