When shopping for a Preferred Provider Organization (PPO) health plan in Michigan, two of the most prominent names that come up are Blue Cross Blue Shield of Michigan (BCBSM) and Priority Health. Both insurers are well-regarded in the state, but their approaches, network sizes, cost structures, and member benefits can vary significantly. In this detailed comparison, we’ll explore the key features and differences to help you decide which PPO coverage option best suits your needs.
Blue Cross Blue Shield of Michigan (BCBSM)
Background and Network: Blue Cross Blue Shield of Michigan is the largest health insurer in the state, with an extensive network that includes over 33,000 doctors and 152 hospitals. Its long-standing presence in Michigan ensures a wide range of provider choices, making it particularly attractive for those who prioritize access to a large pool of healthcare professionals.
Coverage and Plan Flexibility: BCBSM’s PPO plans allow members to seek care both in-network and out-of-network, giving them flexibility to choose specialists without the need for referrals. While out-of-network care is covered, it typically comes at a higher cost. This level of freedom is ideal for individuals who want to maintain control over their healthcare decisions, especially if they need specialized treatments not available within the network.
Cost Considerations:
- Monthly Premiums: PPO plans from BCBSM tend to have higher premiums compared to more restrictive plans like HMOs, but this is offset by the added flexibility in choosing providers.
- Deductibles and Coinsurance: For example, the State Health Plan PPO includes a $400 individual deductible and a 10% coinsurance rate for most services.
- Out-of-Pocket Maximums: Members face an out-of-pocket maximum of $2,000 for individuals and $4,000 for families. Once this limit is reached, the plan covers 100% of covered services.
- Copayments: Office visit copays are $20, while emergency room visits have a $200 copay, which is waived if the patient is admitted.
Additional Benefits:
- Virtual Care: BCBSM offers telehealth services and a 24-hour nurse line for advice on urgent medical issues.
- Preventive Care: Routine check-ups, screenings, and immunizations are covered in full when using in-network providers.
- Wellness Programs: Members can access wellness tools, health coaching, and fitness incentives through Blue Cross Health & Well-Being.
- Pharmacy Benefits: Prescription drug coverage is robust, often including generic drugs at lower cost-sharing rates.
Priority Health PPO
Background and Network: Priority Health, a Michigan-based nonprofit insurer, is known for its member-centered approach and emphasis on personalized care. While its network is not as large as BCBSM’s, it still covers a significant portion of Michigan’s population, particularly in the Lower Peninsula. Priority Health also offers national access through a partnership with the Cigna Open Access Plus network, making it a strong option for those who frequently travel outside the state or have family members living in other regions.
Coverage and Plan Flexibility: Similar to BCBSM, Priority Health’s PPO plans do not require referrals to see specialists, giving members the freedom to choose their providers. The plans also cover out-of-network care, though at a higher cost, ensuring that members are not restricted to a single set of doctors or hospitals.
Cost Considerations:
- Monthly Premiums: Priority Health’s PPO plans are competitively priced, though exact premiums vary depending on the specific plan and coverage tier.
- Deductibles and Coinsurance: Plans generally offer a range of deductible and coinsurance levels, allowing members to choose the right balance of monthly costs versus out-of-pocket expenses.
- Out-of-Pocket Maximums: Priority Health plans typically include an out-of-pocket maximum to protect members from excessive medical costs.
- Copayments: Members have fixed copays for office visits and urgent care, with specific amounts varying by plan.
Additional Benefits:
- Virtual and Telehealth Services: Priority Health provides 24/7 virtual urgent care, making it easy for members to consult a doctor anytime.
- Preventive Care: Preventive services, including annual physicals, screenings, and vaccines, are fully covered before meeting the deductible.
- Chronic Condition Management: The plan includes programs to help manage chronic conditions such as diabetes or heart disease, providing support for long-term health management.
- Wellness Incentives: Through tools like the Wellbeing Hub, members can track their health goals, access discounted gym memberships, and take advantage of other wellness initiatives.
- Member Tools: Priority Health’s member portal and mobile app offer a user-friendly experience for viewing claims, managing prescriptions, and finding in-network providers.
Side-by-Side Comparison
| Feature | Blue Cross Blue Shield of Michigan (BCBSM) | Priority Health |
| Network Size | Extensive statewide network with over 33,000 providers | Strong Michigan coverage with Cigna partnership for national access |
| Specialist Access | No referral needed | No referral needed |
| Out-of-Network Coverage | Available at higher cost | Available at higher cost |
| Monthly Premiums | Generally higher due to larger network and flexibility | Competitive premiums, with varying deductible levels |
| Deductibles | $400 individual / $800 family (State Health Plan PPO) | Vary by plan; often lower on higher-tier plans |
| Coinsurance | 10% for most services | Vary by plan; typically low for in-network care |
| Out-of-Pocket Maximums | $2,000 individual / $4,000 family | Available, varies by plan |
| Preventive Care | 100% covered in-network | 100% covered in-network before deductible |
| Virtual Care | Telehealth services, 24/7 nurse line | 24/7 virtual urgent care |
| Wellness Programs | Health coaching, fitness incentives | Digital wellness tools, gym discounts |
| Pharmacy Benefits | Comprehensive coverage with lower costs for generics | Comprehensive coverage; details vary by plan |
Choosing the Right Plan
- Select BCBSM PPO if:
- You value the largest network of doctors and hospitals in Michigan.
- You need broad coverage both in-state and nationally.
- You prefer a well-established insurer with decades of experience.
- You value the largest network of doctors and hospitals in Michigan.
- Select Priority Health PPO if:
- You want strong statewide coverage with added national access through Cigna.
- You’re interested in digital wellness tools and virtual care options.
- You’re looking for competitive premiums and plans that include chronic condition management programs.
- You want strong statewide coverage with added national access through Cigna.
Both Blue Cross Blue Shield of Michigan and Priority Health provide high-quality PPO coverage. The best choice depends on your specific healthcare needs, budget, and preference for network size or digital tools. By carefully comparing their features and benefits, you can find the PPO plan that best aligns with your personal healthcare priorities.