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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 2026, 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 4.5 out of 5 stars in 2026.
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 $108.00. 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 features a $0 drug deductible, allowing your prescription coverage to begin immediately. Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through standard mail order, while standard pharmacies charge an $8 copay for a one-month supply. Tier 2 generic drugs cost a $6 copay for a one-month supply at preferred pharmacies and standard mail order, or a $12 copay at standard pharmacies. Brand-name and specialty medications under this plan are subject to coinsurance rather than flat copays. Tier 3 preferred brands require a 20% coinsurance, while Tier 4 non-preferred drugs have a 39% coinsurance across all pharmacy options. Tier 5 specialty drugs are covered with a 33% coinsurance for a one-month supply at preferred, standard, and standard mail-order pharmacies.
Additional Benefits
The Medicare PPO Blue ValueRx (PPO) plan offers comprehensive coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for preventive care and primary care visits. Specialist visits require a copay ranging from $0 to $45, while emergency room care has a $130 copay that is waived if you are admitted. For inpatient hospital stays, members pay a daily copay of $433 for the first seven days and no copay for additional days, with no coinsurance required. Additionally, the plan provides robust routine benefits, including no copays for routine hearing exams and a $200 eyewear allowance every two years. Preventive dental services like cleanings are covered with no copay up to a $500 annual limit, while restorative dental services require a 50% coinsurance. Home health services are also fully covered with no copay and no coinsurance, helping you manage your health needs affordably.
Inpatient Hospital See details
Inpatient hospital care is covered by Medicare PPO Blue ValueRx (PPO) with no coinsurance, though prior authorization is required and non-Medicare-covered stays or upgrades are not covered. For acute hospital stays, there is a $433 daily copay for days 1 through 7 and no copay for days 8 and beyond, while psychiatric stays require a $275 daily copay for days 1 through 5 and no copay for subsequent days.
Outpatient Services See details
Medicare PPO Blue ValueRx (PPO) covers outpatient services with no coinsurance, featuring a $300 copay for outpatient hospital services, a $250 copay per stay for observation services, and a $150 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Medicare PPO Blue ValueRx (PPO) covers partial hospitalization services with a $55 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
Medicare PPO Blue ValueRx (PPO) covers ground and air ambulance services with a $325 copay (waived if admitted) and no coinsurance, though prior authorization is required. 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 PPO Blue ValueRx (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require no coinsurance and a copay ranging from no copay to $50, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance.
Primary Care See details
Medicare PPO Blue ValueRx (PPO) covers primary care physician and opioid treatment services with no copay and no coinsurance, while specialist and telehealth services require a $0 to $45 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are covered with copays up to $30 and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
Medicare PPO Blue ValueRx (PPO) covers preventive services with no copay and no coinsurance, though additional preventive benefits are only partially covered. Excluded sub-services include in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation counseling, telemonitoring, home safety modifications, and counseling.
Hearing Services See details
Hearing services are covered under the Medicare PPO Blue ValueRx (PPO) plan, offering no copay and no coinsurance for annual routine exams and unlimited fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $699.00 to $999.00 for up to two devices per year, while over-the-counter (OTC), inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Medicare PPO Blue ValueRx (PPO) covers vision services with no deductible, offering routine eye exams with a $0 to $45 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 combined limit every two years, but upgrades are not covered.
Dental Services See details
Dental services are partially covered by Medicare PPO Blue ValueRx (PPO), offering Medicare-covered dental with a $45 copay and no coinsurance, and preventive care like exams and cleanings with no copay and no coinsurance up to a $500 annual maximum. Restorative and other comprehensive services require no copay and a 50% coinsurance, while fluoride treatments, other preventive dental services, and orthodontics are not covered.
Home Infusion bundled Services See details
Medicare PPO Blue ValueRx (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Covered Medicare Part B drugs, including chemotherapy and radiation, range from no coinsurance up to 20% coinsurance, while Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Medicare PPO Blue ValueRx (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare PPO Blue ValueRx (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by Medicare PPO Blue ValueRx (PPO) with no coinsurance, though prior authorization is required. Some diagnostic services are covered with no copay, but diagnostic procedures, tests, lab services, and therapeutic radiological services are not covered, while outpatient x-rays carry a $10 copay and diagnostic radiological services require a minimum $250 copay.
Home Health Services See details
Home Health Services are covered under the Medicare PPO Blue ValueRx (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare PPO Blue ValueRx (PPO) partially covers cardiac rehabilitation services with no coinsurance, though standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by Medicare PPO Blue ValueRx (PPO) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Medicare PPO Blue ValueRx (PPO) partially covers Other Services, offering a meal benefit for chronic illnesses with no copay and no coinsurance. Acupuncture, over-the-counter (OTC) items, and other supplemental services are not covered under this plan.
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