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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 $84.70. 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, allowing your prescription coverage to begin immediately. For Tier 1 preferred generic drugs, 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 cost an $11 copay for a 1-month supply at preferred locations, but you can secure a 3-month supply with no copay. Brand-name and specialty medications on this plan require coinsurance rather than flat copays. Tier 3 preferred brands have a 20% coinsurance, while Tier 4 non-preferred drugs require 25% coinsurance across all pharmacy and mail order options. Tier 5 specialty drugs incur a 33% coinsurance for a 1-month supply at both standard and preferred locations.
Additional Benefits
The Medicare Plus Blue Vitality (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay for primary care physician visits, telehealth, and annual preventive physicals. For inpatient hospital stays, members pay a $250 daily copay for days one through seven and no copay for days eight through ninety, with no coinsurance required. Outpatient hospital services carry a copay of $150 to $220, while emergency room visits require a $130 copay that is waived if you are admitted. This plan also includes key supplemental benefits, such as dental care covered up to a $1,500 annual maximum with no copay or coinsurance for most routine services. Routine hearing and vision exams are covered with no copay, and home health services also feature no copay and no coinsurance. However, members should expect a 20% coinsurance for dialysis services and up to 20% coinsurance for durable medical equipment and prosthetic devices.
Inpatient Hospital See details
Medicare Plus Blue Vitality (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $250 daily copay for days 1 through 7 and no copay for days 8 through 90. Unlimited additional acute care days are covered with no copay, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medicare Plus Blue Vitality (PPO) covers outpatient services with no coinsurance, featuring a $150 to $220 copay for outpatient hospital services and a $130 copay per stay for observation services. Ambulatory surgical center and blood services are covered with no copays and no coinsurance, while outpatient substance abuse sessions require a $30 copay and no coinsurance.
Partial Hospitalization See details
Medicare Plus Blue Vitality (PPO) covers partial hospitalization services 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 ground and air ambulance services with a $325 copay and no coinsurance. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and any health-related locations are not covered.
Emergency Services See details
Medicare Plus Blue Vitality (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 3 days. Urgently needed services feature a copay of $0 to $50 and no coinsurance, while worldwide emergency services are covered up to a $50,000 limit with no coinsurance and copays ranging from $50 to $325.
Primary Care See details
Medicare Plus Blue Vitality (PPO) partially covers primary care services with no coinsurance, offering primary care physician visits, telehealth, and opioid treatment with no copay. Other covered benefits, including specialist visits, chiropractic care, psychiatric services, and physical therapy, require copays ranging from $15 to $40, while podiatry services are not covered.
Preventive Services See details
Preventive services under Medicare Plus Blue Vitality (PPO) are partially covered with no copay and no coinsurance for annual physicals, kidney disease education, smoking cessation, and fitness benefits. Sub-services that are not covered under this plan include health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
Medicare Plus Blue Vitality (PPO) hearing services are partially covered, featuring one routine exam and one fitting evaluation per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay ranging from $495.00 to $1,695.00 and no coinsurance, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered by Medicare Plus Blue Vitality (PPO), featuring partially covered eye exams with a $0 to $30 copay, no coinsurance, and no deductible for one routine annual exam, while other eye exam services are not covered. For eyewear, some services are covered with no copay and no coinsurance, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by Medicare Plus Blue Vitality (PPO) up to a $1,500 annual maximum for both in-network and out-of-network care. Most covered services, including exams, cleanings, fillings, and root canals, require no copay and no coinsurance, while Medicare-covered dental services have a $0 to $30 copay and no coinsurance; however, orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Medicare Plus Blue Vitality (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other Part B drugs have no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by Medicare Plus Blue Vitality (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Plus Blue Vitality (PPO) partially covers medical equipment with no copays, requiring no coinsurance to 20% coinsurance for durable medical equipment and diabetic supplies, and 20% coinsurance for prosthetic devices and medical supplies. Prior authorization is required, preferred manufacturer limitations apply, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Medicare Plus Blue Vitality (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Diagnostic lab services have no copay, while other diagnostic procedures and tests require a copay of up to $150. Radiological services carry a $35 copay for X-rays, with copays starting at $35 for therapeutic radiology and $100 for diagnostic 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 covered under Medicare Plus Blue Vitality (PPO) with no coinsurance, but only some services are covered in practice. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for 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) care with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 copay per day for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medicare Plus Blue Vitality (PPO) provides partially covered other services, which exclude acupuncture. Covered benefits include over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, mobile mental health services for a $20 copay and no coinsurance, and non-transport ambulance services for a $90 copay and no coinsurance.
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