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 depending on the drug tier and pharmacy you use. For example, you will pay a $11 copay for preferred generic drugs at a preferred pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The Medicare Plus Blue PPO Essential (PPO) plan offers comprehensive coverage with a variety of benefits. The plan includes coverage for inpatient and outpatient services, with varying copays depending on the specific service. It also provides coverage for primary care, preventive services, hearing, vision, and dental, with specific copays and maximum benefits for each. Additional benefits include coverage for home health, cardiac rehabilitation, skilled nursing facilities, and other services such as ambulance, emergency, and dialysis. This plan also offers coverage for medical equipment, diagnostic and radiological services, and home infusion bundled services. However, it's important to note that some services, like certain hearing aids, dental procedures, and other services, may have limitations or are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not 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.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, outpatient substance abuse services, and outpatient blood services, are covered. 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 services have a copay of $45.00, and Outpatient Blood Services include an enhanced benefit with a three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by 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 Services are covered by the Medicare Plus Blue PPO Essential (PPO) plan, with a $350 copay for both ground and air ambulance services and no coinsurance. Transportation Services are partially covered, with one round trip per year for medical transport to any health-related location. Transportation Services to plan-approved health-related locations are not covered.
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, while Urgently Needed Services have a copay between $0 and $50, and Worldwide Emergency Services have a copay ranging from $50 to $350 depending on the specific service.
Primary Care See details
The Medicare Plus Blue PPO Essential (PPO) plan covers primary care, 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, other healthcare professional services with a copay between $0 and $45, 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
Preventive Services, including Medicare-covered services, annual physical exams, and additional preventive services, are covered. Additional services such as health education, in-home safety assessments, and others are not covered.
Hearing Services See details
The Medicare Plus Blue PPO Essential (PPO) plan covers hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids are covered once per year and every three years, respectively. Prescription hearing aids (all types) are covered with a maximum benefit of $750 per ear every three years, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for eye exams, with a copay between $0 and $45, and eyewear. Eyewear benefits include coverage for contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 per year; however, eyeglass frames and upgrades are not covered.
Dental Services See details
Dental Services are covered with a maximum benefit of $1,500 per year, and include oral exams with no copay for up to two visits per year, dental x-rays with no copay for up to one set every two years, and prophylaxis (cleaning) with no copay for up to two visits per year. Restorative services, endodontics, periodontics, and oral and maxillofacial surgery are also covered, while 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. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs are also covered with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the Medicare Plus Blue PPO Essential (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0-20%, and Prosthetic Devices and Medical Supplies, each with a 20% coinsurance. The plan does not cover Durable Medical Equipment for use outside the home, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay required for all diagnostic services, diagnostic procedures/tests with a copay between $0 and $150, and diagnostic radiological services with a copay between $100 and $150. Lab services have no copay, therapeutic radiological services have a $35 copay, 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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-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, or Additional Cardiac Rehabilitation Services. There is a copay for some services, but the specific amount is not mentioned.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but require 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
Other Services include Over-the-Counter (OTC) Items, with a maximum benefit of $95 every three months, and a meal benefit for chronic illnesses. 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, 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. Other 2 includes 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