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Medicare PPO Blue ValueRx (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Medicare PPO Blue ValueRx (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Medicare PPO Blue ValueRx (PPO) in 2025, please refer to our full plan details page.
Medicare PPO Blue ValueRx (PPO) is a PPO plan offered by Blue Cross and Blue Shield of Massachusetts, Inc. available for enrollment in 2025 to people living in Massachusetts except Berkshire Dukes and Nantucket. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that Medicare PPO Blue ValueRx (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 PPO Blue ValueRx (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 PPO Blue ValueRx (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $87.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $10000.00 (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 $10000.00 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 PPO Blue ValueRx (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $6 copay at preferred pharmacies and a $12 copay at standard pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase and pay nothing for covered Part D drugs. This plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The Medicare PPO Blue ValueRx (PPO) plan offers coverage for a variety of services with varying costs. Inpatient hospital stays require a copay, while outpatient services have copays depending on the specific service. Emergency services and primary care visits have copays, and preventive services are covered. The plan also includes benefits for hearing, vision, and dental services, with specific copays and maximum benefits. Other services like home health, skilled nursing, and home infusion are covered with copays or coinsurance. Additionally, the plan covers ambulance services, cardiac rehabilitation services, dialysis services, and medical equipment, each with its own cost structure.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $320 copay for days 1-7, and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you pay a $275 copay for days 1-5, and no copay for days 6-90.
Outpatient Services See details
Outpatient services are covered by the Medicare PPO Blue ValueRx (PPO) plan, including outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient hospital services have a $300 copay, observation services have a $250 copay, and ambulatory surgical center services have a $200 copay. Both individual and group sessions for outpatient substance abuse have a copay between $30 and $30, and outpatient blood services have a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare PPO Blue ValueRx (PPO) plan, but requires prior authorization. The copay for this benefit is $55.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the Medicare PPO Blue ValueRx (PPO) plan. Ground and Air Ambulance Services have a $325 copay, with no coinsurance, and Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the Medicare PPO Blue ValueRx (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a copay between $0 and $50, and Worldwide Emergency Services have a $90 copay for Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation.
Primary Care See details
The Medicare PPO Blue ValueRx (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $20 copay, physician specialist services with a copay between $0 and $40, mental health specialty services, other health care professional services with a copay between $0 and $40, psychiatric services, physical therapy and speech-language pathology services with a $20 copay, additional telehealth benefits with a copay between $0 and $40, and opioid treatment program services. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, including Medicare-covered preventive services with prior authorization, annual physical exams, and additional preventive services. Some services, like in-home safety assessments, personal emergency response systems, and medical nutrition therapy, are not covered.
Hearing Services See details
Hearing Services include routine hearing exams with no copay for one exam per year and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are covered with a copay between $699 and $999 for two hearing aids per year, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
The Medicare PPO Blue ValueRx (PPO) plan covers vision services including eye exams with a copay between $0 and $40, and eyewear including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, with a combined maximum benefit of $200 every two years. Upgrades are not covered.
Dental Services See details
The Medicare PPO Blue ValueRx (PPO) plan covers dental services, including oral exams with a $40 copay, and other diagnostic services, with an annual maximum benefit of $1,000. Restorative, adjunctive general, endodontics, periodontics, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and oral and maxillofacial surgery are covered with 50% coinsurance. Fluoride treatment and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered with prior authorization. Insulin has a $35 copay with 0-20% coinsurance, while other drugs have 0-20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the Medicare PPO Blue ValueRx (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits are covered under the Medicare PPO Blue ValueRx (PPO) plan, including Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices and Medical Supplies with 20% coinsurance. The plan does not cover Durable Medical Equipment for use outside the home and Diabetic Supplies/Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the Medicare PPO Blue ValueRx (PPO) plan. Diagnostic procedures/tests and lab services are not covered, while diagnostic radiological services have a copay of at most $250.00, and outpatient X-ray services have a copay of $10.00.
Home Health Services See details
Home Health Services are covered with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the Medicare PPO Blue ValueRx (PPO) plan, but the plan does not cover the specific services of Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services. The copay for these services is listed separately.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medicare PPO Blue ValueRx (PPO), but require prior authorization. You will have no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services includes a Meal Benefit for chronic illness, while 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. This plan does not require authorization or referral for additional services.
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