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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. In the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, while preferred brand drugs have 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. Those who qualify for the low-income subsidy (LIS) will pay $0 for Part D drugs.
Additional Benefits
The Medicare Plus Blue PPO Part B Credit (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services and ambulatory surgical center services have copays. Emergency services and primary care visits often have copays, while preventive services, hearing exams, and routine vision exams have no copay. This plan also covers hearing aids, vision eyewear, and dental services, with specific limits on coverage. The plan includes benefits for ambulance, home health, and skilled nursing facility services, as well as medical equipment. Home infusion bundled services and dialysis have coinsurance requirements.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $375 copay for days 1-7, and no copay for days 8-90; for Inpatient Hospital Psychiatric, you pay a $290 copay for days 1-7, and no copay for days 8-90. Additional days and upgrades for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered, and non-Medicare-covered stays are not covered.
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 (ASC) Services have a $300 copay. Outpatient substance abuse individual and group sessions have a copay between $55 and $55.
Partial Hospitalization See details
Partial hospitalization is covered under the Medicare Plus Blue PPO Part B Credit (PPO) plan, but requires prior authorization. You will pay a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Medicare Plus Blue PPO Part B Credit (PPO) plan. Ground and air ambulance services have a $360 copay, with no coinsurance, 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. Emergency Services have a $110 copay and no coinsurance, Urgently Needed Services have a $0 - $45 copay and no coinsurance, and Worldwide Emergency Coverage has a $110 copay, Worldwide Urgent Coverage has a $45 copay, and Worldwide Emergency Transportation has a $360 copay; all have no coinsurance.
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, mental health specialty services with a $40 copay for individual and group sessions, physical therapy and speech-language pathology services with a $40 copay, and opioid treatment program services with a $40 copay. Other health care professional services are covered with a copay between $0 and $55. Psychiatric services are covered with a $40 copay for individual and group sessions. Podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and other preventive services, are covered. Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefits (Memory Fitness), Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit are covered. Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing services include hearing exams with no copay, and prescription hearing aids with a maximum benefit of $600 every three years for both in-network and out-of-network services; however, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered. Routine hearing exams are limited to 1 visit every year, and fitting/evaluation for hearing aids is limited to 1 visit every three years.
Vision Services See details
Vision services include eye exams, with routine eye exams costing no copay and other eye exam services costing a $55 copay. Eyewear includes a $100 combined maximum benefit per year for contact lenses and eyeglass frames, with eyeglass lenses covered, but eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a maximum benefit of $1,000 per year. Oral exams have a copay between $0 and $55, and there are 2 visits per year, while dental x-rays, prophylaxis (cleaning), fluoride treatment, and oral and maxillofacial surgery are covered, with varying limits on the number of visits and specific details. Maxillofacial prosthetics and orthodontics are not covered, and other services like restorative services, endodontics, and periodontics have limitations on the number of services covered. Adjunctive general services, implant services, prosthodontics (removable and fixed) are offered as optional, supplemental benefits.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with 0-20% coinsurance. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the Medicare Plus Blue PPO Part B Credit (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance and Prosthetics/Medical Supplies with no copay and 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, with prior authorization required for all services. Diagnostic Procedures/Tests have a copay ranging from $0 to $150, Lab Services have no copay, Diagnostic Radiological Services have a copay of at most $325, Therapeutic Radiological Services have a copay of at most $45, and Outpatient X-Ray Services have a $35 copay.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the Medicare Plus Blue PPO Part B Credit (PPO) plan. Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the Medicare Plus Blue PPO Part B Credit (PPO) plan. There is no copay for days 1-20, but there is a $214 copay for days 21-100; additional and non-Medicare-covered SNF stays are not covered.
Other Services See details
Other Services for Medicare Plus Blue PPO Part B Credit (PPO) includes coverage for Meal Benefits and Other 2, but 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. Other 2 has a copay of $90.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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