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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 $15.10. 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 an annual drug deductible of $150. 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, while standard options charge a $5 or $15 copay. Tier 2 generic drugs cost a $5 copay for a 1-month supply and no copay for a 3-month supply at preferred locations, compared to $10 and $30 copays at standard locations. For higher-tier medications, coverage transitions to coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 25% coinsurance. Tier 5 specialty drugs require a 31% coinsurance for a 1-month supply at both preferred and standard pharmacies.
Additional Benefits
The Medicare Plus Blue Essential (PPO) plan offers affordable medical coverage with no copay and no coinsurance for primary care visits, telehealth, and preventive services. If you require hospital care, inpatient acute stays have a daily copay of $350 for the first seven days with no coinsurance, while emergency room visits require a $130 copay. Outpatient hospital services carry a copay ranging from $125 to $350, and specialist office visits require a $45 copay. Specialty benefits like dental care are partially covered with copays ranging from no copay up to $45 and an annual maximum benefit of $950, while routine eye exams feature copays from no copay to $45. Diagnostic hearing exams and home health services are covered with no copay, though routine hearing aids, eyewear, and transportation services are not covered by this plan. For prescription and medical equipment needs, home infusion services and laboratory tests have no copay, while medical equipment and dialysis require up to 20% coinsurance.
Inpatient Hospital See details
Medicare Plus Blue Essential (PPO) covers inpatient hospital services with no coinsurance, requiring a daily copay of $350 for days 1-7 of acute stays and $300 for days 1-7 of psychiatric stays, followed by no copay for remaining days. While additional acute stay days are covered with no copay, additional psychiatric days, upgrades, and non-Medicare-covered stays 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 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 outpatient substance abuse sessions require a $45 copay and no coinsurance.
Partial Hospitalization See details
Medicare Plus Blue Essential (PPO) covers partial hospitalization services with a $45.00 copay and no coinsurance. Prior authorization may be required for these services.
Ambulance and Transportation Services See details
Medicare Plus Blue Essential (PPO) covers ground and air ambulance services with a $350 copay and no coinsurance, which is not waived if you are admitted to the hospital. Transportation services are not covered under this plan.
Emergency Services See details
Medicare Plus Blue Essential (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within 3 days, and no coinsurance, while urgently needed services feature no copay to a $50 copay and no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 limit with no coinsurance and copays of $130, $50, and $350, respectively.
Primary Care See details
Medicare Plus Blue Essential (PPO) offers primary care, telehealth, and opioid treatment services with no copay and no coinsurance. Specialist, physical therapy, and occupational therapy visits require a $45 copay and no coinsurance, mental health services have a $20 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered by Medicare Plus Blue Essential (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. While smoking cessation counseling and remote access technologies are covered, several supplemental services such as fitness benefits, health education, and in-home safety assessments are not covered.
Hearing Services See details
Hearing services covered by Medicare Plus Blue Essential (PPO) include diagnostic hearing exams with no copay, no coinsurance, and no deductible, though routine hearing exams and fitting evaluations are not covered. For prescription hearing aids, some services are covered but inner ear, outer ear, and over the ear prescription hearing aids, as well as over-the-counter hearing aids, are not covered.
Vision Services See details
Medicare Plus Blue Essential (PPO) partially covers vision services, offering one routine eye exam every year with a copay ranging from no copay to $45 and no coinsurance. Other eye exam services and all eyewear, including contact lenses, eyeglasses, lenses, frames, and upgrades, are not covered.
Dental Services See details
Medicare Plus Blue Essential (PPO) dental services are partially covered, featuring a $0 to $45 copay and no coinsurance up to an annual maximum of $950 for both in-network and out-of-network care. While most preventive and comprehensive services have no copay and no coinsurance, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Medicare Plus Blue Essential (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no copay and range from no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Medicare Plus Blue Essential (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is partially covered by Medicare Plus Blue Essential (PPO) with no copays, though prior authorization is required and coinsurance ranges from no coinsurance up to 20%. While durable medical equipment, prosthetics, medical supplies, and diabetic supplies are covered, diabetic therapeutic shoes and inserts are not covered.
Diagnostic and Radiological Services See details
Medicare Plus Blue Essential (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Lab services have no copay, outpatient x-rays have a $35 copay, and other diagnostic tests and radiological services have copays ranging from $0 to $150, with minimum copays starting at $35 for therapeutic and $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
Cardiac Rehabilitation Services are not covered under the Medicare Plus Blue Essential (PPO) plan, as all individual sub-services are excluded from coverage.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by Medicare Plus Blue Essential (PPO) with no coinsurance, requiring prior authorization but no prior three-day 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 period are not covered.
Other Services See details
Other services are partially covered by Medicare Plus Blue Essential (PPO), with exclusions for acupuncture, over-the-counter items, and meal benefits. Covered services include non-Medicare-covered mobile mental health for a $20 copay with no coinsurance, and ambulance no-transport services for a $90 copay with no coinsurance.
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