A non-government entity
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 $284.00. 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:
Sign up for Medicare Plus Blue PPO Assure (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The Medicare Plus Blue PPO Assure (PPO) plan has an "Enhanced Alternative" drug benefit. There is no deductible for prescription drugs with this plan. During the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $7 copay at a preferred pharmacy for a 30-day supply of a Tier 1 drug. After your total drug costs reach $2000, 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 comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient hospital stays with a $100 copay for the first seven days, outpatient services with a copay, and emergency services with a $125 copay. You will also find coverage for primary care, hearing, vision, and dental services, including routine exams and hearing aids, and a $1,500 annual dental benefit. Additional benefits include coverage for ambulance services, home health, and home infusion services. The plan also covers medical equipment, diagnostic services, and skilled nursing facilities with varying cost-sharing. The plan also provides an over-the-counter benefit, and mental health and substance abuse services.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric care, are covered under the Medicare Plus Blue PPO Assure (PPO) plan. For days 1-7 of Inpatient Hospital-Acute and Psychiatric care, there is 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 by the Medicare Plus Blue PPO Assure (PPO) plan, with a copay of $75-$150 for Outpatient Hospital Services and no copay for Ambulatory Surgical Center (ASC) Services. Outpatient Substance Abuse Services are not covered, while Outpatient Blood Services are covered with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare Plus Blue PPO Assure (PPO) plan, but requires prior authorization.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including ground and air ambulance services with a $250 copay. Transportation Services to a Plan Approved Health-related Location are covered, with 28 days of medical transport. Transportation Services to any other health-related location are not covered.
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, 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 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. The plan does not cover podiatry services.
Preventive Services See details
Preventive services are covered under the Medicare Plus Blue PPO Assure (PPO) plan, including annual physical exams, additional preventive services, and kidney disease education services. Some services, such as health education, in-home safety assessments, and counseling services, are not covered. Home and bathroom safety devices and modifications are covered up to $100 every year.
Hearing Services See details
Hearing Services include coverage for routine hearing exams, fitting/evaluation for hearing aids, and prescription hearing aids. Routine hearing exams are covered once per year, and fitting/evaluation for hearing aids is covered once every three years. Prescription hearing aids are covered up to $750 every three years, per ear, for both in and out-of-network services.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam covered every year, and other eye exam services, including Lasik and RK. Eyewear includes contact lenses, with one pair covered per year, and eyeglass lenses and frames, which are covered under a $150 combined maximum benefit per year. 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, including 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, and some services are offered as optional supplemental benefits; contact the plan for more details.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B insulin drugs, you pay a $35 copay and 0-20% coinsurance; for Medicare Part B chemotherapy/radiation and other Medicare Part B drugs, you pay 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Assure (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. 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. Prior authorization is required for all services.
Home Health Services See details
Home Health Services are covered by the Medicare Plus Blue PPO Assure (PPO) plan 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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medicare Plus Blue PPO Assure (PPO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $120 every three months, and a meal benefit for chronic illness. Acupuncture, 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, 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 services include Mobile Mental Health with a $20 copay and Ambulance No transport with a $90 copay.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved