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Medicare Plus Blue PPO Vitality (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue PPO 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 PPO Vitality (PPO) in 2025, please refer to our full plan details page.
Medicare Plus Blue PPO 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 2025.
It's important to know that Medicare Plus Blue PPO 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 PPO 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 PPO Vitality (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $29.00. 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 $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 PPO Vitality (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and the pharmacy you use. For generic drugs, you can expect to pay a copay between $11 and $47, depending on the pharmacy. For brand-name drugs, you will pay 50% coinsurance, and for non-preferred drugs, you will pay 33% coinsurance. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Medicare Plus Blue PPO Vitality (PPO) plan offers a range of benefits with varying costs. For inpatient hospital stays, you'll pay a $250 copay for the first week, and then no copay for the remainder of your stay. Outpatient services like primary care, mental health, and specialist visits have copays ranging from $0 to $40. Preventive services, hearing exams, and routine eye exams have no copay. The plan also includes coverage for dental services up to $1,500 per year, and offers vision coverage for eye exams, contact lenses, and frames. Other benefits include ambulance services, emergency services, and coverage for home health services, with specific copays and coinsurance amounts varying by service.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you'll pay a $250 copay for days 1-7 and no copay for days 8-90, while Inpatient Hospital Psychiatric has the same cost structure.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $150-$220, observation services, ambulatory surgical center (ASC) services with no copay, outpatient substance abuse services with a $30 copay for individual and group sessions, and outpatient blood services with a waived three-pint deductible. Prior authorization is required for outpatient hospital and ASC services.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare Plus Blue PPO Vitality (PPO) plan, with a $30 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services includes coverage for ground and air ambulance services with a $325 copay, and Transportation Services to any health-related location, with 1 round trip per year via medical transport. Transportation services to plan-approved health-related locations are not covered. There is no coinsurance for these services.
Emergency Services See details
Emergency Services are covered, with a $125 copay and no coinsurance. Urgently Needed Services have a copay between $0 and $50, with no coinsurance. Worldwide Emergency Services are covered, including Worldwide Emergency Coverage with a $125 copay, Worldwide Urgent Coverage with a $50 copay, and Worldwide Emergency Transportation with a $325 copay; all of these have no coinsurance, and are subject to a maximum plan benefit of $50,000.
Primary Care See details
The Medicare Plus Blue PPO Vitality (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $40 copay, physician specialist services with a $30 copay, mental health specialty services with a $20 copay for individual and group sessions, other healthcare 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 $40 copay, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, annual physical exams, additional preventive services, kidney disease education services, and other preventive services like glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit. Health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, counseling services, enhanced disease management, and telemonitoring services are not covered. The plan also covers additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, and home and bathroom safety devices and modifications with a maximum plan benefit coverage amount of $100 per year.
Hearing Services See details
Hearing Services for Medicare Plus Blue PPO Vitality (PPO) include hearing exams with no copay, as well as coverage for Routine Hearing Exams and Fitting/Evaluation for Hearing Aids, each with a limit of one visit per year and every three years, respectively. Prescription Hearing Aids are covered up to a maximum of $750 every three years, while Prescription Hearing Aids - 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 coverage for eye exams with a copay between $0 and $30, and routine eye exams have no copay. Contact lenses, eyeglass lenses, and eyeglass frames are covered, and there is a $150 maximum benefit every calendar year that applies to frames or elective contact lenses, while 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. Medicare Dental Services have a copay between $0 and $30, while 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), restorative services (1 visit), endodontics (root canals - once per tooth per lifetime), periodontics (deep cleaning - once per quadrant per 24 months), and oral and maxillofacial surgery (2 per tooth per lifetime, brush biopsy - 2 per year, extractions - once per tooth per lifetime).
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and the coinsurance is between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, and Medical Supplies have a 20% coinsurance, but both have no copay. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $100 and $150, Therapeutic Radiological Services have a copay of $35, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan with no copay and no coinsurance, but authorization is required. 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 the following sub-services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for the covered services, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The Medicare Plus Blue PPO Vitality (PPO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $50 every three months, including nicotine replacement therapy and Naloxone. Other services are also covered, including mobile mental health services with a $20 copay and ambulance services with a $90 copay. 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.
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