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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'll pay a copay for generic drugs, which ranges from $10 to $20 depending on the pharmacy. For preferred brand and non-preferred drugs, you'll pay coinsurance of 50% and 33%, respectively. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The Medicare Plus Blue PPO Part B Credit (PPO) plan offers a variety of benefits, including coverage for inpatient hospital stays with copays ranging from $290-$375 depending on the type of care, and no copay for days 8-90. Outpatient services, ambulance services, and emergency services are also covered with varying copays. The plan provides no copay for primary care physician services, routine eye exams, and home health services, while also covering hearing and vision services with copays. This plan also covers dental services, diagnostic and radiological services, and skilled nursing facility (SNF) services with some cost-sharing. Additionally, the plan offers coverage for home infusion bundled services, dialysis services, and medical equipment. While it offers many benefits, it's important to note that certain services like cardiac rehabilitation, private duty nursing, and some other services have limited or no coverage.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric care. For Inpatient Hospital-Acute, you'll pay a $375 copay for days 1-7 and no copay for days 8-90, while additional days are covered with no copay; non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you'll pay a $290 copay for days 1-7 and no copay for days 8-90, with additional days and non-Medicare-covered stays not covered.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a $350 copay, observation services, ambulatory surgical center services with a $300 copay, outpatient substance abuse services with a $55 copay for both individual and group sessions, and outpatient blood services with a waived three-pint deductible. Prior authorization is required for outpatient hospital services and ambulatory surgical center services.
Partial Hospitalization See details
Partial Hospitalization is covered with a $55 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by Medicare Plus Blue PPO Part B Credit (PPO), with no coinsurance. Ground and air ambulance services have a $360 copay, while transportation services to any health-related location are covered for one round trip per year, with no cost sharing. 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. 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
Primary Care Physician Services are covered with no copay, and Chiropractic Services are covered with a $15 copay. Occupational Therapy, Physician Specialist Services, Physical Therapy and Speech-Language Pathology Services, and Psychiatric Services have copays of $35, $55, $40, and $40, respectively. Individual and Group Sessions for Mental Health Specialty Services, and Individual and Group Sessions for Psychiatric Services all have a $40 copay. Other Health Care Professional services have a copay between $0 and $55, and Opioid Treatment Program Services have a $40 copay.
Preventive Services See details
Preventive Services, including Medicare-covered preventive services, annual physical exams, and other services, are covered by this plan, while specific services such as health education, in-home safety assessments, and several others are not covered. Additional sessions of smoking and tobacco cessation counseling, fitness benefits, remote access technologies, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a Welcome Visit are covered.
Hearing Services See details
Hearing Services include routine hearing exams with a maximum copay of $55, and fitting/evaluation for hearing aids with a maximum copay of $0. Prescription hearing aids are covered up to $600 per ear every three years, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams with no copay, and other eye exam services with a $55 copay. Eyewear includes a $100 maximum benefit per year for frames or elective contact lenses, and contact lenses and eyeglass lenses are covered. Eyeglasses (lenses and frames) and upgrades are not covered.
Dental Services See details
The Medicare Plus Blue PPO Part B Credit (PPO) plan covers dental services, including oral exams with a copay of $0-$55, dental x-rays, prophylaxis (cleaning), fluoride treatment, restorative services, endodontics, periodontics, and oral and maxillofacial surgery. Maxillofacial prosthetics and orthodontics are not covered, and some services like implant services, prosthodontics, and fixed/removable services are 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 and between 0% and 20% coinsurance, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by 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 a coinsurance between 0% and 20%, and Prosthetic Devices and Medical Supplies with a 20% coinsurance. Durable Medical Equipment for use outside the home, and 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 Part B Credit (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, Lab Services have no copay, Diagnostic Radiological Services have a copay between $150 and $325, Therapeutic Radiological Services have a copay of $45, 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 or 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 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.
Other Services See details
Other Services are partially covered under the Medicare Plus Blue PPO Part B Credit (PPO) plan. Acupuncture, Over-the-Counter (OTC) Items, Meal Benefit, 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 services have a $90 copay.
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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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