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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 your prescriptions, which varies based on the drug tier and whether you use a preferred or standard pharmacy. For example, preferred generic drugs have a $10 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for your Part D covered drugs. This plan may also reduce your premium if you qualify for the low-income subsidy (LIS).
Additional Benefits
The Medicare Plus Blue PPO Part B Credit (PPO) plan offers a range of benefits with varying cost-sharing. You'll find no copays for primary care, preventive services, hearing exams, oral exams, home health services, and skilled nursing facility days 1-20. Other services include copays for hospital stays, outpatient services, specialist visits, and more. The plan also covers vision and dental services, with copays for eye exams and a maximum annual dental benefit of $1,000. Emergency and ambulance services have copays, and you'll also encounter coinsurance for dialysis, medical equipment, and certain drugs.
Inpatient Hospital See details
Inpatient Hospital coverage includes Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both requiring prior authorization. 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. 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 include coverage for all 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 individual and group sessions, and outpatient blood services. This plan waives the three-pint deductible for outpatient blood services.
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 have a $55 copay for this benefit.
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 each have a $360 copay, and there is no coinsurance. Transportation Services to a Plan Approved Health-related Location are covered for 28 days. Transportation Services to any other Health-related Location are not covered.
Emergency Services See details
Emergency Services are covered by the Medicare Plus Blue PPO Part B Credit (PPO) plan. Emergency Services have a $110 copay, while Urgently Needed Services have a copay between $0 and $45, and Worldwide Emergency Services have a $110, $45, and $360 copay depending on the service.
Primary Care See details
The Medicare Plus Blue PPO Part B Credit (PPO) plan covers primary care physician services with no copay. Chiropractic services have a $15 copay, with routine care at a $55 copay and other chiropractic services at a $35 copay. Occupational therapy services have a $35 copay, while physician specialist services have a $55 copay. Mental health specialty services, including individual and group sessions, have a $40 copay. Physical therapy and speech-language pathology services have a $40 copay. Other health care professional services have a copay between $0 and $55. Psychiatric services, including individual and group sessions, have a $40 copay. Opioid treatment program services also have a $40 copay.
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 more are not covered.
Hearing Services See details
The Medicare Plus Blue PPO Part B Credit (PPO) plan covers hearing exams with no copay, as well as routine hearing exams (1 every year) and fitting/evaluation for hearing aids (1 every three years). Prescription hearing aids (all types) are covered with a maximum benefit of $600 per ear every three years, however, prescription hearing aids for inner ear, outer ear, and over the ear are not covered. OTC hearing aids 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 eyeglass frames, with a combined maximum benefit of $100 per year for frames or elective contact lenses.
Dental Services See details
Dental services are covered, with a maximum benefit of $1,000 per year. Oral exams have no copay, with a limit of 2 per year, while dental x-rays are limited to 1 and prophylaxis (cleaning) and fluoride treatments are limited to 2 and 1, respectively, per year, with no copay.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is 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. You will pay a coinsurance of 20% for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20%, Prosthetic Devices with a 20% coinsurance, and Medical Supplies with a 20% coinsurance; however, 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 under the Medicare Plus Blue PPO Part B Credit (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $150, while 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 copay of $35.
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 prior 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. Specifically, 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 for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services for the Medicare Plus Blue PPO Part B Credit (PPO) plan includes coverage for a meal benefit, with no copay and no coinsurance, and other services, including mobile mental health with a $40 copay, and ambulance (no transport) 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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