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Medicare Plus Blue Assure (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue Assure (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 Assure (PPO) in 2026, please refer to our full plan details page.
Medicare Plus Blue Assure (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 Assure (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 Assure (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 Assure (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $191.60. 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 $6200.00 (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 $6200.00 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 Assure (PPO) plan features a $0 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, there is no copay for a one-month or three-month supply when using preferred pharmacies or preferred mail order services. Tier 2 generic drugs cost as low as a $7 copay for a one-month supply, and have no copay for a three-month supply through preferred channels. For higher-tier prescriptions, costs are calculated as a percentage of the drug cost rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance across all pharmacy and mail order options. Specialty medications in Tier 5 require a 33% coinsurance for a one-month supply at both standard and preferred pharmacies.
Additional Benefits
The Medicare Plus Blue Assure (PPO) plan offers robust coverage with no copay for primary care visits, telehealth services, and annual preventive physical exams. For specialized care, members pay a low $10 copay for specialist visits, while inpatient hospital stays require a $100 daily copay for the first seven days and no copay thereafter. Emergency care is covered with a $130 copay, which is waived if admitted, and urgent care visits range from no copay up to $40. This plan also features strong ancillary benefits, including dental care with no copay for cleanings and exams up to a $1,500 annual limit, alongside routine hearing and vision exams with no copay. Eyewear is covered up to a $150 annual maximum, and prescription hearing aids are available with copays ranging from $495 to $1,695. While many services feature no coinsurance, some specialized treatments like dialysis and certain medical equipment require a 20% coinsurance.
Inpatient Hospital See details
Medicare Plus Blue Assure (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $100 daily copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and while unlimited additional acute care days are covered, psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medicare Plus Blue Assure (PPO) covers outpatient services with no coinsurance, including outpatient hospital services for a $75 to $150 copay and observation services for a $130 copay per stay. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions require a $10 copay and no coinsurance.
Partial Hospitalization See details
Medicare Plus Blue Assure (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
Ambulance and Transportation Services are partially covered by Medicare Plus Blue Assure (PPO), with ground and air ambulance services requiring a $250 copay and no coinsurance. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Medicare Plus Blue Assure (PPO) covers emergency services with a $130 copay (waived if admitted within three days) and urgently needed services with a $0 to $40 copay, with no coinsurance or deductibles applying to either service. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit with no coinsurance, featuring copays of $130, $40, and $250 respectively.
Primary Care See details
Medicare Plus Blue Assure (PPO) partially covers primary care and professional services with no coinsurance, featuring no copay for primary care visits, telehealth, and opioid treatment. Specialist visits require a $10 copay, therapy services have a $30 copay, and chiropractic care copays range from $10 to $35, while podiatry services are not covered.
Preventive Services See details
Medicare Plus Blue Assure (PPO) provides preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. This benefit is partially covered, as additional services such as health education, in-home safety assessments, personal emergency response systems, and medical nutrition therapy are not covered.
Hearing Services See details
Medicare Plus Blue Assure (PPO) covers annual routine hearing exams and fitting evaluations with no deductible, no copay, and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $495 to $1,695, though over-the-counter options and inner, outer, or over-the-ear models are not covered.
Vision Services See details
Medicare Plus Blue Assure (PPO) vision services are partially covered, offering one routine eye exam per year with a $0 to $10 copay and no coinsurance, while other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered. Eyewear, including contact lenses, eyeglass lenses, and frames, is covered with no copay, no coinsurance, and a combined annual maximum of $150.
Dental Services See details
Medicare Plus Blue Assure (PPO) dental services are partially covered up to a $1,500 annual maximum for both in-network and out-of-network care, with no coinsurance. Covered Medicare dental services have a $0 to $10 copay, and other covered services like cleanings, exams, and fillings have no copay; however, other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medicare Plus Blue Assure (PPO) with no copay and no coinsurance, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and no coinsurance to 20% coinsurance, while 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 Assure (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by Medicare Plus Blue Assure (PPO) with no copays, though coinsurance ranges from no coinsurance up to 20% and prior authorization is required. While durable medical equipment, prosthetics, and diabetic supplies are included, this benefit is partially covered as diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Medicare Plus Blue Assure (PPO) with no coinsurance, though prior authorization is required. There is no copay for lab services, while diagnostic procedures and tests range from a $0 to $75 copay. Outpatient X-rays and therapeutic radiological services start at a $35 copay, and diagnostic radiological services require a minimum copay of $75.
Home Health Services See details
Home Health Services are covered by Medicare Plus Blue Assure (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare Plus Blue Assure (PPO) provides Cardiac Rehabilitation Services with no coinsurance, and while some services are covered, Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) are not covered. Copayments for these rehabilitation services range from $10 to $15.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medicare Plus Blue Assure (PPO) 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 daily copay for days 21 through 100, with no coverage for additional days.
Other Services See details
Medicare Plus Blue Assure (PPO) partially covers other services, providing over-the-counter items and chronic illness meals with no copay and no coinsurance, while acupuncture is not covered. Non-Medicare-covered mobile mental health services are covered with a $20 copay and no coinsurance, and ambulance non-transport services require a $90 copay and no coinsurance.
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