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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 $113.00. 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 an enhanced alternative drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you will pay a copay for your prescriptions. For preferred generic drugs, the copay is $10 at preferred pharmacies and $18 at standard pharmacies. For preferred brand drugs and non-preferred drugs, you will pay 50% and 33% coinsurance, respectively.
Additional Benefits
The Medicare Plus Blue PPO Signature (PPO) plan offers a wide range of benefits with varying costs. For inpatient hospital stays, you'll pay a $175 copay for the first 7 days, and no copay for the remainder. Outpatient services have copays, and emergency services have a $125 copay. The plan includes coverage for primary care, preventive, hearing, vision, and dental services. Many services have no copay, while others have copays ranging from $0 to $30. There are also benefits for home health, medical equipment, and diagnostic services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $175 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you will also pay a $175 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services are covered by the Medicare Plus Blue PPO Signature (PPO) plan. Outpatient Hospital Services have a copay between $125 and $205, while Ambulatory Surgical Center (ASC) Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare Plus Blue PPO Signature (PPO) plan, with a $30 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Medicare Plus Blue PPO Signature (PPO) plan. Ground and air ambulance services have a copay of $285.00, and there is no coinsurance. Transportation Services to any health-related location is covered, with 1 round trip medical transport per year.
Emergency Services See details
Emergency Services are covered by the Medicare Plus Blue PPO Signature (PPO) plan, with a $125 copay, and no coinsurance. Urgently Needed Services have a copay between $0 and $50, and no coinsurance. Worldwide Emergency Services are covered with a $125 copay for Worldwide Emergency Coverage, a $50 copay for Worldwide Urgent Coverage, and a $285 copay for Worldwide Emergency Transportation, and a maximum plan benefit of $50,000.
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
The Medicare Plus Blue PPO Signature (PPO) plan covers preventive services, including annual physical exams, with no copay. Some additional services, such as Health Education, In-Home Safety Assessment, and Counseling Services, are not covered. Other covered services include Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit.
Hearing Services See details
Hearing services include hearing exams with no copay, routine hearing exams with a copay between $0 and $30, fitting/evaluation for hearing aids with a copay of $0, and prescription hearing aids with a maximum benefit of $750 per ear every three years. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include eye exams, with a copay of $0-$30, and eyewear. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum of $150 per year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $1500 per year. Medicare dental services have a copay of $0 - $30, and other dental services include oral exams (2 per year), dental x-rays (1 set of up to 4 bitewings or up to 6 periapical every 2 years), prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), and oral surgery (2 per tooth per lifetime), and the plan does not cover maxillofacial prosthetics or orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin has a $35 copay and 0-20% coinsurance for Medicare Part B Insulin Drugs. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
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 a coinsurance of 0% to 20%, Prosthetics/Medical Supplies with a coinsurance of 20%, and Diabetic Equipment with no copay. 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 all diagnostic services, procedures, and tests, with a copay of up to $125.00 for diagnostic procedures and tests, and no copay for lab services. Therapeutic Radiological Services have a copay of at least $35.00, while Outpatient X-Ray Services have a $35.00 copay.
Home Health Services See details
Home Health Services are covered under the Medicare Plus Blue PPO Signature (PPO) plan, with no copay or coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover any specific services, including Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. There is a copay for covered services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Plus Blue PPO Signature (PPO) plan, with a $0 copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $65 every three months, and a Meal Benefit for chronic illnesses. Acupuncture, 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, and Self-Directed Personal Assistance Services are not covered. Additionally, Other 1 services, which include Mobile Mental Health, have a $20 copay, and Other 2 services, including Ambulance No transport, have a $90 copay.
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