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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 $141.00. 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 with this plan. During the initial coverage phase, you will pay a copay for generic drugs, and coinsurance for brand name and non-preferred drugs. After your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Medicare Plus Blue PPO Signature (PPO) plan offers a variety of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and primary care have copays depending on the service. Preventive services, hearing exams, and some vision services have no copay, while dental services are covered up to $1500 per year. The plan also covers home health, ambulance, and emergency services, with some services requiring copays or coinsurance.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric care, are covered with a $175 copay for days 1-7, and no copay for days 8-90. Additional days for inpatient acute care are covered with no copay, while non-Medicare-covered stays and upgrades for acute and psychiatric care are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services, are covered. 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 for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services include coverage for all ambulance services, with a copay of $285 for both ground and air ambulance services, and coverage for transportation services to any health-related location, with 1 round trip covered every year. However, transportation services to plan-approved health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Medicare Plus Blue PPO Signature (PPO) plan. Emergency Services has a $125 copay, and Urgently Needed Services has a copay between $0 and $50. Worldwide Emergency Services has a $125 copay for Worldwide Emergency Coverage, a $50 copay for Worldwide Urgent Coverage, and a $285 copay for Worldwide Emergency Transportation.
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. The plan does not cover podiatry services.
Preventive Services See details
Preventive Services, including annual physical exams, are covered by the Medicare Plus Blue PPO Signature (PPO) plan. Additionally, services like additional smoking cessation counseling, fitness benefits, remote access technologies, and home/bathroom safety devices are covered.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $750 every three years, but some services like prescription hearing aids for the inner, outer, and over the ear are not covered, along with OTC hearing aids.
Vision Services See details
Vision services include eye exams, eyewear, and other services. Eye exams have a copay of $0-$30, with routine eye exams having no copay. Eyewear has a combined maximum benefit of $150 per year, and contact lenses, eyeglass lenses, and eyeglass frames are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services include a maximum plan benefit of $1500 per year for both in-network and out-of-network services, with oral exams covered with a copay between $0 and $30 for up to 2 visits per year, and dental x-rays covered with a copay between $0 and $30 for a limited number of x-rays. Additionally, prophylaxis (cleaning) and fluoride treatments are covered with a copay between $0 and $30 for a limited number of visits per year, while maxillofacial prosthetics and orthodontics are not covered. Other services, such as prosthodontics, implants, and adjunctive general services, are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Signature (PPO) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include coverage for Durable Medical Equipment (DME), with a coinsurance between 0% and 20% and no copay, though Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies and Diabetic Equipment are covered, with a 20% coinsurance for Prosthetic Devices and Medical Supplies, but Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the Medicare Plus Blue PPO Signature (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $125, Lab Services have no copay, Diagnostic Radiological Services have a minimum copay of $100, and Therapeutic Radiological Services have a minimum copay of $35. Outpatient X-Ray Services have a $35 copay.
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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for some services, but the specific amount is not detailed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medicare Plus Blue PPO Signature (PPO) plan. There is no 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
The "Other Services" benefit covers Over-the-Counter (OTC) items with a maximum benefit coverage of $65.00 every three months, as well as a meal benefit for a chronic illness, and "Other 2" services with a $90 copay for ambulance (no transport). Acupuncture, 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.
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