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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. During the initial coverage phase, you will pay a copay for your prescriptions. For example, you will pay a $6 copay at a preferred pharmacy for preferred generic drugs, and a $42 copay for standard generic drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy (LIS), your premium will be $0.
Additional Benefits
The Medicare PPO Blue ValueRx (PPO) plan offers a range of benefits, including inpatient hospital stays with copays of $320-$275, and outpatient services with copays ranging from $30-$300. The plan also covers ambulance services with a $325 copay, emergency services with a $125 copay, and primary care with copays from $0-$40. Preventive, hearing, vision, and dental services are also covered, with varying copays and coinsurance. Additionally, the plan provides home health services with no copay, and skilled nursing facility care with a $0 copay for the first 20 days. However, it's important to note that some services like routine chiropractic care, podiatry, and certain dental and vision services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a copay of $320 for days 1-7, and no copay for days 8-90. For Inpatient Hospital Psychiatric, you will pay a copay of $275 for days 1-5, and no copay for days 6-90. Non-Medicare-covered stay for Inpatient Hospital-Acute and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered, including outpatient hospital services with a $300 copay, observation services with a $250 copay, ambulatory surgical center services with a $200 copay, and outpatient substance abuse services with a $30 copay for both individual and group sessions. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the Medicare PPO Blue ValueRx (PPO) plan, with a $55 copay. Prior authorization is required for this benefit.
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, and there is no coinsurance, while 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, while Urgently Needed Services have a copay between $0 and $50. Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation each have a $90 copay.
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, and mental health specialty services with varying copays. The plan also covers other health care professionals with a copay between $0 and $40, psychiatric services with varying copays, 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, including Medicare-covered services, annual physical exams, and additional preventive services are covered. 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, and fitting/evaluation for hearing aids, both of which are covered. Prescription hearing aids are covered, with a copay between $699 and $999 per visit for all types.
Vision Services See details
Vision services include eye exams with a copay between $0 and $40, and eyewear benefits including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames. There is a combined maximum benefit of $200 every two years for eyewear, while upgrades are not covered.
Dental Services See details
The Medicare PPO Blue ValueRx (PPO) plan covers dental services, including Medicare Dental Services with a $40 copay and other dental services with a $1,000 maximum benefit per year. Oral exams are covered with a $40 copay for up to 3 visits per year, and dental X-rays are covered with a $40 copay for up to 7 X-rays. Fluoride treatment and orthodontics are not covered, but restorative services, adjunctive general services, endodontics, periodontics, prosthodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and oral and maxillofacial surgery are covered with a 50% coinsurance.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0-20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0-20%.
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 include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices and Medicare-covered Medical Supplies have a 20% coinsurance, while Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered, and Diabetic Equipment requires prior authorization.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered under 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, and Outpatient X-Ray Services have a $10 copay.
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 specific services listed, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services, are not covered. The plan has a copay, but specific information about the copay is not provided.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are covered by the Medicare PPO Blue ValueRx (PPO) plan, with a $0 copay for days 1-20 and a $203 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
Other Services include a meal benefit for chronic illness with no maximum plan benefit coverage amount, but 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.
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