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Medicare Plus Blue PPO Part B Credit (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue PPO Part B Credit (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 Part B Credit (PPO) in 2025, please refer to our full plan details page.
Medicare Plus Blue PPO Part B Credit (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 Part B Credit (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 Part B Credit (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 Part B Credit (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 $102.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan has a $600.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
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 $9000.00 (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 $9000.00 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 Part B Credit (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for each prescription, which varies depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the coverage gap. After your yearly out-of-pocket drug costs reach $2,000, you pay nothing for Medicare Part D covered drugs.
Additional Benefits
The Medicare Plus Blue PPO Part B Credit (PPO) plan offers a range of benefits, including inpatient hospital stays with copays, and outpatient services with copays for various services. This plan also covers emergency services, primary care, preventive services, hearing, vision, and dental services, each with specific copays or coverage limits. Additional benefits include ambulance services, home health services, and skilled nursing facility stays, with varying cost-sharing structures. Diagnostic and radiological services are covered with copays, while medical equipment and dialysis services are covered with coinsurance. However, certain services like cardiac rehabilitation and some transportation options are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits for the Medicare Plus Blue PPO Part B Credit (PPO) plan include coverage for Inpatient Hospital-Acute with a $375 copay for days 1-7, and no copay for days 8-90; and Inpatient Hospital Psychiatric with a $290 copay for days 1-7, and no copay for days 8-90. Additional days for Inpatient Hospital-Acute are covered with no copay, but Non-Medicare-covered stay and Upgrades for Inpatient Hospital-Acute are not covered, as are Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services are covered. Outpatient hospital services have a $350 copay, and ambulatory surgical center services have a $300 copay. Individual and group outpatient substance abuse sessions have a copay between $55 and $55.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare Plus Blue PPO Part B Credit (PPO) plan, with a $55 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the Medicare Plus Blue PPO Part B Credit (PPO) plan. Ground and air ambulance services have a copay of $360, with no coinsurance, while transportation services to a plan-approved health-related location are not covered, and 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 by the plan. Emergency Services and Worldwide Emergency Coverage have a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $360 copay.
Primary Care See details
The Medicare Plus Blue PPO Part B Credit (PPO) plan covers primary care physician services with no copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $55 copay, and mental health specialty services with a $40 copay for individual and group sessions. This plan also covers physical therapy and speech-language pathology services with a $40 copay, and opioid treatment program services with a $40 copay. Additionally, telehealth services are covered. Podiatry services are not covered.
Preventive Services See details
The Medicare Plus Blue PPO Part B Credit (PPO) plan covers preventive services, including annual physical exams, with no copay. Additional services like health education, in-home safety assessments, and others are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams with no copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered up to $600 per ear every three years, while OTC hearing aids, and prescription hearing aids for the inner and outer ear are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Routine eye exams have no copay, while other eye exam services have a $55 copay. Eyewear includes contact lenses, eyeglass lenses, and frames, with a combined maximum benefit of $100 every year; eyeglass lenses and frames are available every year. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1000 per year. Oral exams have a copay between $0 and $55, and Dental X-Rays, Prophylaxis (Cleaning), Fluoride Treatment, Restorative Services, Endodontics, Periodontics, and Oral and Maxillofacial Surgery are covered with varying limitations. Maxillofacial Prosthetics and Orthodontics are not covered, and some services are offered as optional supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Part B Credit (PPO) plan. The coinsurance for dialysis services is 20%.
Medical Equipment See details
Medical equipment is covered by the Medicare Plus Blue PPO Part B Credit (PPO) plan, including durable medical equipment with a coinsurance between 0% and 20%, and prosthetics and medical supplies with a 20% coinsurance. Durable medical equipment for use outside the home, and diabetic supplies and therapeutic shoes/inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $150, while Lab Services have no copay. Diagnostic Radiological Services have a minimum copay of $150 and a maximum copay of $325, Therapeutic Radiological Services have a $45 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 Part B Credit (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medicare Plus Blue PPO Part B Credit (PPO) plan. Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are also not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Medicare Plus Blue PPO Part B Credit (PPO) plan, with a $0 copay for days 1-20 and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered stays for Skilled Nursing Facility (SNF) are not covered.
Other Services See details
Other Services include coverage for a meal benefit, and other services such as mobile mental health services with a $40 copay, and ambulance (no transport) services with a $90 copay. Acupuncture, over-the-counter items, 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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