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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 $101.00. 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. Under this plan, Tier 1 preferred generic drugs have no copay when filled at preferred pharmacies or through standard mail order. For Tier 2 generic drugs, you will pay a $6 copay for a one-month supply at preferred pharmacies and standard mail order, compared to a $12 copay at standard pharmacies. Higher-tier medications are subject to coinsurance rather than flat copayments under this plan. Tier 3 preferred brand drugs require a 20% coinsurance, while Tier 4 non-preferred drugs carry a 39% coinsurance across all pharmacy options. Specialty medications in Tier 5 require a 33% coinsurance for a one-month supply.
Additional Benefits
The Medicare PPO Blue ValueRx (PPO) plan offers robust coverage with no coinsurance for many key medical services, including inpatient hospital stays, outpatient procedures, and emergency care, though specific daily or per-visit copays apply. Beneficiaries enjoy no copay and no coinsurance for primary care visits, annual physicals, routine preventive care, and home health services. Specialist consultations and physical therapy require low copays of up to $45 with no coinsurance. For extra health benefits, this plan provides preventive dental and routine hearing services with no copay, alongside a $200 eyewear allowance every two years. Comprehensive dental services are covered with a 50% coinsurance up to a $500 annual limit, while prescription hearing aids require copays ranging from $699 to $999. Additionally, durable medical equipment and dialysis services are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
Inpatient hospital services are partially covered by Medicare PPO Blue ValueRx (PPO) with no coinsurance, requiring a $433 daily copay for days 1-7 of acute stays and a $275 daily copay for days 1-5 of psychiatric stays, with no copays for subsequent days. Prior authorization is required, and upgrades as well as non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under Medicare PPO Blue ValueRx (PPO) are covered with no coinsurance, featuring a $300 copay for outpatient hospital services and a $250 copay per stay for observation services. Ambulatory surgical center services require a $150 copay with no coinsurance, outpatient substance abuse sessions carry a $30 copay with no coinsurance, and outpatient blood services have no copay or coinsurance.
Partial Hospitalization See details
Medicare PPO Blue ValueRx (PPO) covers partial hospitalization services with a $55.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Medicare PPO Blue ValueRx (PPO) covers ground and air ambulance services with a $325 copay and no coinsurance per service, with the copay waived if you are admitted to the hospital. Prior authorization is required for ambulance services, and transportation services to health-related locations are 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 a copay ranging from no copay to $50 with no coinsurance, 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) offers primary care and opioid treatment services with no copay and no coinsurance, while other covered services like specialists, mental health, and physical therapy feature copays ranging from $0 to $45 and no coinsurance. Podiatry services are not covered under this plan, and chiropractic benefits are only partially covered since routine and other chiropractic services are excluded.
Preventive Services See details
Medicare PPO Blue ValueRx (PPO) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, but do not cover sub-services such as in-home safety assessments, personal emergency response systems, alternative therapies, and medical nutrition therapy.
Hearing Services See details
Hearing services are partially covered by Medicare PPO Blue ValueRx (PPO), featuring no copay and no coinsurance for routine exams and fitting evaluations. Prescription hearing aids are covered for up to two devices per year with no coinsurance and a copay ranging from $699.00 to $999.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by Medicare PPO Blue ValueRx (PPO), as other eye exam services and eyewear upgrades are not covered. Routine eye exams require no copay to a $45 copay and no coinsurance, while covered eyewear has no copay, no coinsurance, and no deductible, subject to a $200 combined maximum limit every two years.
Dental Services See details
Medicare PPO Blue ValueRx (PPO) partially covers dental services up to a $500 annual limit, excluding fluoride treatment, other preventive dental services, and orthodontics. Medicare-covered dental services require a $45 copay and no coinsurance, while covered preventive care has no copay and no coinsurance, and comprehensive services require no copay and 50% coinsurance.
Home Infusion bundled Services See details
Medicare PPO Blue ValueRx (PPO) covers Home Infusion bundled Services with no copay, though prior authorization is required. Part B chemotherapy, radiation, and other drugs are covered with no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the Medicare PPO Blue ValueRx (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
Medicare PPO Blue ValueRx (PPO) covers durable medical equipment, prosthetic devices, and medical supplies with no copay and a 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 under this benefit.
Diagnostic and Radiological Services See details
Medicare PPO Blue ValueRx (PPO) partially covers diagnostic and radiological services with no coinsurance, though prior authorization is required. Diagnostic services have no copay, but diagnostic procedures, tests, and lab services are not covered. Covered diagnostic radiological services require a minimum $250 copay and outpatient X-rays have a $10 copay, while therapeutic radiological services are not covered.
Home Health Services See details
Home Health Services are covered by the Medicare PPO Blue ValueRx (PPO) plan with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Medicare PPO Blue ValueRx (PPO) provides Cardiac Rehabilitation Services with no coinsurance, and while some services are covered, cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) services are not covered.
Skilled Nursing Facility (SNF) See details
Medicare PPO Blue ValueRx (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring a daily copay of $10 for days 1 through 20 and $218 for days 21 through 100. Prior authorization is required and a prior three-day hospital stay is not necessary, though additional days beyond the standard 100 days are not covered.
Other Services See details
Medicare PPO Blue ValueRx (PPO) partially covers other services, providing a limited-duration meal benefit for chronic illness with no copay and no coinsurance. However, acupuncture and over-the-counter (OTC) items are not covered under this plan.
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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