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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 $209.50. 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. For Tier 1 preferred generics, you pay no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail-order services, while standard options cost a $5 copay for one month. Tier 2 generics cost a $7 copay for a 1-month supply at preferred locations, but you pay no copay for a 3-month supply. For brand-name and specialty medications, costs transition to coinsurance across all pharmacy and mail-order options. Tier 3 preferred brands require a 20% coinsurance, and Tier 4 non-preferred drugs require a 25% coinsurance for both 1-month and 3-month supplies. Tier 5 specialty drugs carry a 33% coinsurance for a 1-month supply.
Additional Benefits
The Medicare Plus Blue Assure (PPO) plan provides robust medical coverage with no copay for primary care doctor visits, telehealth services, and routine preventive care. Inpatient hospital stays require a $100 daily copay for the first seven days and no copay for days eight through 90, with no coinsurance. Emergency room visits feature a $130 copay, which is waived upon hospital admission, while outpatient surgical services are fully covered with no copay. For extra wellness benefits, the plan features dental coverage with a $1,500 annual limit and no copay for cleanings, exams, and root canals. Members also receive a $150 annual eyewear allowance and a routine annual hearing exam with no copay. Additionally, the plan includes home health services with no copay and a $50 quarterly allowance for over-the-counter items.
Inpatient Hospital See details
Medicare Plus Blue Assure (PPO) covers inpatient acute and psychiatric 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
Outpatient services under Medicare Plus Blue Assure (PPO) are covered with no coinsurance, featuring a $75 to $150 copay for hospital services, a $130 copay per stay for observation services, and a $10 copay for substance abuse sessions. Ambulatory surgical center and outpatient blood services are fully covered with no copay and no coinsurance, though prior authorization is required for some services.
Partial Hospitalization See details
Medicare Plus Blue Assure (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization may be required for these covered services.
Ambulance and Transportation Services See details
Medicare Plus Blue Assure (PPO) covers ground and air ambulance services with a $250 copay and no coinsurance, which is not waived if you are admitted to the hospital. While some transportation services are covered, transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
Medicare Plus Blue Assure (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within three days. Urgently needed services range from no copay up to a $40 copay with no coinsurance, while worldwide emergency services are covered up to $50,000 with no coinsurance and copays ranging from $40 to $250.
Primary Care See details
Medicare Plus Blue Assure (PPO) primary care benefits are partially covered, as podiatry services are not covered. Covered services feature no coinsurance, with no copay for primary care physician visits, telehealth, and opioid treatment, and copays ranging from $10 to $35 for specialists, therapies, psychiatric, and chiropractic care.
Preventive Services See details
Preventive services are covered by Medicare Plus Blue Assure (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and routine screenings. The plan's additional preventive services are partially covered, excluding sub-services like health education, weight management, and in-home safety assessments, while still providing fitness benefits and smoking cessation counseling.
Hearing Services See details
Hearing services covered by Medicare Plus Blue Assure (PPO) include one routine hearing exam and fitting evaluation annually with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $495.00 to $1,695.00 for up to two devices 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 with no deductibles, featuring one annual routine eye exam for a $0 to $10 copay and no coinsurance. Eyewear is covered with no copay or coinsurance up to a $150 annual limit for contact lenses, eyeglass lenses, and frames, while other eye exams, upgrades, and combined eyeglasses (lenses and frames) are not covered.
Dental Services See details
Medicare Plus Blue Assure (PPO) offers partially covered dental services with a $1,500 annual maximum for both in-network and out-of-network care. Covered services like exams, cleanings, x-rays, fillings, and root canals have no copay and no coinsurance, while Medicare-covered dental services have a $0 to $10 copay and no coinsurance. Other diagnostic dental services, other preventive dental 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, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require no copay and a coinsurance of no coinsurance up to 20%, while Part B insulin has a $35 copay and a coinsurance of no coinsurance up to 20%.
Dialysis Services See details
Dialysis services are covered under the Medicare Plus Blue Assure (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Plus Blue Assure (PPO) partially covers medical equipment with no copays, though prior authorization is required. Covered durable medical equipment and diabetic supplies range from no coinsurance to 20% coinsurance, prosthetic devices and medical supplies require 20% coinsurance, and diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Medicare Plus Blue Assure (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. There is no copay for lab services, a $0 to $75 copay for diagnostic tests, a $35 copay for X-rays, and copays starting at $35 for therapeutic radiological services and $75 for diagnostic radiological services.
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, though some services are covered while Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) services are not covered. These uncovered services require copayments ranging from $10 to $15.
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 inpatient hospital stay requirement, though prior authorization is required. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
Other services are partially covered by Medicare Plus Blue Assure (PPO), which excludes acupuncture. Covered benefits include over-the-counter items (up to $50 every three months) and chronic illness meal benefits with no copay and no coinsurance, alongside mobile mental health services for a $20 copay and no coinsurance, and non-transport ambulance services for a $90 copay and no coinsurance.
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