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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 2026, 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 2026.
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 provides robust coverage for core medical needs with clear copays and no coinsurance on many primary services. Members pay a $10 copay for primary care visits, a $40 copay for specialists, and no copay for telehealth consultations. Inpatient hospital stays require a $390 daily copay for days one through five, with no copay for days six through ninety, while outpatient services are available for a $340 copay. In addition to medical care, the plan features comprehensive vision, dental, and hearing benefits to help reduce your out-of-pocket costs. Routine vision exams, contact lenses, and preventive dental cleanings are covered with no copay, while comprehensive dental services require a 20% coinsurance up to a $3,000 annual limit. Members also benefit from a quarterly $25 over-the-counter allowance, no-copay home health services, and affordable prescription hearing aid copays ranging from $699 to $999.
Inpatient Hospital See details
Inpatient Hospital benefits are partially covered by BlueMedicare Value (PFFS), featuring a $390 copay per day for days 1 to 5, no copay for days 6 to 90, and no coinsurance for acute and psychiatric stays. However, additional days, non-Medicare-covered stays, and upgrades for acute care are not covered.
Outpatient Services See details
BlueMedicare Value (PFFS) covers outpatient services with no coinsurance, including outpatient hospital, observation, and ambulatory surgical center services for a $340 copay. Individual and group outpatient substance abuse sessions require a $40 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
BlueMedicare Value (PFFS) covers partial hospitalization benefits with a $55.00 copay and no coinsurance. This benefit ensures you have affordable access to covered partial hospitalization services with predictable out-of-pocket costs.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by BlueMedicare Value (PFFS), as transportation services to plan-approved or any health-related locations are not covered. Ground ambulance services require a $325 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay.
Emergency Services See details
BlueMedicare Value (PFFS) partially covers emergency services, as worldwide emergency transportation is not covered. Covered emergency services require a $115 copay and no coinsurance, urgently needed services require a $40 copay and no coinsurance, and worldwide emergency and urgent care are covered up to a $15,000 limit with a 20% coinsurance and no copay.
Primary Care See details
BlueMedicare Value (PFFS) partially covers primary care benefits with no coinsurance, though podiatry and routine chiropractic services are not covered. Covered services require copays ranging from $10 for primary care visits up to $40 for specialists, while additional telehealth benefits are provided with no copay.
Preventive Services See details
BlueMedicare Value (PFFS) partially covers preventive services with no copay or coinsurance for covered benefits, which include annual physical exams, fitness benefits, remote access technologies, kidney disease education, glaucoma screenings, diabetes self-management training, digital rectal exams, and post-welcome visit EKGs. However, Medicare-covered Zero Dollar Preventive Services, Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), 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
BlueMedicare Value (PFFS) partially covers hearing services, excluding OTC hearing aids and inner ear, outer ear, or over the ear prescription hearing aids. Covered exams have a $35 copay, routine exams and fittings have no copay, and covered prescription hearing aids require a $699 to $999 copay, all with no coinsurance or deductibles.
Vision Services See details
Vision services are partially covered under BlueMedicare Value (PFFS) with no deductible and no coinsurance, although individual eyeglass lenses and eyeglass frames are not covered. Routine eye exams, contact lenses, and eyeglasses (lenses and frames) have no copay, while other eye exams and eyewear services carry a copay of up to $40 with a $100 annual maximum.
Dental Services See details
BlueMedicare Value (PFFS) dental services are partially covered up to a $3,000 annual limit, offering preventive care like exams, cleanings, and X-rays with no copay and no coinsurance. Covered comprehensive services such as restorative, periodontics, removable prosthodontics, and oral surgery require a 20% coinsurance and no copay, while Medicare-covered dental services have a $40 copay and no coinsurance. Fluoride, endodontics, implants, fixed prosthodontics, adjunctive general, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueMedicare Value (PFFS) covers home infusion bundled services, including Medicare Part B insulin drugs for a $35 copay and no coinsurance. Other covered Part B drugs, including chemotherapy and radiation drugs, require no copay and a coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
BlueMedicare Value (PFFS) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Value (PFFS) covers medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes or inserts with a 20% coinsurance and no copay. Diabetic supplies are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Value (PFFS) covers diagnostic and radiological services with varying cost-sharing depending on the specific service. Diagnostic procedures and lab services have no copay and 0% to 20% coinsurance, while diagnostic radiological services require a $25 to $340 copay and no coinsurance. Therapeutic radiological and outpatient X-ray services have a 20% coinsurance and no copay.
Home Health Services See details
Home health services are covered by BlueMedicare Value (PFFS) with no copay and no coinsurance.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the BlueMedicare Value (PFFS) plan. This includes cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) rehabilitation services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) benefits are partially covered by BlueMedicare Value (PFFS), featuring no copay and no coinsurance for days 1 to 20, followed by a $218 daily copay and no coinsurance for days 21 to 100. Additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BlueMedicare Value (PFFS) partially covers Other Services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $25 every three months. Acupuncture, meal benefits, and dual eligible SNPs with highly integrated services are not covered.
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