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Medicare Plus Blue Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare Plus Blue Value (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 Value (PPO) in 2026, please refer to our full plan details page.
Medicare Plus Blue Value (PPO) is a PPO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2026 to people living in State of Michigan. This plan received an overall rating of 4.5 out of 5 stars in 2026.
It's important to know that Medicare Plus Blue Value (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 Value (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 Value (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 has a $675.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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 Value (PPO) prescription drug plan features an annual drug deductible of $615. For Tier 1 preferred generics, you will pay a low $2 copay for a 1-month supply at preferred pharmacies and mail-order services, or a $7 copay at standard locations. Tier 2 generics cost a $15 copay at preferred pharmacies and mail-order services, or a $20 copay at standard pharmacies for a 1-month fill. Brand-name and specialty medications are subject to coinsurance rather than flat copays under this plan. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 31% coinsurance at both preferred and standard pharmacies. Tier 5 specialty drugs are covered at a 25% coinsurance for a 1-month supply.
Additional Benefits
The Medicare Plus Blue Value (PPO) plan provides comprehensive medical coverage with no coinsurance for many key services, including inpatient hospital stays, outpatient care, and emergency services. You will enjoy no copay and no coinsurance for primary care visits, telehealth services, and home health care. For specialist visits, emergency room care, and outpatient hospital services, you can expect predictable flat copayments and no coinsurance. Preventive care, routine hearing exams, and routine dental cleanings are fully covered under this plan with no copay and no coinsurance. While routine vision exams are covered with low to no copays, please note that corrective eyewear is not covered. For specialized needs, diagnostic services, medical equipment, and skilled nursing facility stays are covered with varying copays or up to twenty percent coinsurance.
Inpatient Hospital See details
Inpatient Hospital services under Medicare Plus Blue Value (PPO) are partially covered with no coinsurance, featuring a daily copay of $430 for days 1 through 7 of acute stays and $330 for days 1 through 7 of psychiatric stays, with no copay for remaining days. Unlimited additional acute days are covered at no copay, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
Medicare Plus Blue Value (PPO) covers outpatient services with no coinsurance, including outpatient hospital services for a $400 copay, observation services for a $130 copay per stay, and ambulatory surgical center services for a $50 copay. Outpatient substance abuse sessions require a $50 copay with no coinsurance, while outpatient blood services are fully covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Medicare Plus Blue Value (PPO) covers partial hospitalization services with a copay of $105.00 and no coinsurance. Prior authorization is required for some of these covered services.
Ambulance and Transportation Services See details
Medicare Plus Blue Value (PPO) covers ground and air ambulance services with a $400 copay and no coinsurance, which is not waived if you are admitted to the hospital. While some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Medicare Plus Blue Value (PPO) covers emergency services with a $130 copay (waived if admitted to the hospital within three days) and urgently needed services with copays ranging from no copay to $50, both featuring no coinsurance. Worldwide emergency, urgent, and transportation services are also covered up to a $50,000 maximum benefit with no coinsurance and copays ranging from $50 to $400.
Primary Care See details
Medicare Plus Blue Value (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist, occupational therapy, psychiatric, and mental health services require a $50 copay and no coinsurance. Physical and speech therapy carry a $65 copay and no coinsurance, podiatry is not covered, and while some chiropractic services are covered, routine and other chiropractic services are not.
Preventive Services See details
Preventive services under Medicare Plus Blue Value (PPO) are partially covered, featuring no copay and no coinsurance for annual physicals, fitness benefits, and screenings, while kidney disease education requires a $25 copay and no coinsurance. Sub-services that are not covered include health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Medicare Plus Blue Value (PPO) hearing services are partially covered, offering one routine hearing exam and fitting evaluation per year with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $495.00 to $1,695.00, but OTC hearing aids as well as inner ear, outer ear, and over the ear prescription aids are not covered.
Vision Services See details
Vision Services covered by Medicare Plus Blue Value (PPO) include one routine eye exam every year with a copay ranging from no copay to $50, no coinsurance, and no deductible, while other eye exams are not covered. Although eyewear is technically listed as covered, it is not covered in practice as contact lenses, eyeglasses, lenses, frames, and upgrades are all excluded from coverage.
Dental Services See details
Dental Services are partially covered by Medicare Plus Blue Value (PPO), offering preventive care such as cleanings, exams, x-rays, and fluoride treatments with no copay and no coinsurance. Medicare-covered dental services have a $0 to $50 copay and no coinsurance, but restorative, endodontics, periodontics, prosthodontics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
Medicare Plus Blue Value (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while covered insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Medicare Plus Blue Value (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare Plus Blue Value (PPO) covers medical equipment, including durable medical equipment, prosthetics, and diabetic supplies, with no copay and prior authorization required. Coinsurance ranges from no coinsurance up to 20% for durable medical equipment and diabetic supplies, while prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts require 20% coinsurance.
Diagnostic and Radiological Services See details
Medicare Plus Blue Value (PPO) covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic tests range from no copay up to $155, lab services carry a $40 copay, outpatient X-rays cost $45, and diagnostic and therapeutic radiological services require minimum copays of $120 and $80, respectively.
Home Health Services See details
Home health services are covered under the Medicare Plus Blue Value (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare Plus Blue Value (PPO) covers Cardiac Rehabilitation Services with no coinsurance; however, while some services are covered, specific programs like cardiac ($40 copay), intensive cardiac ($50 copay), pulmonary ($30 copay), and SET for PAD ($25 copay) rehabilitation are not covered.
Skilled Nursing Facility (SNF) See details
Medicare Plus Blue Value (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other services are partially covered under Medicare Plus Blue Value (PPO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $25 maximum limit every three months via reimbursement. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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