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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 $3.50. 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, and coinsurance for brand-name and non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy.
Additional Benefits
The Medicare Plus Blue PPO Essential (PPO) plan offers a range of benefits with varying cost-sharing. You can expect copays for inpatient hospital stays, outpatient services, primary care visits, and ambulance services. Many services have no copay, including preventive services, hearing exams, dental exams, and home health services. The plan also covers vision services, including eye exams and eyewear up to a set amount, and dental services up to a maximum yearly benefit. Additionally, it provides coverage for home infusion, dialysis, and medical equipment, with some services subject to coinsurance. However, certain services like cardiac rehabilitation and some types of nursing and personal care are not covered.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $420 copay for days 1-7, and no copay for days 8-90; additional days are covered with no copay. Inpatient Hospital Psychiatric has 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 are covered, including all outpatient hospital services, observation services, and outpatient substance abuse services. Outpatient hospital services have a copay between $150 and $350, while ambulatory surgical center services have no copay. Individual and group sessions for outpatient substance abuse have a copay of $45.
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 include coverage for Medicare-covered ground and air ambulance services, each with a $350 copay. Transportation Services to any health-related location are covered for one round trip per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Medicare Plus Blue PPO Essential (PPO) plan. Emergency Services have a $125 copay, and there is no coinsurance. Urgently Needed Services have a copay between $0-$50, and no coinsurance. Worldwide Emergency Services have a $125 copay for Worldwide Emergency Coverage, a $50 copay for Worldwide Urgent Coverage, and a $350 copay for Worldwide Emergency Transportation, with no coinsurance.
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 services with a $40 copay, physician specialist services with a $45 copay, and individual and group mental health specialty sessions with a $20 copay. Additionally, physical therapy and speech-language pathology services have a $40 copay, and other healthcare professional services may have a copay between $0 and $45. Psychiatric services and additional telehealth benefits are also covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, and additional preventive services, with services like health education and home safety assessments not covered. The plan covers additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, kidney disease education services, and other preventive services like glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following a Welcome Visit.
Hearing Services See details
Hearing Services includes coverage for hearing exams with no copay, and up to one routine hearing exam and one fitting/evaluation for a hearing aid per year. This plan also covers prescription hearing aids up to $750 every three years, but does not cover inner ear, outer ear, or over-the-ear prescription hearing aids, nor OTC hearing aids.
Vision Services See details
Vision Services include coverage for eye exams with a copay of $0-$45, and eyewear. Eyewear includes a $150 maximum benefit per year that can be used for frames or elective contact lenses, and the plan does not cover eyeglasses.
Dental Services See details
The Medicare Plus Blue PPO Essential (PPO) plan covers dental services with a maximum benefit of $1,500 per year for both in-network and out-of-network services, including oral exams with no copay for two visits per year, dental x-rays, prophylaxis (cleaning) with no copay for two visits per year, fluoride treatment with no copay for one visit per year, and restorative services with no copay, as well as oral and maxillofacial surgery with no copay for two visits per lifetime. 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 for these services.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Essential (PPO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment is covered by the Medicare Plus Blue PPO Essential (PPO) plan, including Durable Medical Equipment (DME) with 0-20% coinsurance and no copay, and Prosthetics/Medical Supplies with coinsurance. However, 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 include coverage for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $150, and lab services with no copay. Radiological services are 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 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 not covered by the Medicare Plus Blue PPO Essential (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, and Additional Cardiac Rehabilitation Services.
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. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The Medicare Plus Blue PPO Essential (PPO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, 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. Over-the-counter (OTC) items are covered, with a maximum benefit of $95 every three months, and the plan offers Nicotine Replacement Therapy (NRT) and Naloxone coverage. The plan covers a meal benefit for chronic illnesses, and other services include a copay of $90 for ambulance non-transport services.
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