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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 $213.00. 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 with no deductible. During the initial coverage phase, you'll pay a copay or coinsurance for your prescriptions. For example, preferred generic drugs have a $7 copay at preferred pharmacies. The plan's premium is $84.20, but may be reduced to $57.60 if you qualify for the low-income subsidy. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The Medicare Plus Blue PPO Assure (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $100 copay for the first 7 days, and no copay for days 8-90. Outpatient services have copays ranging from $75 to $150, while emergency services have a $125 copay. Primary care, hearing, vision, and dental services are also covered, with specific copays and maximum benefits. This plan also includes coverage for ambulance and transportation services, preventive services like annual physical exams with no copay, and home health services with no copay. Additional benefits include coverage for home infusion, dialysis, and medical equipment, with varying copays and coinsurance. The plan also has an "Other Services" benefit that covers over-the-counter (OTC) items with a maximum benefit of $120 every three months.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services, both of which require prior authorization. For the first 7 days of Inpatient Hospital-Acute or Inpatient Hospital Psychiatric stays, the copay is $100 per day, and there is no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the Medicare Plus Blue PPO Assure (PPO) plan, with copays ranging from $75 to $150 for Outpatient Hospital Services, and no copay for Ambulatory Surgical Center (ASC) Services. Outpatient Substance Abuse Services are not covered.
Partial Hospitalization See details
Partial Hospitalization is covered with prior authorization. There is no copay or coinsurance for this benefit.
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 each have a $250 copay, and there is no coinsurance. Transportation Services to any health-related location are covered, with one round trip medical transport per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under 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.
Primary Care See details
The Medicare Plus Blue PPO Assure (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $30 copay, and physical therapy and speech-language pathology services with a $30 copay. The plan also covers mental health specialty services with a $20 copay for individual and group sessions, psychiatric services with a $20 copay for individual and group sessions, 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 preventive services, including annual physical exams, with no copay. Additional services like Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefits, Remote Access Technologies, Home and Bathroom Safety Devices and Modifications, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are also covered, but services such as Health Education, Counseling Services, and others are not covered. Home and Bathroom Safety Devices and Modifications have a maximum plan benefit coverage amount of $100.00 per year.
Hearing Services See details
Hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids are covered. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is covered once every three years. Prescription hearing aids (all types) are covered, with a maximum plan benefit of $750.00 per ear every three years, though some services are not covered, including prescription hearing aids for the inner ear, outer ear, and over the ear.
Vision Services See details
The Medicare Plus Blue PPO Assure (PPO) plan covers eye exams, including routine eye exams once per year and other eye exam services such as Lasik and RK. The plan also covers eyewear, including one pair of contact lenses or standard eyeglass lenses per calendar year, and one eyeglass frame, up to a combined maximum of $150. 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 $1500 per year. Oral exams are covered for 2 visits per year, dental x-rays are covered with limitations, prophylaxis (cleaning) is covered for 2 visits per year, and fluoride treatment is covered for 1 visit per year. Restorative services, endodontics, periodontics, and oral and maxillofacial surgery are also covered with limitations. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Insulin, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs is between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Assure (PPO) plan. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment is covered under the Medicare Plus Blue PPO Assure (PPO) plan, including Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetics/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.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $75, Lab Services have no copay, Diagnostic Radiological Services have a copay of $75, Therapeutic Radiological Services have a copay of $35, and Outpatient X-Ray Services have a copay of $35.
Home Health Services See details
Home Health Services are covered by Medicare Plus Blue PPO Assure (PPO) with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
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 with prior authorization required. There is no copay for days 1-20, but there is a $214 copay for days 21-100.
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 coverage amount of $120 every three months, but does not cover acupuncture. Additionally, the plan covers other services with a $90 copay. However, 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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