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BlueMedicare Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Select (PPO) in 2025, please refer to our full plan details page.
BlueMedicare Select (PPO) is a PPO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Select counties in S.FL/ W.FL/C.FL,N.E. FL/N.W FL. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that BlueMedicare Select (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 BlueMedicare Select (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 BlueMedicare Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $112.90. 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 a $290.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $10100.00 (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 $10100.00 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 BlueMedicare Select (PPO) plan has a $290 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, Tier 1 (Preferred Generic) drugs have a $10 copay at standard and mail order pharmacies. For Tier 5 (Specialty Tier) drugs, there is no copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs.
Additional Benefits
The BlueMedicare Select (PPO) plan offers a variety of benefits to help cover your healthcare costs. The plan includes coverage for inpatient and outpatient services, with varying copays depending on the specific service. You'll find no copay for many services, including primary care and preventive services, while other services like emergency care and ambulance services have copays. This plan also covers hearing, vision, and dental services, with some services having a copay. Additionally, the plan covers home health, dialysis, and medical equipment, with some services having coinsurance. However, it's important to note that certain services like acupuncture, over-the-counter items, and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you will pay a $225 copay for days 1-7 and no copay for days 8-90, and for Inpatient Hospital Psychiatric, you will pay a $318 copay for days 1-5 and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute is covered with no copay for days 91-999, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the BlueMedicare Select (PPO) plan, including all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $130, Observation Services have a $125 copay, and Ambulatory Surgical Center Services have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Select (PPO) plan with a $20 copay, and prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Select (PPO) plan, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $150 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the BlueMedicare Select (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $25 copay; all services have no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Select (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $45 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $20 copay for individual and group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $40, and additional telehealth benefits have a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive Services include Medicare-covered services with no copay, and Additional Preventive Services, Kidney Disease Education Services, and Other Preventive Services, which may have a copay. The Additional Preventive Services do not include 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, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services.
Hearing Services See details
Hearing Services includes hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $350 and $1825 for all types of prescription hearing aids, but inner ear, outer ear, and over-the-ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay of $0-$45, while routine eye exams have no copay. Eyewear has no copay, and a service-specific out-of-pocket maximum of $100.
Dental Services See details
The BlueMedicare Select (PPO) plan offers coverage for Medicare Dental Services with a $45 copay, and other Dental Services with no copay. Oral exams, Dental X-Rays, Prophylaxis (Cleaning), Prosthodontics (removable), and Oral and Maxillofacial Surgery are covered, but Fluoride Treatment, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics (fixed), and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and a coinsurance between 0% and 20%, while Other Medicare Part B Drugs have no copay and a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Select (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment, Prosthetics/Medical Supplies, and Diabetic Equipment. Durable Medical Equipment has no copay and 0-20% coinsurance, but Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have 20% coinsurance, and Medical Supplies have no coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with a copay for some services. Diagnostic Procedures/Tests have a copay between $0 and $10, while Lab Services have no copay. Diagnostic Radiological Services have a maximum copay of $150, and Therapeutic Radiological Services have a coinsurance of at least 20%. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Select (PPO) 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 specific services are not covered. Prior authorization is required, and more information on copays is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Select (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services, under the BlueMedicare Select (PPO) plan, are not covered. Specifically, acupuncture, over-the-counter items, meal benefits, and other services are not covered.
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