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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 $112.00. 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. In 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 a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium is $26.40.
Additional Benefits
The Medicare Plus Blue PPO Signature (PPO) plan offers a wide array of benefits with varying costs. Inpatient hospital stays have a copay, but many outpatient services, including ambulatory surgical centers, have no copay. The plan also includes coverage for emergency services, with copays depending on the type of service and location, and covers ambulance and transportation services. This plan provides coverage for primary care, preventive services, and offers benefits for hearing, vision, and dental services, each with specific copays and annual limits. It also covers home infusion bundled services, dialysis, medical equipment, and diagnostic services, with associated copays or coinsurance. Additional benefits include home health services with no copay, skilled nursing facility stays, and cardiac rehabilitation services.
Inpatient Hospital See details
Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-7, there is a $175 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $125-$205, observation services, and ambulatory surgical center services with no copay. Outpatient substance abuse services, including individual and group sessions, have a copay of $30, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare Plus Blue PPO Signature (PPO) plan. There is a $30 copay for this benefit, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare Plus Blue PPO Signature (PPO) plan, including both ground and air ambulance services. Ground and air ambulance services have a copay of $285. Transportation Services to any health-related location are covered, with one round trip medical transport per year.
Emergency Services See details
Emergency Services are covered by Medicare Plus Blue PPO Signature (PPO). Emergency Services have a $125 copay, and there is no coinsurance. Urgently Needed Services have a copay between $0 and $50, with no coinsurance. Worldwide Emergency Services are also covered, with a $125 copay for Worldwide Emergency Coverage, a $50 copay for Worldwide Urgent Coverage, and a $285 copay for Worldwide Emergency Transportation; there is no coinsurance.
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, and mental health specialty services with a $20 copay for individual and group sessions. The plan also covers physical therapy and speech-language pathology services with a $35 copay, and additional telehealth 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 Medicare-covered zero-dollar preventive services, annual physical exams, additional preventive services, kidney disease education, and other preventive services. Some services like health education, in-home safety assessment, and counseling services are not covered. Home and bathroom safety devices and modifications are covered up to $100 per year.
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, with a maximum benefit of $750 per ear every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear 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. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 per year, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1,500 per year. Oral exams have a copay between $0 and $30 for up to 2 visits per year, while dental x-rays are limited to one set every two years. Other services like Oral and Maxillofacial Surgery have a limit of 2 visits per tooth per lifetime, and Maxillofacial Prosthetics and Orthodontics are not covered.
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% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is coinsurance between 0% and 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 is covered under the Medicare Plus Blue PPO Signature (PPO) plan, including Durable Medical Equipment (DME) with 0-20% coinsurance and Prosthetic Devices with 20% coinsurance. Medical Supplies have a 20% coinsurance, while 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 with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are not covered. The plan has a copay for these 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, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The Medicare Plus Blue PPO Signature (PPO) plan does not cover 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, 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, or Self-Directed Personal Assistance Services. Over-the-counter (OTC) items are covered with a maximum benefit of $65 every three months. Other services have a $90 copay.
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