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BlueMedicare Value (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Value (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Value (PPO) in 2025, please refer to our full plan details page.
BlueMedicare Value (PPO) is a PPO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Pinellas County. This plan received an overall rating of 3.5 out of 5 stars in 2025.
It's important to know that BlueMedicare Value (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 Value (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 Value (PPO), 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.
This plan has a $175.00 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 Value (PPO) plan has a $175 deductible for prescription drugs. During the initial coverage phase, you'll pay either a copay or coinsurance depending on the drug tier and pharmacy. For example, you'll pay no copay for preferred generic drugs at a standard pharmacy or through mail order. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs. If you qualify for the low-income subsidy, you will pay no premium.
Additional Benefits
The BlueMedicare Value (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services with copays varying by service, and coverage for ambulance and emergency services with a copay. Primary care, preventive, and hearing services are covered with copays, as are vision and dental services. The plan also includes home health services, medical equipment, and skilled nursing facility stays with specific cost-sharing structures. This plan provides coverage for diagnostic and radiological services, home infusion, and dialysis. Additionally, it offers other services like Over-the-Counter (OTC) items with a quarterly allowance. However, it's important to note that some services, such as cardiac rehabilitation, certain hearing aids, and several other specialized services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $320 copay for days 1-6, and no copay for days 7-90. 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 are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for BlueMedicare Value (PPO) covers all outpatient hospital services, with copays ranging from $0 to $295, and observation services with a $125 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse services have a $20 copay per session, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Value (PPO) plan, but requires prior authorization. You will pay a $20 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, with prior authorization required for all ambulance services. Ground and Air Ambulance Services have a $250 copay, but there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered by the BlueMedicare Value (PPO) plan, with a $125 copay and no coinsurance for Emergency Services, a $125 copay and no coinsurance for Worldwide Emergency Coverage, and a $125 copay and no coinsurance for Worldwide Urgent Coverage. Urgently Needed Services have a $40 copay with no coinsurance. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Value (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay. It also covers physician specialist services with a $45 copay, mental health specialty services with a $20 copay, and other health care professional services with a copay between $0 and $20. Physical therapy and speech-language pathology services are covered with a copay between $0 and $40, and additional telehealth benefits are covered with a copay between $0 and $45. Podiatry services are not covered, and routine chiropractic care is also not covered.
Preventive Services See details
Preventive services include Medicare-covered services, with specific services like glaucoma screenings, diabetes self-management training, and others having no copay. Annual physical exams, health education, and several other services are not covered.
Hearing Services See details
Hearing services are covered under the BlueMedicare Value (PPO) plan, including hearing exams with a $45 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are covered with a copay between $350 and $1825, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, nor are over-the-counter hearing aids.
Vision Services See details
The BlueMedicare Value (PPO) plan covers vision services, including eye exams with a copay of $0-$45 and eyewear with no copay. Eyewear has a combined maximum benefit of $200 per year.
Dental Services See details
Dental services are covered under the BlueMedicare Value (PPO) plan, with a $45 copay for Medicare dental services. Other dental services, restorative services, endodontics, periodontics, prosthodontics, and oral and maxillofacial surgery have no copay. Adjunctive general services, 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. For Medicare Part B Insulin Drugs, there is a $35 copay, with a coinsurance between 0% and 20%. 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 Value (PPO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), with no copay and 0-20% coinsurance, though Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices are covered with 20% coinsurance, and Medical Supplies have no coinsurance. Diabetic Equipment is covered, and Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $110, Therapeutic Radiological Services have a coinsurance of at least 20%, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Value (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueMedicare Value (PPO) plan. Prior authorization is required for this service.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Value (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 include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $56.00 every three months, and includes nicotine replacement therapy. Acupuncture, Meal Benefit, 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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