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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 $64.00. 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. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $11 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy, you'll pay $7.90 for Part D drugs.
Additional Benefits
The Medicare Plus Blue PPO Vitality (PPO) plan offers comprehensive coverage with a variety of benefits. The plan covers inpatient and outpatient hospital services, with copays ranging from $0 to $250. It also includes coverage for primary care, preventive, hearing, vision, and dental services. Additional benefits include ambulance services, emergency services, and home health services. The plan provides coverage for medical equipment, and diagnostic and radiological services. The plan also offers coverage for skilled nursing facilities, home infusion services, and dialysis services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $250 copay for days 1-7, and no copay for days 8-90. Inpatient Hospital Psychiatric has the same cost structure.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services, are covered. Outpatient hospital services have a copay between $150 and $220, while individual and group outpatient substance abuse sessions each have a copay of $30; Ambulatory Surgical Center (ASC) Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare Plus Blue PPO Vitality (PPO) plan, but requires prior authorization. You will have a $30 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan. Ground and air ambulance services have a copay of $325.00, with no coinsurance. Transportation Services are partially covered; transportation to any health-related location is covered for one round trip per year, and transportation to a plan-approved health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan. Emergency Services have a $125 copay, and no coinsurance; Urgently Needed Services have a copay between $0 and $50, and no coinsurance; and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage, $50 for Worldwide Urgent Coverage, and $325 for Worldwide Emergency Transportation, and no coinsurance, with a maximum plan benefit coverage of $50,000.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $15 copay, routine chiropractic care has a $30 copay, and other chiropractic services have a $35 copay. Individual and group mental health and psychiatric sessions have a $20 copay, physician specialist services have a $30 copay, occupational therapy services and physical therapy/speech therapy have a $40 copay, and other health care professionals have a copay between $0 and $30.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered. Additional services like health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
Hearing services are covered, with no copay for hearing exams. Routine hearing exams are covered once per year with a copay between $0 and $30, while fitting/evaluation for hearing aids is covered once every three years. Prescription hearing aids are covered up to a maximum of $750 per ear every three years, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision Services includes coverage for eye exams with a copay between $0 and $30, and routine eye exams have no copay. Eyewear is covered, with a combined maximum benefit of $150 per year for contact lenses and eyeglass frames, and standard eyeglass lenses are covered annually; however, eyeglass frames and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1,500 per year. This plan offers no copay for Medicare Dental Services, and copays between $0 and $30 for other services, including oral exams, dental x-rays, cleaning, and fluoride treatments. Maxillofacial prosthetics and orthodontics are not covered, and some other services are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Medicare Plus Blue PPO Vitality (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay, and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Vitality (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical equipment benefits are covered under the Medicare Plus Blue PPO Vitality (PPO) plan, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance; however, Durable Medical Equipment for use outside the home, 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 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 Vitality (PPO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan, but require prior authorization. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Medicare Plus Blue PPO Vitality (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, Self-Directed Personal Assistance Services, and Dual Eligible SNPs with Highly Integrated Services. Over-the-Counter (OTC) Items are covered with a maximum benefit of $50.00 every three months. Other services include Mobile Mental Health with a $20 copay, and Ambulance No transport with a $90 copay.
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