A non-government entity
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:
Sign up for Medicare Plus Blue PPO Essential (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 Essential (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay a copay or coinsurance for your prescriptions depending on the drug tier and the pharmacy you use. For example, for preferred generic drugs, you'll pay an $11 copay at a preferred pharmacy, and $20 at a standard pharmacy. After your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The Medicare Plus Blue PPO Essential (PPO) plan offers a range of benefits, including inpatient hospital stays with copays, outpatient services, and coverage for emergency services. You'll find no copays for preventive services, along with coverage for vision and dental services with annual maximums. The plan also includes home health services with no copay, and covers medical equipment with coinsurance. Additional benefits include coverage for ambulance services, hearing exams, and a yearly allowance for eyewear. The plan also covers home infusion services, dialysis services, and diagnostic and radiological services. However, it's important to note that certain services like cardiac rehabilitation, additional home care, and specific dental and vision procedures are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $420 copay for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a $300 copay for days 1-7, and no copay for days 8-90. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services, are covered by the Medicare Plus Blue PPO Essential (PPO) plan. Outpatient Hospital Services have a copay between $150 and $350, while Ambulatory Surgical Center (ASC) Services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $45, and Outpatient Blood Services have a three-pint deductible waived.
Partial Hospitalization See details
Partial hospitalization is covered under the Medicare Plus Blue PPO Essential (PPO) plan with a $45 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with a $350 copay for both ground and air ambulance services. Transportation Services to any health-related location are covered for 1 round trip per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medicare Plus Blue PPO Essential (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a copay between $0 and $50. Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $50 copay, and Worldwide Emergency Transportation has a $350 copay, with a maximum plan benefit coverage of $50,000.
Primary Care See details
The Medicare Plus Blue PPO Essential (PPO) plan covers primary care physician services, chiropractic services with a $15 copay, occupational therapy with a $40 copay, physician specialist services with a $45 copay, 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 $40 copay, additional telehealth benefits, and opioid treatment program services. Podiatry services are not covered.
Preventive Services See details
The Medicare Plus Blue PPO Essential (PPO) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services are partially covered, with health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, nutritional/dietary benefits, home-based palliative care, in-home support services, support for caregivers of enrollees, enhanced disease management, telemonitoring services, home and bathroom safety devices and modifications, and counseling services not covered.
Hearing Services See details
Hearing Services include coverage for routine hearing exams with a copay between $0 and $45, and fitting/evaluation for hearing aids, limited to one visit every three years. Prescription Hearing Aids (all types) are covered up to $750 per ear every three years, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0 to $45, and routine eye exams have no copay; eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 every year.
Dental Services See details
Dental Services are covered, with a maximum plan benefit of $1500 per year. Medicare Dental Services have a copay between $0 and $45, while Oral Exams are limited to 2 per year and have a copay between $0 and $45. Dental X-Rays are covered once every 2 years, Prophylaxis (Cleaning) is covered twice per year, and Fluoride Treatment is covered once per year. Restorative Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery are also covered, but with limitations on the number of visits and periodicity. Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Essential (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a coinsurance of 0-20% and no copay, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance and no copay, while Medical Supplies have a 20% coinsurance and no copay. 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 with a copay between $0 and $150, and lab services with no copay. Radiological services are also covered, including diagnostic radiological services with a copay between $100 and $150, therapeutic radiological services with a $35 copay, and outpatient X-ray services with a $35 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medicare Plus Blue PPO Essential (PPO) plan. The plan does not cover any services within the Cardiac Rehabilitation Services benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered with prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered SNF stays and non-Medicare-covered SNF stays are not covered.
Other Services See details
Under "Other Services", 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. Over-the-counter (OTC) items and a meal benefit for chronic illness are 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