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Medicare Plus Blue PPO Signature (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue PPO Signature (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare Plus Blue PPO Signature (PPO) in 2025, please refer to our full plan details page.
Medicare Plus Blue PPO Signature (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 State of Michigan. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Medicare Plus Blue PPO Signature (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 Medicare Plus Blue PPO Signature (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 Medicare Plus Blue PPO Signature (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $91.00. 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 no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $6500.00 (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 $6500.00 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 Medicare Plus Blue PPO Signature (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still be responsible for a share of the costs for any excluded drugs covered under an enhanced benefit.
Additional Benefits
The Medicare Plus Blue PPO Signature (PPO) plan offers a wide array of benefits, including inpatient and outpatient hospital services, with varying copays depending on the service. Emergency, primary care, preventive, hearing, vision, and dental services are also covered, with copays ranging from $0 to $285, depending on the service. This plan also provides coverage for ambulance, transportation, and home health services, often with no copay or coinsurance. Additionally, the plan covers medical equipment, diagnostic and radiological services, and skilled nursing facility stays, with costs varying based on the specific service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For the first 7 days of an Inpatient Hospital stay, there is a $175 copay, and then no copay for days 8-90; Inpatient Hospital Psychiatric has the same cost-sharing structure.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay between $125 and $205, and observation services. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services, including individual and group sessions, have a $30 copay. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare Plus Blue PPO Signature (PPO) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. Ground and air ambulance services have a $285 copay, with no coinsurance. Transportation services to any health-related location are covered for one round trip per year, with no copay or coinsurance.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $50, and Worldwide Emergency Services have a copay between $50 and $285, depending on the service.
Primary Care See details
The Medicare Plus Blue PPO Signature (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $30 copay, mental health specialty services with a $20 copay for individual and group sessions, other health care professional services with a copay between $0 and $30, psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Additional services like smoking cessation counseling, fitness benefits, remote access technologies, and home and bathroom safety devices are also covered, with a maximum benefit of $100 per year for home and bathroom safety devices.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams (1 per year) and fitting/evaluation for hearing aids (1 every three years). Prescription hearing aids are covered up to $750 every three years, but inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision Services include eye exams and eyewear. Eye exams have a copay of $0-$30, with routine eye exams having no copay, and other eye exam services having a $30 copay. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 per year; however, eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include Medicare Dental Services with a copay of $0 - $30, and other dental services, including oral exams (2 per year), dental x-rays (once every 2 calendar years), prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), restorative services (1 per tooth/surface), endodontics (root canals, once per tooth per lifetime), periodontics (deep cleaning, once per quadrant per 24 months), and oral and maxillofacial surgery (2 per tooth per lifetime), all of which have limitations on the number of visits. Maxillofacial prosthetics and orthodontics are not covered, and some services are offered as optional supplemental benefits. There is a maximum plan benefit coverage of $1500 per year for both in-network and out-of-network services.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, but require prior authorization. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Signature (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including Diagnostic Procedures/Tests with a copay between $0 and $125, Lab Services with no copay, Diagnostic Radiological Services with a copay between $100 and $125, Therapeutic Radiological Services with a copay of $35, and Outpatient X-Ray Services with a $35 copay. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the Medicare Plus Blue PPO Signature (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any specific services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Medicare Plus Blue PPO Signature (PPO) plan's other services include coverage for over-the-counter items with a $65 benefit every three months, meal benefits, mobile mental health services with a $20 copay, and ambulance (no transport) services with a $90 copay; however, acupuncture, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, and several other services are not covered.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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