Michigan health plan · 2025

Blue Dental PPO 100/80/50 (50/50/50)-1000 SG · 15560MI0440003

Blue Cross Blue Shield of Michigan offers this marketplace plan (Plan ID 15560MI0440003). Use the modules below to compare premiums, coverage structure, provider access, and formulary context against alternative options in the same market.

Metal level: Low Plan type: PPO CSR: Standard Low Off Exchange Plan Issuer: Blue Cross Blue Shield of Michigan
Telehealth Data pending HSA eligible Check with issuer Dental Adult/Child Vision Not listed

2025 cost summary

Key premiums & cost sharing

Rates mirror the latest CMS import (Tue, 10 Mar 2026 06:40 GMT). Personalize costs with your ZIP, age, and subsidies in the plan finder.

Monthly premium

$16 – $42

Before subsidies

Estimate after subsidies

Deductible

N/A

N/A

See deductible details

Max out-of-pocket

N/A

N/A

Review MOOP rules

Office visits

Primary care See benefits
Specialist See benefits

Drug tiers

Generic See drug coverage
Preferred brand See drug coverage

View formulary tiers

$19 / mo before subsidies

≈ $231 per year before tax credits.

Start with this unsubsidized premium, then apply marketplace tax credits to see your final monthly payment.

  • Ideal for shoppers comparing Bronze vs. Silver budgets.
  • Update your Marketplace application to apply premium tax credits.

$69 / mo before subsidies

≈ $829 per year before tax credits.

Pre-subsidy rate for a couple with one dependent. Switch to Silver CSR plans if you qualify to reduce these numbers.

  • Compares well against PPO vs HMO networks when planning for childcare and telehealth needs.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$98 / mo before subsidies

≈ $1175 per year before tax credits.

Pairs with cost-sharing reductions (CSR) when you select a Silver tier and qualify based on income.

  • Use this estimate before adding childcare, dental, or vision extras.
  • CSR Silver variants can lower deductibles dramatically for eligible incomes.
  • CSR savings require a Silver variant. Use the plan finder to load Silver options if you need lower deductibles.

$43 / mo before subsidies

≈ $520 per year before tax credits.

Shows the combined pre-subsidy rate for two adults. Add dependents or subsidies in your application to refine it.

  • Great for households deciding between PPO and HMO networks.
  • Telehealth and HSA perks (when offered) apply to both members.
Issuer profile See benefits
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Enrollment guidance

Stay on top of 2025 ACA deadlines

Open Enrollment window

Marketplace enrollment for 2025 coverage typically runs Nov 1 – Jan 15 (dates may vary slightly in Michigan). Submit changes before the deadline to avoid a coverage gap.

  • Enroll by Dec 15 for Jan 1 starts.
  • Finalize plan switches before the window closes.

Special Enrollment Periods

You can change plans mid-year if you experience a qualifying life event (move, childbirth, marriage, loss of other coverage).

  • Report the event within 60 days.
  • Keep documentation handy for Healthcare.gov or your state exchange.

CSR & subsidy reminders

Premium tax credits and cost-sharing reductions (CSR) update annually when you re-submit your marketplace application.

  • Enter accurate income to maximize Advanced Premium Tax Credits.
  • Standard Low Off Exchange Plan plans like this one keep deductibles and copays lower if you qualify.

Thinking about switching?

Before you leave your current plan, compare networks, drug coverage, and total cost using the cards on this page.

  • Match provider networks so ongoing care isn’t disrupted.
  • Confirm prescriptions stay on-formulary or budget for tier changes.

Premium snapshot

Plan identifiers & filings

Track the official identifiers, documents, and filing dates tied to this plan. Open the marketing or formulary links whenever you need the latest PDF from the issuer.

Plan ID 15560MI0440003
Coverage year 2025
State Michigan
Issuer Blue Cross Blue Shield of Michigan
Variant ID 15560MI0440003-00
Available variants

Standard Off Exchange Plan · 15560MI0440003-00
Last plan update Wed, 14 Aug 2024 00:00 GMT
Last HealthPorta import Tue, 10 Mar 2026 06:40 GMT

Network stats

Provider access snapshot

Review the network branding plus the number of in-network clinicians we track from issuer filings. Counts update with each CMS import (Tue, 10 Mar 2026 06:40 GMT).

All providers in Michigan N/A
PCPs in Michigan N/A
Telehealth support Data pending
Nationwide providers N/A
N/A doctors statewide N/A PCPs N/A OB/GYN

Provider network(s)

['MIN003']

Providers Michigan All US states
All N/A N/A
PCP N/A N/A
Allergy N/A N/A
OB/GYN N/A N/A
Dentists N/A N/A

Drug coverage overview

0 drugs tracked

Inspect tier distribution plus authorization, step therapy, and quantity-limit counts sourced from HealthPorta’s formulary import.

Prior authorization Drugs
Required 0
Not Required 0
Step therapy Drugs
Required 0
Not Required 0
Quantity limits Drugs
Has Limit 0
No Limit 0

Customer highlights

What stands out for members

  • Issuer: Blue Cross Blue Shield of Michigan · Plan ID 15560MI0440003 · 2025 filing.
  • Variant 15560MI0440003-00 (Standard Off Exchange Plan) currently displayed.
  • Use the cards on this page to explore network stats, drug coverage, and cost-sharing details.
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Benefits

Covered services & limitations

Pregnancy & family

Maternity, newborn, pediatric dental and vision extras.

Basic Dental Care - Child

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Procedure(s) per 2 Years

Scaling and root planing - 1x per quadrant, per 24 months. Fillings - 1x per 24 months for primary teeth, 1x per 48 months for permanent teeth. Periodontal maintenance - 3x per calendar year in combination with routine prohylaxis (cleaning). Root canals - 1x per lifetime per tooth. Simple and surgical extractions - 1x per lifetime. Pediatric members are defined as members age 18 or younger when their coverage begins.

Exclusions: nan

Major Dental Care - Child

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Procedure(s) per 3 Years

Covered Periodontal surgery services - 1x every 36 months per quadrant. Onlays, crowns, veneers - 1x every 60 months. Bridges and dentures - 1x every 84 months. Pediatric members are defined as members age 18 or younger when their coverage begins.

Exclusions: Implants are not covered.

Wellness & extras

Vision, dental, therapies, prosthetics, weight management.

Accidental Dental

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Emergency palliative treatment for temporary pain relief

Exclusions: 6-month waiting period waived for emergency palliative treatment. Benefit only applies to MOOP for pediatric members. Pediatric members are defined as members age 18 or younger when their coverage begins.

Basic Dental Care - Adult

20.00% Coinsurance after deductible
Tier 1 in-network 20.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Procedure(s) per 3 Years

Scaling and root planing - 1x per quadrant, per 36 months. Fillings - 1x per 24 months for primary teeth, 1x per 48 months for permanent teeth. Periodontal maintenance - 2x per calendar year in combination with routine prohylaxis (cleaning). Root canals - 1x per lifetime per tooth. Simple and surgical extractions - 1x per lifetime. Members age 19 or older when their coverage begins are considered non-pediatric.

Exclusions: nan

Dental Check-Up for Children

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00%

Limit: 3.0 Procedure(s) per Year

Prophylaxis (Cleaning) - 3x per calendar year. Exams - 2x per calendar year. Bitewing X-rays - One set (up to 4) per calendar year. Fluoride - 2x per calendar year. Sealants - 1x per permanent molars, every 3 years. Pediatric members are defined as members age 18 or younger when their coverage begins.

Exclusions: nan

Major Dental Care - Adult

50.00% Coinsurance after deductible
Tier 1 in-network 50.00% Coinsurance after deductible
Out-of-network 50.00% Coinsurance after deductible

Limit: 1.0 Procedure(s) per 3 Years

Covered Periodontal surgery services - 1x every 36 months per quadrant. Onlays, crowns, veneers - 1x every 60 months. Bridges and dentures - 1x every 84 months. Implants - 1x per tooth, per lifetime, excluding 3rd molars. Members age 19 or older when their coverage begins are considered non-pediatric.

Exclusions: nan

Orthodontia - Adult

Coverage details pending

nan

Exclusions: nan

Orthodontia - Child

Coverage details pending

nan

Exclusions: nan

Routine Dental Services (Adult)

No Charge
Tier 1 in-network No Charge
Out-of-network 50.00%

Limit: 2.0 Procedure(s) per Year

Prophylaxis (Cleaning)- 2x per calendar year. Exams - 2x per calendar year. Bitewing X-rays - One set (up to 4) per calendar year. Fluoride - not covered. Sealants - not covered. Members age 19 or older when their coverage begins are considered non-pediatric.

Exclusions: nan

Variant attributes

Blue Dental PPO 100/80/50 (50/50/50)-1000 SG · Variant 15560MI0440003-00

Plan identifiers & tier

Issuer-provided metadata for this variant.

Business Year

2025

CSR Variation Type

Standard Low Off Exchange Plan

HIOS Product ID

15560MI044

Metal Level

Low

Plan ID (Standard Component ID with Variant)

15560MI0440003-00

Plan Marketing Name

Blue Dental PPO 100/80/50 (50/50/50)-1000 SG

Plan Variant Marketing Name

Blue Dental PPO 100/80/50 (50/50/50)-1000 SG

Issuer & service area

Issuer-provided metadata for this variant.

Issuer ID

15560

Issuer Marketplace Marketing Name

Blue Cross Blue Shield of Michigan Mutual Insurance Company

Market Coverage

SHOP (Small Group)

Multiple In Network Tiers

No

National Network

Yes

Network ID

MIN003

Out of Country Coverage

Yes

Out of Country Coverage Description

Emergency

Out of Service Area Coverage

Yes

Out of Service Area Coverage Description

Any licensed dentist in the US can participate in the Tier 2 par per claim Blue Par Select arrangement. Similar to PPO, dentists accept Blue Cross' approved amount for covered services as payment in full, less deductible or any coinsurance.

Service Area ID

MIS009

State Code

MI

Cost sharing & actuarial values

Issuer-provided metadata for this variant.

Begin Primary Care Deductible Coinsurance After Number Of Copays

0

Inpatient Copayment Maximum Days

0

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Group

$850 per group

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out Network, Family Per Person

$425 per person

Maximum Out of Pocket for Medical EHB Benefits, Combined In/Out

$425

Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Group

$850 per group

Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Family Per Person

$425 per person

Maximum Out of Pocket for Medical EHB Benefits, In Network (Tier 1), Individual

$425

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Group

per group not applicable

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Family Per Person

per person not applicable

Maximum Out of Pocket for Medical EHB Benefits, Out of Network, Individual

Not Applicable

Additional attributes

Issuer-provided metadata for this variant.

Begin Primary Care Cost-Sharing After Number Of Visits

0

Child-Only Offering

Allows Adult and Child-Only

Composite Rating Offered

No

Dental Only Plan

Yes

First Tier Utilization

100%

Import Date

2024-08-14 20:01:41

Guaranteed Rate

Guaranteed Rate

New/Existing Plan

Existing

Medical EHB Deductible, Combined In/Out of Network, Family Per Group

$150 per group

Medical EHB Deductible, Combined In/Out of Network, Family Per Person

$50 per person

Medical EHB Deductible, Combined In/Out of Network, Individual

$50

Medical EHB Deductible, In Network (Tier 1), Family Per Group

$75 per group

Medical EHB Deductible, In Network (Tier 1), Family Per Person

$25 per person

Medical EHB Deductible, In Network (Tier 1), Individual

$25

Medical EHB Deductible, Out of Network, Family Per Group

$150 per group

Medical EHB Deductible, Out of Network, Family Per Person

$50 per person

Medical EHB Deductible, Out of Network, Individual

$50

Plan Effective Date

2025-01-01

Plan Level Exclusions

$1,000 annual benefit maximum for members age 19 or older when coverage begins.

Plan Type

PPO

QHP/Non QHP

Off the Exchange

Source Name

SERFF

Plan ID

15560MI0440003

Copay & coinsurance

Pharmacy cost sharing by tier

Drug tier Pharmacy type Copay amount Copay option Coinsurance rate Coinsurance option Mail order

Questions & answers

Frequently asked questions

How do I choose the right ACA plan in Michigan?

Blue Dental PPO 100/80/50 (50/50/50)-1000 SG (15560MI0440003) is a Low PPO from Blue Cross Blue Shield of Michigan in Michigan for the 2025 coverage year.

Compare it against other options with the HealthPorta plan finder to confirm premiums, deductibles, and network access fit your household.

Does Blue Dental PPO 100/80/50 (50/50/50)-1000 SG support telehealth or virtual urgent care?

The issuer has not published telehealth details yet. Review the Summary of Benefits and Coverage to confirm if virtual visits are included.

Is Blue Dental PPO 100/80/50 (50/50/50)-1000 SG HSA-eligible and does it include dental or vision coverage?

HSA eligibility is not published; check the Summary of Benefits or ask the issuer.

Dental add-ons: Adult, Child.

Vision coverage is not listed for this plan.

Does Blue Dental PPO 100/80/50 (50/50/50)-1000 SG support mail-order prescriptions?

Mail order coverage is not listed for this plan, so confirm with the issuer before relying on home delivery.

Is there out-of-country coverage for Blue Dental PPO 100/80/50 (50/50/50)-1000 SG?

Yes, limited out-of-country coverage is available. Review the Summary of Benefits for reimbursement steps. Details: Emergency

Does Blue Dental PPO 100/80/50 (50/50/50)-1000 SG cover care outside the service area?

Yes, you have limited out-of-area coverage. See the plan documents for referral and prior authorization rules. Details: Any licensed dentist in the US can participate in the Tier 2 par per claim Blue Par Select arrangement. Similar to PPO, dentists accept Blue Cross' approved amount for covered services as payment in full, less deductible or any coinsurance.

How do I enroll in or manage payments for Blue Dental PPO 100/80/50 (50/50/50)-1000 SG?

Use HealthPorta to shortlist plans, then finish enrollment through Healthcare.gov or your state-based marketplace.

Disclaimer: Based on the Tue, 10 Mar 2026 06:40 GMT HealthPorta import from CMS issuer filings. Data is best-effort and should be validated with the issuer directly. Sources: CMS.gov and the HealthPorta Healthcare MRF API.
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