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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 $247.40. 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 prescription drug deductible, meaning your coverage begins immediately without any out-of-pocket deductible costs. For Tier 1 preferred generic drugs, you will pay no copay for a one-month or three-month supply at preferred pharmacies and preferred mail-order services, while standard pharmacies charge a $5 or $15 copay. Tier 2 generic drugs cost a $7 copay for a one-month supply at preferred locations, but you can save with no copay for a three-month supply. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, and Tier 4 non-preferred drugs carry a 25% coinsurance for both one-month and three-month fills. Specialty drugs in Tier 5 have a 33% coinsurance for a one-month supply at all pharmacy and mail-order options.
Additional Benefits
The Medicare Plus Blue Assure (PPO) plan offers comprehensive coverage with predictable cost-sharing, featuring no copay for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a $100 daily copay for the first seven days and no copay for days eight through 90, while outpatient hospital services require a $75 to $150 copay. Emergency care is available with a $130 copay, which is waived if admitted, while urgent care visits range from no copay to a $40 copay. This plan also includes valuable dental, vision, and hearing benefits, highlighted by no copay for routine preventive dental care up to a $1,500 annual limit and no copay for routine hearing exams. Vision care features no copay for eyewear up to a $150 annual limit, and members receive over-the-counter items up to $50 every three months with no copay. Additionally, skilled nursing facility stays require no copay for the first 20 days, and diagnostic lab services are fully covered with no copay.
Inpatient Hospital See details
Medicare Plus Blue Assure (PPO) covers inpatient hospital services with no coinsurance, requiring a $100 daily copay for days 1 through 7 and no copay for days 8 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare Plus Blue Assure (PPO) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services at no copay. Outpatient hospital services require a $75 to $150 copay, observation services have a $130 copay per stay, and outpatient substance abuse sessions carry a $10 copay.
Partial Hospitalization See details
Partial hospitalization is covered by Medicare Plus Blue Assure (PPO) 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 covered by Medicare Plus Blue Assure (PPO) with a $250 copay and no coinsurance for both ground and air ambulance services. However, transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Medicare Plus Blue Assure (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within three days, and no coinsurance. Urgently needed services range from no copay to a $40 copay with no coinsurance, while worldwide emergency services are covered up to a $50,000 limit with no coinsurance and copays ranging from $40 to $250.
Primary Care See details
Medicare Plus Blue Assure (PPO) provides partially covered primary care services with no coinsurance, featuring no copay for primary care physician visits, telehealth, and opioid treatment. Covered specialist, therapy, chiropractic, and mental health services require copays ranging from $10 to $35, while podiatry services are not covered.
Preventive Services See details
Medicare Plus Blue Assure (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management, with no copay and no coinsurance. Additional preventive services are partially covered; however, 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, palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home/bathroom safety, and counseling are not covered.
Hearing Services See details
Medicare Plus Blue Assure (PPO) covers hearing services with no copay and no coinsurance for annual routine hearing exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $495.00 to $1,695.00 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
Medicare Plus Blue Assure (PPO) vision services are partially covered, offering routine eye exams with a $0 to $10 copay and no coinsurance, and eyewear with no copay, no coinsurance, and a $150 annual limit. While contact lenses, eyeglass lenses, and frames are covered, other eye exam services, upgrades, and eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services are partially covered by Medicare Plus Blue Assure (PPO) with no copay and no coinsurance for most preventive and comprehensive benefits, up to a combined $1,500 annual limit. Medicare-covered dental services require a $0 to $10 copay and no coinsurance, while orthodontics, maxillofacial prosthetics, other diagnostic, and other preventive dental services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medicare Plus Blue Assure (PPO) with no copay, though prior authorization is required. Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while insulin is covered with a $35 copay and 0% 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
Medicare Plus Blue Assure (PPO) covers medical equipment with no copays, requiring prior authorization for all services. Durable medical equipment and diabetic supplies carry no copay and coinsurance ranging from no coinsurance to 20%, while prosthetic devices and medical supplies have a 20% coinsurance. Diabetic equipment 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. Lab services have no copay, diagnostic tests range from no copay to $75, outpatient X-rays and therapeutic radiology have a $35 copay, and diagnostic radiological services have a minimum $75 copay.
Home Health Services See details
Home Health Services are covered under the Medicare Plus Blue Assure (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare Plus Blue Assure (PPO) covers Cardiac Rehabilitation Services with no coinsurance, but some services are covered while standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) are not covered. These non-covered rehabilitation services require copayments of $10 for pulmonary rehab and $15 for the other rehabilitation services.
Skilled Nursing Facility (SNF) See details
Medicare Plus Blue Assure (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Medicare Plus Blue Assure (PPO) partially covers other services, excluding acupuncture, while offering over-the-counter items (up to $50 every three months) and chronic illness meal benefits with no copay and no coinsurance. Covered mobile mental health services require a $20 copay and no coinsurance, and non-transport ambulance services are available for a $90 copay and no coinsurance.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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