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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 $72.00. 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 the pharmacy you use. For example, preferred generic drugs have an $11 copay at a preferred pharmacy, while standard generic drugs have a $42 copay. After 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 provides a range of benefits, including coverage for inpatient and outpatient hospital services, with varying copays. You can expect to pay copays for services like primary care visits, specialist visits, emergency services, and some therapies, while preventive services, hearing exams, and routine eye exams have no copay. Dental services are covered up to $1,500 per year. This plan also offers additional benefits such as coverage for ambulance services, home health services with no copay, and home infusion. Additional benefits include coverage for hearing aids up to $750 every three years, and eyewear with a maximum benefit of $150 per year. The plan also includes coverage for medical equipment, diagnostic services, and skilled nursing facility stays, but specific cost-sharing amounts and limitations may apply.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered, but require prior authorization. For Inpatient Hospital-Acute, you pay a $250 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you also pay a $250 copay for days 1-7, and no copay for days 8-90.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services with a copay of $150-$220, observation services, and ambulatory surgical center (ASC) services with no copay. Outpatient substance abuse services have a $30 copay for both individual and group sessions, and outpatient blood services are also covered.
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 are covered, including both ground and air ambulance services. Ground and air ambulance services have a copay of $325, and no coinsurance. Transportation services to any health-related location are not covered, but transportation services to a plan-approved health-related location are covered for 28 days.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered by the Medicare Plus Blue PPO Vitality (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a copay between $0 and $50. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $325 copay, with a maximum plan benefit of $50,000.
Primary Care See details
Primary Care, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, and Physical Therapy and Speech-Language Pathology Services are covered, with copays ranging from $20 to $40. Chiropractic Services are covered with a $15 copay for Medicare-covered services, and $30 or $35 copays for routine and other chiropractic services, respectively, each limited to one visit per year. Occupational Therapy Services are covered with a $40 copay, while Podiatry Services are not covered. Other Health Care Professional services are covered with a copay between $0 and $30. Additional Telehealth Benefits and Opioid Treatment Program Services are also covered.
Preventive Services See details
The Medicare Plus Blue PPO Vitality (PPO) plan covers preventive services, including no copay for Medicare-covered preventive services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. Additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, and home and bathroom safety devices are covered as well, with a maximum plan benefit coverage amount of $100 for home and bathroom safety devices. Health education, in-home safety assessment, personal emergency response system, 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 benefit, home-based palliative care, in-home support services, support for caregivers of enrollees, and counseling services are not covered.
Hearing Services See details
The Medicare Plus Blue PPO Vitality (PPO) plan covers hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids, each with a maximum copay of $30. Prescription hearing aids are covered up to a maximum of $750 every three years, and the plan does not cover inner ear, outer ear, or over the ear prescription hearing aids, or OTC hearing aids.
Vision Services See details
Vision Services includes coverage for eye exams with a copay of $0-$30, and routine eye exams with no copay. Eyewear is covered with a combined maximum benefit of $150 per year, and contact lenses, eyeglass lenses and eyeglass frames are covered, but eyeglass frames are not covered.
Dental Services See details
The Medicare Plus Blue PPO Vitality (PPO) plan covers various dental services, including oral exams with a copay between $0 and $30, with a maximum benefit of $1,500 per year for both in-network and out-of-network services. Some services, such as Maxillofacial Prosthetics and Orthodontics, are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 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 include Durable Medical Equipment (DME) with a 0-20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment. 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, with a copay required for all diagnostic and radiological services. 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 and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Medicare Plus Blue PPO Vitality (PPO) plan, but the specific services listed, including Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD Services are not covered. There is a copay for some cardiac and pulmonary rehabilitation services, but the exact cost is not specified.
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. You will have no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $50.00 every three months, and Mobile Mental Health with a $20 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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