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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 $2.00. 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:
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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 or coinsurance depending on the drug tier and the pharmacy you use. For example, preferred generic drugs have an $11 copay at a preferred pharmacy, while standard generic drugs have a $42 copay. After your yearly out-of-pocket drug costs reach $2000, you will enter the catastrophic coverage phase and pay nothing for your Part D covered drugs.
Additional Benefits
The Medicare Plus Blue PPO Essential (PPO) plan offers a wide range of benefits. It includes coverage for inpatient and outpatient hospital services, with varying copays depending on the service. This plan also covers emergency services, primary care visits, preventive services, hearing exams, and vision services, often with no copay. Additional benefits include dental services, home infusion, dialysis, medical equipment, diagnostic and radiological services, and home health services. The plan also offers some coverage for ambulance services and partial hospitalization. Some services, like skilled nursing facility stays, require copays for certain days.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, there is a $420 copay for days 1-7 and no copay for days 8-90, and for Inpatient Hospital Psychiatric, there is 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 and substance abuse 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 have a copay of $45. Outpatient blood services are also covered, including services not usually covered by Medicare plans.
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, including ground and air ambulance services, are covered by this plan. Ground and air ambulance services have a copay of $350, while transportation services to any health-related location 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 has a $125 copay for Worldwide Emergency Coverage, a $50 copay for Worldwide Urgent Coverage, and a $350 copay for Worldwide Emergency Transportation.
Primary Care See details
The Medicare Plus Blue PPO Essential (PPO) plan covers primary care, including primary care physician services, with no copay. Chiropractic services have a $15 copay, and routine chiropractic care has a $45 copay for one visit per year, while other chiropractic services have a $35 copay for one visit per year. Occupational therapy services have a $40 copay. Physician specialist services have a $45 copay, and physical therapy and speech-language pathology services have a $40 copay. Individual and group mental health specialty sessions, and individual and group psychiatric sessions, have a $20 copay. Other health care professional visits have copays that range from $0 to $45. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered under Medicare Plus Blue PPO Essential (PPO), including Medicare-covered preventive services, annual physical exams, and additional preventive services. Additional sessions of smoking and tobacco cessation counseling and fitness benefits are also covered. However, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and other services are not covered.
Hearing Services See details
Hearing Services include hearing exams with no copay, and routine hearing exams and fitting/evaluation for hearing aids, both of which are limited to once every year and once every three years respectively. Prescription hearing aids (all types) are covered with a maximum benefit of $750 per ear every three years, while inner ear, outer ear, and over the ear prescription hearing aids, and OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear, with routine eye exams covered with no copay, and other eye exam services having a $45 copay. Eyewear includes contact lenses, eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $150 every year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Medicare Plus Blue PPO Essential (PPO) plan covers dental services with a maximum benefit of $1500 per year for both in-network and out-of-network services. Oral exams have a $0-$45 copay, and are limited to 2 per year, and dental x-rays are covered once every two years. Other services such as maxillofacial prosthetics and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the Medicare Plus Blue PPO Essential (PPO) plan, including Medicare Part B Insulin Drugs with a $35 copay and between 0% and 20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with between 0% and 20% coinsurance. Prior authorization is required for this benefit.
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 between 0% and 20%, and Prosthetic Devices and Medical Supplies with a 20% coinsurance. 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 are covered by the Medicare Plus Blue PPO Essential (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, Lab Services have no copay, Diagnostic Radiological Services have a copay between $100 and $150, 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. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Medicare Plus Blue PPO Essential (PPO) plan, but the specific services are not covered. There is a copay for some services, but the exact amount is not specified.
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, there is a $214 copay; additional days beyond Medicare-covered SNF and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items with a maximum benefit of $95 every three months, and Mobile Mental Health with a $20 copay. 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, and Self-Directed Personal Assistance Services are not covered.
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