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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 $248.00. 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. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy you use. For example, preferred generic drugs have a $7 copay at preferred pharmacies. Once 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 Assure (PPO) plan offers a range of benefits beyond standard Medicare coverage. This plan includes coverage for inpatient hospital stays with a $100 copay for days 1-7, and no copay for days 8-90, as well as outpatient services with a copay of $75-$150. Additionally, the plan provides coverage for ambulance services, emergency services, primary care, preventive services, hearing, vision, and dental services. The plan covers a variety of services, including routine eye exams, hearing exams, and dental care. It also covers home health services with no copay, and offers additional benefits such as over-the-counter items with a maximum benefit of $120 every three months. However, it's important to note that some services, such as cardiac rehabilitation and certain types of hearing aids and vision services, are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered. For days 1-7, you will pay a $100 copay, and for days 8-90, there is no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services and observation services, are covered with a copay of $75-$150 for outpatient hospital services and no copay for ambulatory surgical center services. Outpatient substance abuse services are not covered, and outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. There is no information about the cost of this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare Plus Blue PPO Assure (PPO) plan. Ground and air ambulance services have a $250 copay, and 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 by the Medicare Plus Blue PPO Assure (PPO) plan. Emergency Services have a $125 copay, and Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $40 copay, and Worldwide Emergency Transportation has a $250 copay, with a maximum plan benefit of $50,000.
Primary Care See details
Primary Care benefits include coverage for primary care physician services, chiropractic services with a $15 copay, occupational therapy services with a $30 copay, physician specialist services, mental health specialty services with a $20 copay for individual and group sessions, psychiatric services with a $20 copay for individual and group sessions, physical therapy and speech-language pathology services with a $30 copay, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The Medicare Plus Blue PPO Assure (PPO) plan covers a variety of preventive services, including Medicare-covered preventive services with no copay, and additional services such as glaucoma screening, diabetes self-management training, and home and bathroom safety devices with a maximum plan benefit coverage amount of $100 every year. Some services, such as health education, in-home safety assessments, and counseling services are not covered.
Hearing Services See details
Hearing exams are covered, including routine hearing exams with one visit per year and fitting/evaluation for hearing aids with one visit every three years. Prescription hearing aids are covered with a maximum plan benefit of $750.00 per ear every three years. Prescription hearing aids (all types) are covered with two visits every three years. Prescription hearing aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, other eye exam services, and eyewear. Routine eye exams are covered once per year, and other eye exam services (Lasik and RK) are covered with no limit. Contact lenses are covered, and the plan provides a $150 maximum benefit every calendar year that applies to frames or elective contact lenses. Eyeglass lenses are covered (1 pair) every calendar year. Eyeglass frames are covered (1 frame) every calendar year, with a $150 maximum benefit. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Medicare Plus Blue PPO Assure (PPO) plan covers dental services, with a maximum benefit of $1,500 per year for both in-network and out-of-network services. The plan covers oral exams (2 per year), dental x-rays (limited), prophylaxis (cleaning) (2 per year), fluoride treatments (1 per year), restorative services (limited), endodontics (limited), periodontics (limited), and oral and maxillofacial surgery (limited). 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 the coinsurance ranges from 0% to 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance that ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Assure (PPO) plan. You are responsible for a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0-20%, Prosthetic Devices and Medical Supplies with a 20% coinsurance, 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, including diagnostic procedures/tests with a copay between $0 and $75, lab services with no copay, diagnostic radiological services with a copay of at most $75, therapeutic radiological services with a copay of at most $35, and outpatient X-ray services with 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 or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by 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. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items with a maximum benefit of $120.00 every three months, and a meal benefit for a chronic illness. 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. Other 1 includes a $20 copay for Mobile Mental Health, and Other 2 includes a $90 copay for Ambulance No transport.
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