Medicare Plus Blue Essential (PPO)

Medicare Plus Blue Essential (PPO) is a PPO plan offered by BCBS of Michigan Mutual Insurance Company available for the 2026 plan year 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.

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:

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.

Plan Providers

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, Health Care Service Corporation, HealthSpring^SM, HealthSun, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.