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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 $66.80. 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 drug deductible, meaning your prescription drug coverage begins immediately. For Tier 1 preferred generic drugs, you pay no copay for both 1-month and 3-month supplies at preferred pharmacies or through preferred mail order. Tier 2 generic drugs also offer no copay for a 3-month supply at preferred locations, while a 1-month supply carries an $11 copay. For higher-tier medications, costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance for all pharmacy and mail-order fills. Tier 5 specialty drugs require a 33% coinsurance for a 1-month supply at both standard and preferred pharmacies.
Additional Benefits
The Medicare Plus Blue Vitality (PPO) plan offers robust medical coverage with affordable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, telehealth services, and routine preventive care. Specialist visits require a copay of $15 to $40, while emergency room visits carry a $130 copay with no coinsurance. For inpatient hospital stays, members pay no coinsurance and a $250 daily copay for the first seven days, with no copay required for days eight through 90. Additional benefits include routine dental, vision, and hearing exams with no copay, alongside a $1,500 annual maximum allowance for dental services. Home health services are covered with no copay and no coinsurance, and skilled nursing facility stays require no copay for the first 20 days. Durable medical equipment and dialysis services are also covered, featuring no copays and coinsurance up to 20 percent.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Medicare Plus Blue Vitality (PPO) with no coinsurance, requiring a $250 daily copay for days 1 through 7 and no copay for days 8 through 90 for both acute and psychiatric stays. Unlimited additional acute days are covered at no copay, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare Plus Blue Vitality (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services carry a $150 to $220 copay, observation services require a $130 copay per stay, and outpatient substance abuse sessions have a $30 copay.
Partial Hospitalization See details
Partial hospitalization services are covered by Medicare Plus Blue Vitality (PPO) with a $55.00 copay and no coinsurance, though prior authorization may be required.
Ambulance and Transportation Services See details
Medicare Plus Blue Vitality (PPO) covers ground and air ambulance services with a $325 copayment and no coinsurance, which is not waived if you are admitted to the hospital. Non-emergency transportation services to health-related locations are not covered under this plan.
Emergency Services See details
Emergency services under the Medicare Plus Blue Vitality (PPO) are covered with a $130 copay (waived if admitted to the hospital within three days) and no coinsurance, while urgently needed services range from no copay to a $50 copay with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum with no coinsurance, featuring copays of $130, $50, and $325 respectively.
Primary Care See details
Primary Care benefits under Medicare Plus Blue Vitality (PPO) are partially covered, featuring no copay and no coinsurance for primary care visits, telehealth, and opioid treatment, while podiatry services are not covered. Other covered services, including specialist visits, mental health, and physical therapy, require copays ranging from $15 to $40 and no coinsurance.
Preventive Services See details
Medicare Plus Blue Vitality (PPO) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. This benefit is partially covered because sub-services like health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling are not covered.
Hearing Services See details
Hearing services are partially covered by Medicare Plus Blue Vitality (PPO), offering routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $495.00 to $1,695.00, though over-the-counter, inner ear, outer ear, and over-the-ear models 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 a $0 to $30 copay, no coinsurance, and no deductible, while other eye exam services are not covered. For eyewear, some services are covered with no copay, coinsurance, or deductible, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under Medicare Plus Blue Vitality (PPO) with an annual maximum benefit of $1,500, offering no copay and no coinsurance for most services, though Medicare-covered dental has a $0 to $30 copay and no coinsurance. Sub-services that are not covered include other diagnostic, other preventive, maxillofacial prosthetics, and orthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medicare Plus Blue Vitality (PPO) with no copay, though prior authorization and step therapy are required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin has a $35 copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Medicare Plus Blue Vitality (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Plus Blue Vitality (PPO) partially covers medical equipment with no copays, though diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment and diabetic supplies have no copay and range from no coinsurance to 20% coinsurance, while prosthetic devices and medical supplies require a 20% coinsurance.
Diagnostic and Radiological Services See details
Medicare Plus Blue Vitality (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Members pay no copay for lab services, a $35 copay for outpatient X-rays, a $0 to $150 copay for diagnostic procedures, and minimum copays of $100 for diagnostic radiology and $35 for therapeutic radiology.
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 offered by Medicare Plus Blue Vitality (PPO) with no coinsurance, though only some services are covered in practice. Standard cardiac rehabilitation ($15 copay), intensive cardiac rehabilitation ($15 copay), pulmonary rehabilitation ($10 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($15 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Medicare Plus Blue Vitality (PPO) covers skilled nursing facility (SNF) care with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Medicare Plus Blue Vitality (PPO) partially covers other services, offering over-the-counter items and chronic illness meal benefits with no copay and no coinsurance. Mobile mental health services require a $20 copay and no coinsurance, and non-transport ambulance services are covered with a $90 copay and no coinsurance, while acupuncture is not covered.
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