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Medicare Plus Blue Essential (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue 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 Essential (PPO) in 2026, please refer to our full plan details page.
Medicare Plus Blue 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 2026.
It's important to know that Medicare Plus Blue 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 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 Essential (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $25.00. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $20.10. 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 a $150.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 Essential (PPO) plan features a $150 drug deductible. For Tier 1 preferred generic drugs, there is no copay for one-month or three-month supplies at preferred pharmacies and preferred mail-order services. Tier 2 generic drugs cost a $5 copay for a one-month supply at preferred locations, but feature no copay when ordering a three-month supply. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs require a 25% coinsurance. Tier 5 specialty drugs have a 31% coinsurance for a one-month supply at both preferred and standard pharmacies or mail-order options.
Additional Benefits
The Medicare Plus Blue Essential (PPO) plan offers comprehensive coverage for essential medical needs, often with no coinsurance and clear copayment structures. Primary care, telehealth services, and preventive care are available with no copay and no coinsurance, while specialist visits, physical therapy, and outpatient mental health services require a $45 copay or less. For emergency situations, the plan features a $130 copay for emergency room visits and a $350 daily copay for the first seven days of acute inpatient hospital stays, followed by no copay for subsequent days. Dental care is covered with no copay and no coinsurance up to a $950 annual limit, and beneficiaries can access one annual routine eye exam with a copay ranging from no copay up to $45. Diagnostic lab tests and home health services are also provided with no copay, though other services like dialysis and medical equipment require a 20% coinsurance. While the plan covers a wide range of medical needs, it is important to note that routine hearing aids, eyewear, and non-emergency transportation services are not covered under this plan.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Medicare Plus Blue Essential (PPO) with no coinsurance, though prior authorization is required. Acute care requires a $350 daily copay for days 1 to 7 and no copay for subsequent unlimited days, while psychiatric care requires a $300 daily copay for days 1 to 7 and no copay for days 8 to 90; upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Medicare Plus Blue Essential (PPO) covers outpatient services with no coinsurance, featuring a $125 to $350 copay for outpatient hospital services and a $130 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while individual and group outpatient substance abuse sessions require a $45 copay with no coinsurance.
Partial Hospitalization See details
Medicare Plus Blue Essential (PPO) covers partial hospitalization services with a $45.00 copay and no coinsurance, although prior authorization may be required.
Ambulance and Transportation Services See details
Medicare Plus Blue Essential (PPO) partially covers ambulance and transportation services, providing ground and air ambulance coverage with a $350 copay and no coinsurance. Transportation services to plan-approved or any other health-related locations are not covered.
Emergency Services See details
Medicare Plus Blue Essential (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 to a $50 copay with no coinsurance, and worldwide emergency services are covered up to $50,000 with copays between $50 and $350 and no coinsurance.
Primary Care See details
Medicare Plus Blue Essential (PPO) provides primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist, physical therapy, and occupational therapy visits require a $45 copay and no coinsurance. Mental health and psychiatric services carry a $20 copay and no coinsurance, chiropractic services are partially covered with a $15 copay and no coinsurance (excluding routine chiropractic care), and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under the Medicare Plus Blue Essential (PPO) plan with no copay and no coinsurance for covered care, including annual physical exams, kidney disease education, and diabetes self-management. While remote access technologies and smoking cessation counseling are covered, several additional services such as fitness benefits, health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services are partially covered by Medicare Plus Blue Essential (PPO), offering covered hearing exams with no copay, no coinsurance, and no deductible. However, routine hearing exams, fitting and evaluations, prescription hearing aids, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by Medicare Plus Blue Essential (PPO), which includes one routine eye exam every year with a copay of $0 to $45 and no coinsurance. Other eye exam services and all eyewear, including contact lenses, eyeglasses, lenses, frames, and upgrades, are not covered under this plan.
Dental Services See details
Medicare Plus Blue Essential (PPO) covers dental services with no copay and no coinsurance up to a $950 annual limit, while Medicare-covered dental services have a $0 to $45 copay with no coinsurance. The plan partially covers dental care, excluding orthodontics, maxillofacial prosthetics, and other diagnostic or preventive dental services.
Home Infusion bundled Services See details
Home infusion bundled services are covered by Medicare Plus Blue Essential (PPO) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the Medicare Plus Blue Essential (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Plus Blue Essential (PPO) partially covers medical equipment with no copays, though coinsurance ranges from no coinsurance to 20% depending on the item, and prior authorization is required. While durable medical equipment, prosthetics, and diabetic supplies are covered, diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by Medicare Plus Blue Essential (PPO) with no coinsurance, though prior authorization is required. Lab services have no copay, diagnostic tests range from a $0 to $150 copay, and radiological services require copays starting at $35 for X-rays and therapeutic services, and a minimum of $100 for diagnostic radiology.
Home Health Services See details
Home health services are covered by Medicare Plus Blue Essential (PPO) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare Plus Blue Essential (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, but cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Medicare Plus Blue Essential (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, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Medicare Plus Blue Essential (PPO) partially covers other services, with exclusions for acupuncture, over-the-counter items, and meal benefits. Covered services include non-Medicare-covered mobile mental health for a $20 copay and no coinsurance, and ambulance no-transport services for a $90 copay and no coinsurance.
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