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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 $129.00. 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'll pay a copay for each prescription, depending on the drug tier and where you fill your prescription. This plan offers an "Enhanced Alternative" drug benefit. In the initial coverage phase, you will pay either a copay or coinsurance for your prescriptions. The copays vary from $10 to $47 depending on the drug tier and pharmacy. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The Medicare Plus Blue PPO Signature (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. The plan also includes coverage for primary care, preventive services, hearing, vision, and dental, with specific copays and maximum benefits for some services. Additional benefits include ambulance, emergency services, and home health services, with specific copays or coinsurance. The plan also covers medical equipment, diagnostic and radiological services, and skilled nursing facility stays, with specific cost-sharing requirements. Notably, the plan provides benefits like OTC items and mobile mental health, while excluding certain services like cardiac rehabilitation and additional home health care hours.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with a $175 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $125 to $205, observation services, and Ambulatory Surgical Center (ASC) services with no copay. Outpatient substance abuse services, including individual and group sessions, are covered with 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, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including services not usually covered by Medicare plans. Ground and Air Ambulance Services each have a $285 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered, while transportation to a plan-approved health-related location is covered.
Emergency Services See details
Emergency Services are covered under the Medicare Plus Blue PPO Signature (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $50. Worldwide Emergency Services, Worldwide Emergency Coverage, have a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $285 copay.
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 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 professionals with a $0-$30 copay, 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
The Medicare Plus Blue PPO Signature (PPO) plan covers preventive services, including annual physical exams, with no copay or coinsurance. The plan also covers additional preventive services, but excludes coverage for health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, and other services. Home and bathroom safety devices and modifications are covered with a maximum plan benefit coverage amount of $100 every year.
Hearing Services See details
Hearing exams are covered with no copay, including routine hearing exams and fitting/evaluation for hearing aids, with a maximum copay of $30 for routine hearing exams. Prescription hearing aids are covered up to $750 every three years, but inner ear, outer ear, and over the ear prescription hearing aids, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services for Medicare Plus Blue PPO Signature (PPO) includes eye exams with a copay of $0-$30, routine eye exams with no copay, and other eye exam services with a $30 copay. Eyewear is covered with a combined maximum of $150 per year for frames or elective contact lenses; contact lenses, eyeglass lenses, and eyeglass frames are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Medicare Plus Blue PPO Signature (PPO) plan covers dental services with a maximum benefit of $1,500 per year, including oral exams with no copay for up to 2 visits per year, and dental X-rays with no copay for 1 set of bitewings or up to 6 periapical every two years. The plan also covers prophylaxis (cleaning) with no copay for 2 visits per year, and fluoride treatment with no copay for 1 visit per year. Adjunctive general services, implant services, prosthodontics (fixed and removable), and orthodontics are offered as optional, supplemental benefits. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 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, with no copay. Durable Medical Equipment (DME) has a coinsurance of 0-20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medical Supplies have a 20% coinsurance, and 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 $35 copay, 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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medicare Plus Blue PPO Signature (PPO) plan. The plan does not cover 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.
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 for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Medicare Plus Blue PPO Signature (PPO) plan's "Other Services" benefit includes Over-the-Counter (OTC) items with a maximum coverage amount of $65 every three months, and "Other 1" benefits like Mobile Mental Health with a $20 copay. Acupuncture, Dual Eligible SNPs, 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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