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Medicare Plus Blue Vitality (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue Vitality (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 Vitality (PPO) in 2026, please refer to our full plan details page.
Medicare Plus Blue Vitality (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 2026.
It's important to know that Medicare Plus Blue Vitality (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 Vitality (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 Vitality (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.50. 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 $6700.00 (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 $6700.00 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 Vitality (PPO) plan features a $0 prescription drug deductible, allowing your coverage to begin immediately without any upfront out-of-pocket costs. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail order partners. Tier 2 generic medications also offer significant savings, featuring no copay for a 3-month supply or an $11 copay for a 1-month supply at preferred locations. For brand-name and specialty medications, your costs are determined by a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance at all pharmacy types. Tier 5 specialty drugs have a 33% coinsurance for a 1-month supply, regardless of whether you use a preferred or standard pharmacy.
Additional Benefits
The Medicare Plus Blue Vitality (PPO) plan offers robust coverage with low out-of-pocket costs, featuring no coinsurance for inpatient hospital stays, outpatient services, and primary care visits. Patients pay a daily copay of $250 for the first seven days of inpatient stays and no copay thereafter, while primary care visits and routine preventive services require no copay. Emergency care carries a $130 copay, which is waived if admitted, and specialist visits require a copay ranging from $15 to $40. For supplemental care, the plan features dental coverage up to a $1,500 annual maximum and routine hearing exams with no copay, though prescription hearing aids require a copay of $495 to $1,695. Routine vision exams require no copay to a $30 copay, while home health services and medical equipment have no copays, with equipment requiring up to 20% coinsurance. Skilled nursing facility stays are also covered with no copay for the first 20 days, followed by a $218 daily copay.
Inpatient Hospital See details
Medicare Plus Blue Vitality (PPO) partially covers inpatient hospital services with no coinsurance, though prior authorization is required. For both acute and psychiatric stays, you pay a $250 daily copay for days 1-7 and no copay for days 8-90. Unlimited additional acute days are covered at no copay, but upgrades, non-Medicare-covered stays, and psychiatric stays beyond 90 days are not covered.
Outpatient Services See details
Medicare Plus Blue Vitality (PPO) covers outpatient services with no coinsurance, featuring a $150 to $220 copay for outpatient hospital services and a $130 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions carry a $30 copay and no coinsurance.
Partial Hospitalization See details
Medicare Plus Blue Vitality (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Medicare Plus Blue Vitality (PPO) covers Medicare-covered ground and air ambulance services with a $325 copay and no coinsurance. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
Medicare Plus Blue Vitality (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services require no coinsurance and a copay ranging from no copay to $50, while worldwide emergency services are covered up to $50,000 with no coinsurance and copays ranging from $50 to $325.
Primary Care See details
Medicare Plus Blue Vitality (PPO) provides partially covered primary care benefits with no coinsurance for all services, including no copay for primary care provider visits, telehealth, and opioid treatment. Other covered services like specialist visits, chiropractic care, and physical therapy require copays ranging from $15 to $40, while podiatry services are not covered.
Preventive Services See details
Medicare Plus Blue Vitality (PPO) preventive services are covered with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered, including fitness benefits and remote access technologies, while sub-services such as health education, in-home safety assessments, and nutritional benefits are not covered.
Hearing Services See details
Medicare Plus Blue Vitality (PPO) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a copay ranging from $495.00 to $1,695.00 and no coinsurance, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Medicare Plus Blue Vitality (PPO), offering one routine eye exam per year with no copay to a $30 copay, no coinsurance, and no deductible. Other eye exams and eyewear services, including contact lenses and eyeglasses, are not covered.
Dental Services See details
Dental services are partially covered by Medicare Plus Blue Vitality (PPO) with an annual maximum benefit of $1,500, offering no copay and no coinsurance for most preventive and comprehensive treatments, though Medicare-covered dental services have a copay of $0 to $30 and no coinsurance. Other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medicare Plus Blue Vitality (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by Medicare Plus Blue Vitality (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Plus Blue Vitality (PPO) partially covers medical equipment with no copays, requiring 20% coinsurance for prosthetics and medical supplies, and no coinsurance to 20% coinsurance for durable medical equipment and diabetic supplies. Prior authorization is required for these covered services, and diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Medicare Plus Blue Vitality (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic procedures range from a $0 to $150 copay, outpatient X-rays and therapeutic radiology require a $35 minimum copay, and diagnostic radiology has a minimum $100 copay.
Home Health Services See details
Home health services are covered by Medicare Plus Blue Vitality (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by Medicare Plus Blue Vitality (PPO) with no coinsurance, though some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered. These excluded services require copayments ranging from $10.00 to $15.00.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medicare Plus Blue Vitality (PPO) with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the 100-day limit are not covered.
Other Services See details
Other Services are partially covered under Medicare Plus Blue Vitality (PPO), excluding acupuncture but offering over-the-counter items (up to $50 every three months) and chronic illness meal benefits with no copay and no coinsurance. Additionally, non-Medicare mobile mental health services are covered with a $20 copay and no coinsurance, and ambulance services with no transport require a $90 copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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