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Medicare Plus Blue PPO Assure (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue PPO 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 PPO Assure (PPO) in 2025, please refer to our full plan details page.
Medicare Plus Blue PPO 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 2025.
It's important to know that Medicare Plus Blue PPO 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 PPO 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 PPO Assure (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $187.00. 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 $5150.00 (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 $5150.00 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 Assure (PPO) plan has an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for generic drugs, which varies depending on the pharmacy. For preferred generic drugs, the copay is $7.00 at preferred pharmacies and $12.00 at standard pharmacies. Brand name drugs have a 50% coinsurance. Once your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The Medicare Plus Blue PPO Assure (PPO) plan offers a wide range of benefits. Inpatient hospital stays have a $100 copay for days 1-7, and no copay for days 8-90. Outpatient services vary, with copays for hospital services, and no copays for ambulatory surgical centers and outpatient blood services. Additional benefits include coverage for ambulance services, emergency services, primary care, preventive services, hearing, vision, and dental services. The plan also covers home infusion, dialysis, medical equipment, diagnostic and radiological services, home health services, and skilled nursing facility services.
Inpatient Hospital See details
The Medicare Plus Blue PPO Assure (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For days 1-7, there is a $100 copay, and for days 8-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered with no copay, while non-Medicare covered stays and upgrades for Inpatient Hospital-Acute are not covered, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including Outpatient Hospital Services with a copay of $75-$150, Ambulatory Surgical Center (ASC) Services with no copay, and Outpatient Blood Services with no copay and a waived deductible. Outpatient Substance Abuse Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare Plus Blue PPO Assure (PPO) plan, but prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $250 copay for each service. Transportation services to any health-related location are covered for one round trip per year.
Emergency Services See details
Emergency Services, including Worldwide Emergency Services, are covered under the Medicare Plus Blue PPO Assure (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0 and $40, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $250 copay.
Primary Care See details
Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services are covered. Chiropractic services have a $15 copay, and routine chiropractic care has no copay, while other chiropractic services have a $35 copay. Occupational Therapy Services, Physical Therapy and Speech-Language Pathology Services have a $30 copay. Mental health and psychiatric individual and group sessions have a $20 copay.
Preventive Services See details
Preventive Services are covered under the Medicare Plus Blue PPO Assure (PPO) plan, including Medicare-covered preventive services, annual physical exams, additional preventive services, kidney disease education services, and other preventive services. Some services like health education, in-home safety assessment, and counseling services are not covered. Home and bathroom safety devices and modifications are covered up to $100 per year.
Hearing Services See details
Hearing services include routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. The plan covers one routine hearing exam and one fitting/evaluation for hearing aid every year and every three years respectively. Prescription hearing aids are covered up to $750 every three years.
Vision Services See details
The Medicare Plus Blue PPO Assure (PPO) plan covers routine eye exams once per year and other eye exam services, including Lasik and RK. Eyewear benefits include a combined maximum of $150 per year for contact lenses, eyeglass lenses, and eyeglass frames, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1,500 per year for both in-network and out-of-network services. Oral exams are covered for up to 2 visits per year, and dental x-rays are covered, including one set of bitewings every two years and full mouth x-rays every five years. Prophylaxis (cleaning) and fluoride treatments are also covered. Orthodontics and Maxillofacial Prosthetics are not covered, and Prosthodontics, removable; Implant Services; and Prosthodontics, fixed are optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, as well as Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Assure (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0-20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance. 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, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $75, Lab Services have no copay, Diagnostic Radiological Services have a copay of $75 or more, Therapeutic Radiological Services have a copay of $35 or more, 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 Assure (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the Medicare Plus Blue PPO Assure (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Plus Blue PPO Assure (PPO) plan, 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 are not covered.
Other Services See details
Other Services include coverage for over-the-counter items with a maximum benefit of $120 every three months, a meal benefit for chronic illnesses, and other services like mobile mental health with a $20 copay and ambulance services with a $90 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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