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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 $298.60. 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 drug deductible, meaning your prescription coverage begins immediately. For Tier 1 preferred generic drugs, you will pay no copay for a 1-month or 3-month supply at preferred pharmacies and preferred mail-order services. Tier 2 generic drugs are also highly affordable, costing just a $7 copay for a 1-month supply or no copay for a 3-month supply when using preferred network options. For higher-tier medications, costs are structured as coinsurance, with Tier 3 preferred brands requiring a 20% coinsurance and Tier 4 non-preferred drugs requiring a 25% coinsurance. Specialty drugs under Tier 5 carry a 33% coinsurance for a 1-month supply across all pharmacy types. Standard pharmacies and mail-order options are available but generally carry higher copays, such as $5 for Tier 1 and $12 for Tier 2 single-month supplies.
Additional Benefits
Medicare Plus Blue Assure (PPO) offers robust medical coverage with no coinsurance for most standard services, including no copay for primary care visits, preventive care, and home health services. Specialist visits feature a low $10 copay, while inpatient hospital stays require a $100 daily copay for the first seven days and no copay for days eight through 90. Outpatient, emergency, and urgent care services are also covered with affordable copays and no coinsurance. For supplemental care, this plan provides routine dental, vision, and hearing exams with no copay, alongside allowances for eyewear and dental treatments. Diagnostic lab tests and skilled nursing facility stays for the first 20 days also carry no copay. However, certain specialized services, including dialysis, durable medical equipment, and Part B drugs, require a coinsurance of up to 20%.
Inpatient Hospital See details
Medicare Plus Blue Assure (PPO) inpatient hospital stays are partially covered with no coinsurance, requiring a $100 daily copay for days 1 through 7 and no copay for days 8 through 90. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare Plus Blue Assure (PPO) outpatient services are covered with no coinsurance, featuring copays of $75 to $150 for outpatient hospital services and $130 per stay for observation services. Patients pay a $10 copay for outpatient substance abuse sessions, while ambulatory surgical center services and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial hospitalization services are covered under the Medicare Plus Blue Assure (PPO) plan with a $55.00 copay and no coinsurance. Prior authorization is required for some of 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, but does not cover transportation services to health-related locations.
Emergency Services See details
Medicare Plus Blue Assure (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within three days, and urgently needed services with no copay to a $40 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also 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) offers partially covered primary care benefits with no coinsurance, though podiatry services are not covered. Patients pay no copay for primary care physician visits, telehealth, and opioid treatment, a $10 copay for specialists, and copays ranging from $10 to $35 for chiropractic, mental health, and therapy services.
Preventive Services See details
Medicare Plus Blue Assure (PPO) covers preventive services, such as annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, but do not cover 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, home-based palliative care, in-home support, caregiver support, enhanced disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are covered by Medicare Plus Blue Assure (PPO) with no copay or coinsurance for one annual routine exam and fitting evaluation. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $495 to $1,695 for up to two aids per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
Medicare Plus Blue Assure (PPO) vision services are partially covered, featuring routine eye exams with a $0 to $10 copay and eyewear coverage with no copay and a $150 annual limit, both with no coinsurance. While routine exams, contacts, eyeglass lenses, and frames are covered, other eye exam services and eyewear upgrades are not covered.
Dental Services See details
Dental services are partially covered by Medicare Plus Blue Assure (PPO), offering a $0 to $10 copay and no coinsurance for Medicare dental services, and no copay and no coinsurance for other covered services up to a $1,500 yearly maximum. While many preventive and restorative treatments are covered, 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 and step therapy are required. Under this benefit, Medicare Part B chemotherapy and other drugs have no copay and 0% to 20% coinsurance, while covered insulin requires a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Medicare Plus Blue Assure (PPO) covers Dialysis Services 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. Durable medical equipment and diabetic supplies feature no copay and 0% to 20% coinsurance, prosthetic devices and medical supplies carry a 20% coinsurance, and diabetic therapeutic shoes or 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. Diagnostic procedures and tests carry a copay of $0 to $75, lab services have no copay, and radiological services require a copay of $35 for X-rays, a minimum of $35 for therapeutic services, and a minimum of $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) offers Cardiac Rehabilitation Services with no coinsurance, and while some services are covered, specific programs like cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered and require copays of $10 to $15.
Skilled Nursing Facility (SNF) See details
Medicare Plus Blue Assure (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, while additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Medicare Plus Blue Assure (PPO) partially covers other services, offering over-the-counter items and chronic illness meals with no copay and no coinsurance, while acupuncture is not covered. Covered mobile mental health services require a $20 copay and no coinsurance, and non-transport ambulance services have a $90 copay and no coinsurance.
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