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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 $291.30. 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, allowing your coverage to begin immediately. For Tier 1 preferred generic drugs, you will pay no copay for one-month or three-month supplies at preferred pharmacies and mail-order services. Tier 2 generic drugs are also highly affordable, costing a $7 copay for a one-month supply or no copay for a three-month supply at preferred pharmacies. Brand-name and specialty medications on higher tiers are subject to coinsurance rather than flat copays. You will pay a 20% coinsurance for Tier 3 preferred brand drugs, a 25% coinsurance for Tier 4 non-preferred drugs, and a 33% coinsurance for Tier 5 specialty medications. Standard pharmacies and mail-order options are also available for generic drugs at slightly higher copays.
Additional Benefits
Medicare Plus Blue Assure (PPO) offers robust medical coverage with predictable costs, featuring no copays for primary care visits, telehealth services, and home health care. For hospital stays, members pay no coinsurance and a $100 daily copay for the first seven days of inpatient care, while outpatient services carry a $75 to $150 copay. Emergency room visits require a $130 copay, which is waived if you are admitted, and urgent care services range from no copay to a $40 copay. This plan also includes valuable supplemental benefits, such as dental coverage with a $1,500 annual limit and no copay for routine cleanings and exams. Vision and hearing benefits feature no coinsurance, providing routine eye exams with copays up to $10 and prescription hearing aid coverage with copays between $495 and $1,695. Additionally, skilled nursing facility stays require no coinsurance and no copay for the first 20 days, while standard durable medical equipment carries a 0% to 20% coinsurance.
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 per stay. While unlimited additional acute care days are covered with no copay, the plan does not cover additional psychiatric days, room upgrades, or non-Medicare-covered stays.
Outpatient Services See details
Medicare Plus Blue Assure (PPO) covers outpatient hospital services with a $75 to $150 copay and no coinsurance, and observation services with a $130 copay per stay and no coinsurance. Ambulatory surgical center services and outpatient blood services are covered with no copay and no coinsurance. Outpatient substance abuse sessions are also covered with a $10 copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by Medicare Plus Blue Assure (PPO) with a $55.00 copay and no coinsurance, although some services may require prior authorization.
Ambulance and Transportation Services See details
Medicare Plus Blue Assure (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance, while additional transportation services to health-related locations are not covered.
Emergency Services See details
Emergency services under Medicare Plus Blue Assure (PPO) are covered with a $130 copay, which is waived if admitted to the hospital within three days, and no coinsurance. Urgently needed services feature no copay to a $40 copay with no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with no coinsurance and copays ranging from $40 to $250.
Primary Care See details
Medicare Plus Blue Assure (PPO) provides partially covered primary care benefits with no coinsurance for all covered services, though podiatry services are not covered. There is no copay for primary care, telehealth, and opioid treatment, while other services like specialist visits, chiropractic care, and therapies require copays ranging from $10 to $35.
Preventive Services See details
Medicare Plus Blue Assure (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive services are only partially covered, as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission 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 devices, and counseling are not covered.
Hearing Services See details
Medicare Plus Blue Assure (PPO) covers annual routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered for up to two devices per year with no coinsurance and a copay ranging from $495.00 to $1,695.00, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Medicare Plus Blue Assure (PPO) offers partially covered vision services with no deductible and no coinsurance, featuring a $0 to $10 copay for one routine eye exam per year. Covered eyewear has no copay and includes contact lenses, standard lenses, and frames up to a combined annual limit of $150, while other eye exam services, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental Services are partially covered by Medicare Plus Blue Assure (PPO) with a $1,500 annual limit for both in- and out-of-network care. Most covered services, including exams, cleanings, and fillings, feature no copay and no coinsurance (Medicare dental services require a $0 to $10 copay and no coinsurance), while other diagnostic services, other preventive services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Medicare Plus Blue Assure (PPO) covers home infusion bundled services with no copay, although prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and insulin, carry a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
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 copay, featuring a 0% to 20% coinsurance for durable medical equipment and diabetic supplies, and a 20% coinsurance for prosthetics and medical supplies. This benefit is partially covered as diabetic therapeutic shoes and inserts are not covered, and prior authorization is required.
Diagnostic and Radiological Services See details
Medicare Plus Blue Assure (PPO) covers diagnostic and radiological services with no coinsurance, although prior authorization is required. Members pay no copay for lab services, a $35 copay for outpatient x-rays, between $0 and $75 for diagnostic procedures, and minimum copays of $35 for therapeutic radiology and $75 for diagnostic radiology.
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
Cardiac Rehabilitation Services are offered by Medicare Plus Blue Assure (PPO) with no coinsurance, but only some services are covered as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These services require copayments ranging from $10.00 to $15.00.
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, a $218 copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by Medicare Plus Blue Assure (PPO), with acupuncture being excluded from coverage. Covered benefits include over-the-counter items and chronic illness meal benefits with no copay and no coinsurance, while mobile mental health services carry a $20 copay and non-transport ambulance services carry a $90 copay, both with no coinsurance.
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