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BlueMedicare Value (PFFS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Value (PFFS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Value (PFFS) in 2025, please refer to our full plan details page.
BlueMedicare Value (PFFS) is a PFFS plan offered by USAble Mutual Insurance Company available for enrollment in 2025 to people living in Select Counties in Arkansas. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that BlueMedicare Value (PFFS) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueMedicare Value (PFFS).
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 BlueMedicare Value (PFFS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $7500.00 (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 $7500.00 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:
Sign up for BlueMedicare Value (PFFS)
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Drug Coverage
Prescription drugs are not covered by BlueMedicare Value (PFFS).
Additional Benefits
The BlueMedicare Value (PFFS) plan offers a range of benefits with varying cost-sharing. Hospital stays have a copay of $390 for days 1-5, and no copay for days 6-90, while outpatient services have a $340 copay. The plan covers primary care with a $20 copay, and offers preventive services with no copay. Hearing exams cost $50, and prescription hearing aids have a copay between $699 and $999. Vision services have a copay of $0-$50 for eye exams, and $50 for eyewear. Dental services include a $50 copay for Medicare services and a 20% coinsurance for some services, up to a $3,000 annual maximum. Other benefits include no copay for home health services, and $0 copay for days 1-20 in a skilled nursing facility.
Inpatient Hospital See details
Inpatient Hospital coverage under the BlueMedicare Value (PFFS) plan includes a copay of $390 for days 1-5, and no copay for days 6-90 for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. Additional days, and non-Medicare covered stays for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including Outpatient Hospital Services, Observation Services, and Ambulatory Surgical Center (ASC) Services, have a copay of $340.00. Outpatient Substance Abuse Services have a copay of $40.00 for both Individual and Group Sessions. Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueMedicare Value (PFFS) plan. You will have a $55 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by BlueMedicare Value (PFFS). Ground ambulance services have a $325 copay, while air ambulance services have a 20% coinsurance, and transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered by the BlueMedicare Value (PFFS) plan. Emergency Services has a $110 copay, while Urgently Needed Services has a $45 copay, and Worldwide Emergency Coverage has a 20% coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
BlueMedicare Value (PFFS) covers primary care physician services with a $20 copay, chiropractic services with a $15 copay, occupational therapy services with a $35 copay, physician specialist services with a $50 copay, mental health specialty services with a $35 copay for individual and group sessions, physical therapy and speech-language pathology services with a $35 copay, and additional telehealth benefits with no copay. This plan does not cover Routine Chiropractic Care, and Podiatry Services are not covered.
Preventive Services See details
The BlueMedicare Value (PFFS) plan covers an annual physical exam with no copay, as well as additional preventive services like Fitness Benefit, Remote Access Technologies, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Medicare-covered zero dollar preventive services, Health Education, In-Home Safety Assessment, Personal Emergency Response System, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services include hearing exams, routine hearing exams, fitting/evaluation for hearing aids, prescription hearing aids, and OTC hearing aids. Hearing exams have a $50 copay, and routine hearing exams have no copay, with one exam covered per year. Fitting/evaluation for hearing aids has no copay, and Prescription Hearing Aids (all types) have a copay between $699 and $999, while Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services with the BlueMedicare Value (PFFS) plan include eye exams with a copay between $0 and $50, while eyewear is covered with a $50 copay. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueMedicare Value (PFFS) plan covers Medicare and other dental services, with a $3,000 annual maximum. Medicare dental services have a $50 copay. Oral exams and dental x-rays have no copay, while prophylaxis (cleaning) has no copay and is limited to 2 visits per year. Restorative services, periodontics, prosthodontics (removable), and oral and maxillofacial surgery have a 20% coinsurance. Fluoride treatment, adjunctive general services, endodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the BlueMedicare Value (PFFS) plan, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B drugs with a coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs are also covered, with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Value (PFFS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have a 20% coinsurance for Medicare-covered services, and Diabetic Supplies have no copay. Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including all diagnostic services, diagnostic procedures/tests, lab services, all radiological services, diagnostic radiological services, therapeutic radiological services, and outpatient X-Ray services, are covered. Diagnostic procedures/tests and lab services have a coinsurance of at most 20%, while diagnostic radiological services have a copay of at most $340.00 and a minimum copayment of $25.00. Therapeutic radiological services and outpatient X-Ray services have a coinsurance of at most 20% and a minimum coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Value (PFFS) plan with no copay and no coinsurance. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the following services: Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. There is a copay for covered services, but the amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Value (PFFS) plan. You will have no copay for days 1-20, and a $203 copay for days 21-100.
Other Services See details
Other Services are not covered by the BlueMedicare Value (PFFS) plan, including acupuncture, over-the-counter items, meal benefits, and Dual Eligible SNPs with Highly Integrated Services.
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