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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 $281.00. 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. The plan has no deductible. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For example, you will pay a $7.00 copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2000.00, you will enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs.
Additional Benefits
The Medicare Plus Blue PPO Assure (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $100 copay for the first seven days, and outpatient services have copays from $0-$150. Emergency services have a $125 copay, and ambulance services have a $250 copay. This plan also covers primary care, preventive services, and vision services with routine eye exams covered once per year and eyewear benefits up to $150. Hearing exams and hearing aids are covered up to $750 every three years, and dental services are covered up to $1,500 per year. Additionally, the plan offers home infusion, dialysis, and medical equipment benefits with varying coinsurance amounts.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For days 1-7, the copay is $100, and there is no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services with the Medicare Plus Blue PPO Assure (PPO) plan covers outpatient hospital services with a copay of $75-$150, observation services, and ambulatory surgical center services with no copay. Outpatient substance abuse services are not covered, but outpatient blood services are covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered. 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, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medicare Plus Blue PPO Assure (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0 and $40, and 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
The Medicare Plus Blue PPO Assure (PPO) plan covers 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. Chiropractic services have a $15 copay, while routine chiropractic care has no copay, and other chiropractic services have a $35 copay; occupational therapy services have a $30 copay. Individual and group sessions for mental health and psychiatric services have a $20 copay. Physical therapy and speech-language pathology services have a $30 copay.
Preventive Services See details
Preventive services, including annual physical exams, are covered. Additional preventive services are covered, but health education, in-home safety assessment, personal emergency response systems, medical nutrition therapy, and several other services are not covered.
Hearing Services See details
Hearing exams, including routine hearing exams and fitting/evaluation for hearing aids, are covered. Prescription hearing aids are covered up to $750 every three years for both in and out-of-network services, but prescription hearing aids for inner ear, outer ear, and over-the-ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services include routine eye exams, other eye exam services, and eyewear benefits. Routine eye exams are covered once per year, and other eye exam services, such as Lasik and RK, are covered. Eyewear benefits include contact lenses, with a $150 combined maximum benefit every year for frames or elective contact lenses, and eyeglass lenses and frames, with a $150 combined maximum benefit every calendar year for frames or elective contact lenses. 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. The plan covers oral exams (2 per year), dental x-rays (limited), prophylaxis (cleaning) (2 per year), fluoride treatment (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. Insulin has a $35 copay and 0-20% coinsurance. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance of 0-20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare Plus Blue PPO Assure (PPO) plan. There is a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetic Devices and Medical Supplies with a 20% coinsurance, but Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. There is no copay for any of these services.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests and Lab Services, are covered with a copay ranging from $0 to $75. Diagnostic Radiological Services have a copay of at most $75, Therapeutic Radiological Services have a copay of at most $35, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered by Medicare Plus Blue PPO Assure (PPO) 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 by the Medicare Plus Blue PPO Assure (PPO) plan. The plan does not cover any services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD 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. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Medicare Plus Blue PPO Assure (PPO) plan's Other Services benefit covers Over-the-Counter (OTC) items with a maximum benefit of $120 every three months, and a copay of $90 for other services. 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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