Medicare Plus Blue Group PPO offers comprehensive health coverage through a group plan sponsor. Medicare Plus Blue Group combines Original Medicare Part A (hospital) and Part B (medical) coverage and expands your coverage to include additional preventive services and much more. (Some group plans may also include Medicare Part D prescription drug coverage.*)
With Medicare Plus Blue Group PPO, you'll get:
- Freedom to choose any doctor or hospital that accepts Original Medicare
- Lower out-of-pocket costs when you receive services from a doctor or hospital in our network
- Nationwide coverage
- No referrals needed to see specialists
- Virtually no paperwork
- One ID card for health services
- Groups have the option of adding benefits not covered by original Medicare. For more information, please contact us.
Our benefits include:
- Preventive tests and physical exams
- More preventive services with no cost share
- Office visits
- Outpatient surgery and services
- Lab and radiology services
- Home health care
- Chiropractic services
- Prostate cancer screening exams
- Ambulance services
- Medicare Part D prescription drug coverage (for some group plans)*
Limitations and cost-sharing may apply. Consult your Evidence of Coverage for specific information about your benefits and cost-sharing responsibilities or contact us.
In addition to our medical and prescription drug plans, Medicare Plus Blue Group PPO offers members a variety of programs designed to promote good health, safety and savings.
* Not all Medicare Plus Blue Group PPO plans provide Medicare Part D prescription drug coverage. If you are unsure whether your plan includes Medicare Part D prescription drug coverage, please contact your plan benefit administrator.
Other Helpful Information
Find a network provider
You can go to any doctor or hospital that accepts your Medicare Plus Blue Group PPO ID card. And, if you choose to see doctors and hospitals in our network, you'll minimize your out-of-pocket costs. To find a network provider in the state of Michigan:
- Use our online provider directory search
Care outside of Michigan
If you need medical care outside of the state of Michigan, you may obtain care from any provider that accepts Medicare. If you receive services outside the state of Michigan, in-network cost sharing will apply for all medical services (except durable medical equipment, prosthetics and orthotics). To locate a provider outside the state of Michigan, please call Member Services at 1-866-684-8216 from 8:30 a.m. to 5 p.m. Eastern time Monday through Friday. TTY users should call 1-800-579-0235.
Part D Prescription Drug coverage
If you are unsure whether your plan includes Medicare Part D prescription drug coverage, please contact your plan benefit administrator.
Formularies and Pharmacy Services
- Group Comprehensive Formulary (PDF)
- Group Enhanced Comprehensive Formulary (PDF)
- Group Formulary Updates (PDF) (coming soon)
- Group Essential, Vitality, Signature Comprehensive Formulary (PDF)
- Group Essential, Vitality, Signature Comprehensive Formulary Updates (PDF) (coming soon)
- Group Assure Comprehensive Formulary (PDF)
- Group Assure Comprehensive Formulary Updates (PDF) (coming soon)
- Group PPO/PDP Pharmacy Directory (PDF)
- Mail-Order Pharmacy Services
- Utilization Management
- Medication Therapy Management Program
- Claims Forms
- Part D prescription drug transition policy
- Grievances and Appeals processes
- Prescription Drug Determination Request (PDF)
Blue Cross Blue Shield of Michigan provides a transition process that allows members to receive a temporary supply of non-formulary drugs or to request a formulary exception on the grounds of medical necessity. Click here for more information about our Transition Policy.