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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 $72.40. 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 offers a $0 drug deductible, allowing your prescription drug coverage to start right away. For Tier 1 preferred generics, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail-order services. Tier 2 generic drugs are also highly affordable, with an $11 copay for a 1-month supply and no copay for a 3-month supply at preferred locations. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brands require 20% coinsurance, Tier 4 non-preferred drugs require 25% coinsurance, and Tier 5 specialty drugs carry a 33% coinsurance for a 1-month supply. Standard pharmacies and standard mail-order options are also available, though they come with slightly higher copays for Tier 1 and Tier 2 prescriptions.
Additional Benefits
The Medicare Plus Blue Vitality (PPO) plan offers robust coverage for essential medical services with predictable cost-sharing, featuring no coinsurance for most inpatient, outpatient, and emergency care. Inpatient hospital stays require a $250 daily copay for the first seven days and no copay thereafter, while primary care visits, telehealth, and annual preventive physicals are available with no copay. Emergency care features a $130 copay with no coinsurance, and specialist office visits require affordable copays ranging from $15 to $40. Beyond standard medical care, this plan provides valuable extra benefits including home health services and routine dental exams, cleanings, and root canals with no copay or coinsurance. Dental coverage includes a generous $1,500 annual maximum benefit, while annual hearing exams are covered with no copay and routine eye exams feature copays up to $30. Additionally, skilled nursing facility stays are covered with no copay for the first 20 days, and members can access over-the-counter items and meals at no cost.
Inpatient Hospital See details
Medicare Plus Blue Vitality (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization and a $250 daily copay for days 1 through 7, followed by no copay for days 8 through 90. Unlimited additional acute care days are covered with no copay, but 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, featuring copays of $150 to $220 for hospital services, $130 per stay for observation services, and $30 for substance abuse sessions. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the Medicare Plus Blue Vitality (PPO) plan 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 both ground and air ambulance services with a $325 copay and no coinsurance, while transportation services to health-related locations are not covered.
Emergency Services See details
Medicare Plus Blue Vitality (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within three days, and urgently needed services with a copay ranging from no copay to $50, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit limit 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 covered services, including no copay for primary care visits, telehealth, and opioid treatment. Copays for other covered services like specialists, therapy, psychiatric care, and chiropractic visits range from $15 to $40, though podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under Medicare Plus Blue Vitality (PPO) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and fitness benefits. Uncovered sub-services include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Medicare Plus Blue Vitality (PPO) covers annual hearing exams with no copay and no coinsurance, while prescription hearing aids are partially covered with no coinsurance and a copay ranging from $495.00 to $1,695.00. OTC hearing aids, as well as inner ear, outer ear, and over the ear prescription 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 deductible, no coinsurance, and a copay ranging from no copay to $30. Other eye exam services and eyewear, 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 for both in-network and out-of-network services. Most covered services, including exams, cleanings, and root canals, feature no copay and no coinsurance, while Medicare-covered dental services have a $0 to $30 copay and no coinsurance. Other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Medicare Plus Blue Vitality (PPO) covers home infusion bundled services with no copay, requiring prior authorization and step therapy. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin requires a $35 copay and ranges from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Medicare Plus Blue Vitality (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Plus Blue Vitality (PPO) partially covers medical equipment with no copays, though prior authorization is required and diabetic therapeutic shoes and inserts are not covered. Covered durable medical equipment and diabetic supplies carry no coinsurance to 20% coinsurance, while prosthetic devices and medical supplies require 20% coinsurance.
Diagnostic and Radiological Services See details
Medicare Plus Blue Vitality (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic lab services have no copay, outpatient X-rays have a $35 copay, and other diagnostic and radiological services have copays ranging from $0 to $150.
Home Health Services See details
Home Health Services are covered under the Medicare Plus Blue Vitality (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare Plus Blue Vitality (PPO) covers cardiac rehabilitation services with no coinsurance, though only some services are covered. Sub-services including cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require copayments of $10 to $15.
Skilled Nursing Facility (SNF) See details
Medicare Plus Blue Vitality (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. Under this plan, you will pay no copay for days 1 through 20, and a $218 daily copay for days 21 through 100, with no coverage provided for additional days beyond the Medicare-covered limit.
Other Services See details
Medicare Plus Blue Vitality (PPO) partially covers other services, excluding acupuncture, and provides a meal benefit and over-the-counter items with no copay and no coinsurance. Mobile mental health services are covered with a $20 copay and no coinsurance, while non-transport ambulance services require a $90 copay and no coinsurance.
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