A non-government entity
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 $67.00. 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:
Sign up for Medicare Plus Blue PPO Vitality (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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 for your prescriptions. The cost depends on the drug tier and whether you use a preferred or standard pharmacy. For example, preferred generic drugs have an $11 copay, while preferred brand drugs have a 50% coinsurance. Once your total drug costs reach $2000, you 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. Inpatient hospital stays have a copay, while outpatient services, including substance abuse, have copays. Emergency services, including worldwide coverage, are available with copays, and primary care visits have no copay. Preventive, hearing, vision, and dental services are covered, with specific copays and limitations on coverage for hearing aids, eyewear, and dental procedures. Home health, dialysis, and medical equipment have no copays or coinsurance for some services, while skilled nursing facilities have a copay after a certain number of days. The plan also includes additional benefits like an OTC allowance and a meal benefit for chronic illnesses.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the Medicare Plus Blue PPO Vitality (PPO) plan, with a $250 copay for days 1-7, and no copay for days 8-90 for Inpatient Hospital-Acute and Psychiatric services. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, and outpatient substance abuse services. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient hospital services have a copay between $150 and $220, and individual and group sessions for outpatient substance abuse each have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered under 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 one round trip medical transport covered every year. Transportation Services - Plan Approved Health-related Location is not covered.
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, and no coinsurance. Worldwide Emergency Services, including Worldwide Emergency Coverage with a $125 copay, Worldwide Urgent Coverage with a $50 copay, and Worldwide Emergency Transportation with a $325 copay, are covered, with a maximum plan benefit of $50,000.
Primary Care See details
The "Medicare Plus Blue PPO Vitality (PPO)" plan covers primary care physician services with no copay, 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, other health care professional services with a $0-$30 copay, psychiatric services with a $20 copay, 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
The Medicare Plus Blue PPO Vitality (PPO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services include home and bathroom safety devices and modifications with a maximum plan benefit coverage amount of $100 per year, as well as additional sessions of smoking and tobacco cessation counseling and a fitness benefit for memory fitness. Some services are not covered, including health education, in-home safety assessment, personal emergency response systems, and counseling services.
Hearing Services See details
Hearing Services are covered, with no copay for hearing exams. Routine hearing exams have a maximum copay of $30, while fitting/evaluation for a hearing aid is covered every three years. Prescription hearing aids are covered up to $750 per ear every three years, while inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams, eyewear, contact lenses, eyeglass lenses, and eyeglass frames. Routine eye exams have no copay, while other eye exam services have a $30 copay. Contact lenses, eyeglass lenses, and eyeglass frames are covered with a $150 combined maximum benefit per year, and eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Medicare Plus Blue PPO Vitality (PPO) plan covers dental services with a copay of $0-$30 for Medicare dental services, and other services, including oral exams, dental x-rays, cleaning, and fluoride treatments, are covered with specific limitations. Maxillofacial prosthetics and orthodontics are not covered, and some services are offered as optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by Medicare Plus Blue PPO Vitality (PPO), and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay, with coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan. You will pay 20% coinsurance for these services.
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. Prosthetics/Medical Supplies have no copay, and Medicare-covered Prosthetic Devices and Medicare-covered Medical Supplies are covered with a 20% coinsurance. 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, 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 or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but specific services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. The plan has a copay for some Cardiac and Pulmonary Rehabilitation Services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medicare Plus Blue PPO Vitality (PPO), 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 for SNF, and Non-Medicare-covered stays for SNF are not covered.
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, and a meal benefit for chronic illnesses; however, acupuncture, Dual Eligible SNPs, 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. "Other 2" services have a $90 copay.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved