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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 2026, 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 2026.
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 has a $950.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 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 features an annual drug deductible of $615. Under this plan, you will pay no copay for 1-month and 3-month supplies of Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs). These cost savings apply to standard retail pharmacies as well as standard mail-order services. For higher-tier medications, cost-sharing is based on coinsurance rather than set copays. Tier 3 (Preferred Brand) drugs require a 21% coinsurance, Tier 4 (Non-Preferred) drugs require a 30% coinsurance, and Tier 5 (Specialty) drugs carry a 25% coinsurance for standard fills. These coinsurance percentages apply to both standard retail and standard mail-order options.
Additional Benefits
The BlueMedicare Value PPO plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits and routine preventive care. Specialist visits, urgent care, and emergency services are accessible with low-to-moderate copayments and no coinsurance. For hospital stays, inpatient care requires structured daily copays with no coinsurance, while outpatient hospital services require a copay and home health services are provided with no copay. This plan also includes essential supplemental benefits, providing routine dental, vision, and hearing exams with no copay and no coinsurance. Prescription hearing aids require copayments, while eyewear is covered with no copay up to a 200 dollar annual maximum. Additionally, durable medical equipment is covered with a 20 percent coinsurance and no copay, ensuring affordable access to necessary medical devices.
Inpatient Hospital See details
BlueMedicare Value (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Acute care requires a $385 copay for days 1 to 7 and no copay for days 8 and beyond, while psychiatric stays require a $350 copay for days 1 to 6 and no copay for days 7 to 90, with upgrades, additional psychiatric days, and non-Medicare-covered stays not covered.
Outpatient Services See details
BlueMedicare Value (PPO) covers outpatient hospital services with a $350 copay and observation services with a $130 copay per stay, both with no coinsurance. Ambulatory surgical center and blood services are covered with no copay and no coinsurance, while outpatient substance abuse services require no coinsurance and a copay of $30 for group sessions or $40 for individual sessions.
Partial Hospitalization See details
BlueMedicare Value (PPO) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
BlueMedicare Value (PPO) covers ground ambulance services with a copay of $0 to $315 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both requiring prior authorization. For transportation benefits, some services are covered but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
BlueMedicare Value (PPO) covers emergency services with a $130 copay (waived if admitted to the hospital within 48 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 lifetime maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Value (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with copays ranging from no copay to $60 and no coinsurance. Additional services such as physical, occupational, mental health, and telehealth therapies require no coinsurance with copays ranging from no copay to $60, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered under the BlueMedicare Value (PPO) plan with no copay and no coinsurance for covered benefits like Medicare-covered zero-dollar preventive services, kidney disease education, select screenings, and memory fitness. However, several supplemental benefits are not covered, including annual physical exams, health education, in-home safety assessments, and nutritional/dietary services.
Hearing Services See details
BlueMedicare Value (PPO) covers hearing services with no deductible, offering routine hearing exams and fittings with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $350 to $1,825, while OTC hearing aids and inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
BlueMedicare Value (PPO) covers vision services with no coinsurance and no deductibles, featuring eye exams with copays ranging from $0 to $60 (including one annual routine exam with no copay), though other eye exam services are not covered. Eyewear, including contact lenses and eyeglasses, is covered with no copay up to a combined annual maximum benefit of $200.
Dental Services See details
BlueMedicare Value (PPO) dental benefits are partially covered, offering Medicare-covered dental services for a $60 copay and no coinsurance, plus preventive and select comprehensive services with no copay and no coinsurance. Covered services include routine exams, cleanings, fillings, dentures, and oral surgery, while other diagnostic services, endodontics, periodontics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueMedicare Value (PPO) covers home infusion bundled services, which require prior authorization and step therapy. Covered Part B insulin drugs have a $35 copay and coinsurance ranging from no coinsurance to 20%, while chemotherapy and other Part B drugs require no copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered under the BlueMedicare Value (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Value (PPO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, subject to prior authorization. Diabetic equipment, including supplies and therapeutic shoes or inserts, is covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Value (PPO) covers diagnostic and radiological services under prior authorization, with diagnostic procedures and tests requiring no coinsurance and a copay of $0 to $75. Lab services have no copay, outpatient X-rays require a $15 copay, diagnostic radiological services have a $0 minimum copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered by BlueMedicare Value (PPO) with no copay and no coinsurance, although prior authorization is required for these services.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the BlueMedicare Value (PPO) plan with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by BlueMedicare Value (PPO) with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the BlueMedicare Value (PPO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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