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Medicare Plus Blue PPO Essential (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue PPO Essential (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 Essential (PPO) in 2025, please refer to our full plan details page.
Medicare Plus Blue PPO Essential (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 Essential (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 Essential (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 Essential (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.00. You must continue to pay paying your reduced 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 $6250.00 (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 $6250.00 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 Essential (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for generic drugs, with the amount varying based on the pharmacy and the specific drug tier. For brand-name and non-preferred drugs, you will pay coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs. This plan may also have a reduced premium if you qualify for the low-income subsidy.
Additional Benefits
The Medicare Plus Blue PPO Essential (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services, with varying copays. You'll have a copay for services like primary care, specialist visits, and therapy, as well as emergency and ambulance services. The plan also includes preventive, hearing, vision, and dental benefits, with specific copays and annual maximums for some services. Additional benefits include home health, skilled nursing, and medical equipment coverage, along with coverage for diagnostic and radiological services. The plan also covers prescription hearing aids up to a certain amount, and offers an OTC benefit and meal benefits for chronic illnesses. However, it's important to note that this plan does not cover some services, such as acupuncture and private duty nursing.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $420 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $300 copay for days 1-7, and no copay for days 8-90; additional days and non-Medicare covered stays are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay of $150-$350, and individual and group outpatient substance abuse sessions each have a copay of $45. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services are covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the Medicare Plus Blue PPO Essential (PPO) plan, but requires prior authorization. You will have a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare Plus Blue PPO Essential (PPO) plan. Ground and air ambulance services each have a $350 copay, with no coinsurance. Transportation Services to any health-related location are covered for one round trip per year with medical transport.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered. Emergency Services has a $125 copay, and no coinsurance. Urgently Needed Services has a copay between $0 and $50, and no coinsurance. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $350 copay; all have no coinsurance.
Primary Care See details
Primary Care benefits include coverage for Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits and Opioid Treatment Program Services. Chiropractic Services have a $15 copay, with Routine Chiropractic Care costing $45 per visit up to 1 visit per year, and Other Chiropractic Services costing $35 per visit up to 1 visit per year, with Chiropractic X-rays covered. Occupational Therapy Services have a $40 copay, and Physician Specialist Services have a $45 copay. Individual and Group Sessions for Mental Health Specialty and Psychiatric Services each have a $20 copay. Other Health Care Professional services have a copay between $0 and $45. Physical Therapy and Speech-Language Pathology Services have a $40 copay.
Preventive Services See details
Preventive Services are covered by the Medicare Plus Blue PPO Essential (PPO) plan, including Medicare-covered preventive services, annual physical exams, and additional preventive services, though health education, in-home safety assessments, and several other services are not covered. Additional sessions of smoking and tobacco cessation counseling, fitness benefits (including memory fitness), remote access technologies, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following welcome visits are covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, and coverage for Routine Hearing Exams and Fitting/Evaluation for Hearing Aids. Prescription Hearing Aids (all types) are covered with a maximum benefit of $750 per ear every three years, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, as well as OTC hearing aids.
Vision Services See details
Vision Services includes coverage for eye exams and eyewear. Eye exams have a copay of $0-$45, and routine eye exams have no copay. Eyewear has a combined maximum benefit of $150 per year for contact lenses, eyeglass lenses, and eyeglass frames.
Dental Services See details
The Medicare Plus Blue PPO Essential (PPO) plan offers dental services, including a $1,500 annual maximum benefit for both in-network and out-of-network services, with copays ranging from $0 to $45. Oral exams have no copay for up to 2 visits per year, and dental X-rays, prophylaxis (cleaning), and fluoride treatments are covered, each with specific limitations. Maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Medicare Plus Blue PPO Essential (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment is covered by Medicare Plus Blue PPO Essential (PPO), including Durable Medical Equipment (DME) with a coinsurance between 0% and 20%, and Prosthetics/Medical Supplies with a coinsurance of 20% for Medicare-covered devices and supplies. 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 all diagnostic services, diagnostic procedures/tests, lab services, and all radiological services. Diagnostic procedures/tests have a copay between $0 and $150, lab services have no copay, diagnostic radiological services have a copay of at least $100 and at most $150, therapeutic radiological services have a copay of $35, and outpatient X-Ray services have a $35 copay.
Home Health Services See details
Home Health Services are covered by the Medicare Plus Blue PPO Essential (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 covered, but the specific services of 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 are not covered. There is a copay for these services, but the exact amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Plus Blue PPO Essential (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100.
Other Services See details
The Medicare Plus Blue PPO Essential (PPO) plan does not cover 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, 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, or Self-Directed Personal Assistance Services. The plan covers Over-the-Counter (OTC) Items with a maximum benefit of $95 every three months, as well as a Meal Benefit for chronic illnesses. Other Services include Mobile Mental Health with a $20 copay, and Ambulance No transport with a $90 copay.
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