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WyoBlue Advantage Essential PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for WyoBlue Advantage Essential PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on WyoBlue Advantage Essential PPO (PPO) in 2026, please refer to our full plan details page.
WyoBlue Advantage Essential 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 Wyoming. The overall rating for this plan is not yet available for 2026.
It's important to know that WyoBlue Advantage Essential 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 WyoBlue Advantage Essential 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 WyoBlue Advantage Essential 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 $615.00 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 $9250.00 (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 $9250.00 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 WyoBlue Advantage Essential PPO (PPO)
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Drug Coverage
The WyoBlue Advantage Essential PPO (PPO) plan features a yearly drug deductible of $615 before coverage begins. For Tier 1 preferred generic drugs, you can expect a $4 copay for a 1-month supply at a preferred pharmacy, with no copay required for a 3-month supply through standard mail order. Tier 2 generic drugs cost a $9 copay for a 1-month supply at preferred pharmacies or through standard mail order. For higher-tier medications, costs are based on coinsurance instead of flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 35% coinsurance. Tier 5 specialty drugs are covered with a 25% coinsurance for a 1-month supply across preferred, standard, and mail-order options.
Additional Benefits
WyoBlue Advantage Essential PPO (PPO) offers comprehensive coverage for essential medical needs with predictable cost-sharing, featuring no copay for primary care doctor visits, annual physical exams, and home health services. For emergency room visits, members pay a $115 copay, while urgent care visits require a $40 copay, both with no coinsurance. Inpatient hospital stays require a $450 daily copay for the first four days, followed by no copay for days five through 90. The plan also includes dental, vision, and hearing benefits, featuring no copays for routine hearing exams and preventive dental care up to annual maximum limits. Vision eyewear and prescription hearing aids are covered up to $600 annually, helping to lower out-of-pocket costs for these services. For specialized medical needs, members pay a $55 copay for specialist visits, while durable medical equipment and dialysis require a 20% coinsurance with no copay.
Inpatient Hospital See details
WyoBlue Advantage Essential PPO (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $450 daily copay for days 1 through 4 and no copay for days 5 through 90. While unlimited additional acute care days are covered with no copay, additional psychiatric days, room upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
WyoBlue Advantage Essential PPO (PPO) covers outpatient hospital services with a $450 to $550 copay and observation services with a $500 copay per stay, both with no coinsurance. Ambulatory surgical center services require a $350 copay, outpatient substance abuse sessions have a $55 copay, and blood services have no copay, with all of these benefits carrying no coinsurance.
Partial Hospitalization See details
WyoBlue Advantage Essential PPO (PPO) covers partial hospitalization services with a $105.00 copay and no coinsurance, and prior authorization is required.
Ambulance and Transportation Services See details
WyoBlue Advantage Essential PPO (PPO) covers ambulance services with a $500 copay and no coinsurance for ground transport, and a 20% coinsurance and no copay for air transport, with prior authorization required. Although some services are covered, transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
WyoBlue Advantage Essential PPO (PPO) covers emergency services with a $115 copay (waived if admitted within 24 hours) and no coinsurance, while urgent care has a $40 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit with no coinsurance and copays ranging from $40 to $115.
Primary Care See details
WyoBlue Advantage Essential PPO (PPO) offers partially covered primary care services with no coinsurance, featuring no copay for primary care physician visits and opioid treatment, while podiatry services are not covered. Other covered services require copayments, such as $15 to $45 for chiropractic care, $35 for occupational therapy, and $55 for specialists, psychiatric care, and physical therapy.
Preventive Services See details
Preventive services are covered under the WyoBlue Advantage Essential PPO (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and various screenings. Additional preventive services are only partially covered with no copay and no coinsurance for personal emergency response systems and remote access technologies, while sub-services such as fitness benefits, health education, and weight management programs are not covered.
Hearing Services See details
WyoBlue Advantage Essential PPO (PPO) covers hearing services with no copay and no coinsurance, which includes one routine hearing exam per year and unlimited fitting evaluations. Prescription hearing aids are partially covered with a $600 maximum benefit per ear annually, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
WyoBlue Advantage Essential PPO (PPO) partially covers vision services, offering one routine eye exam per year with a $0 to $55 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and no deductible, up to a combined maximum benefit of $600 per year.
Dental Services See details
Dental services are partially covered by WyoBlue Advantage Essential PPO (PPO), with Medicare-covered dental services requiring a $55 copay and no coinsurance, and other covered dental services having no copay and no coinsurance up to a $600 annual maximum. While most preventive and comprehensive dental services are covered with no copays or coinsurance, adjunctive general services are not covered.
Home Infusion bundled Services See details
WyoBlue Advantage Essential PPO (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no copay and 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 by WyoBlue Advantage Essential PPO (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
WyoBlue Advantage Essential PPO (PPO) partially covers medical equipment with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though diabetic supplies are not covered. Prior authorization is required for durable medical equipment, prosthetics, and non-Medicare medical supplies.
Diagnostic and Radiological Services See details
WyoBlue Advantage Essential PPO (PPO) covers diagnostic and radiological services, with prior authorization required for these benefits. Diagnostic tests and lab services feature no coinsurance with copays ranging from no copay up to $350, while radiological services include copays starting at $0 for diagnostic imaging, a $40 copay for X-rays, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home health services are covered under the WyoBlue Advantage Essential PPO (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the WyoBlue Advantage Essential PPO (PPO) with no coinsurance, though some services are covered while others are not. Specifically, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered, which carry copays of $30, $40, $25, and $20 respectively.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by WyoBlue Advantage Essential PPO (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard 100-day Medicare limit are not covered.
Other Services See details
Other Services are not covered under the WyoBlue Advantage Essential PPO (PPO). Acupuncture, over-the-counter items, and meal benefits are all excluded from coverage, meaning members are responsible for the full cost of these services.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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