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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 West Coast Florida. 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. For budget-friendly medications, this plan offers no copay for Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs when filled at standard pharmacies or through standard mail order. This makes managing routine prescriptions highly affordable for enrolled members. For higher-tier medications, cost-sharing is based on coinsurance rather than flat copays. Members pay a 21% coinsurance for Tier 3 preferred brand drugs and a 30% coinsurance for Tier 4 non-preferred drugs through standard pharmacy or standard mail order channels. Specialty drugs in Tier 5 carry a 25% coinsurance for a 1-month supply.
Additional Benefits
The BlueMedicare Value (PPO) plan offers robust everyday coverage with no copay and no coinsurance for primary care visits, preventive services, routine eye exams, and preventive dental care. Specialist visits require a $60 copay with no coinsurance, and routine hearing exams also feature no copay. Additionally, the plan covers prescription eyewear with no copay up to a $200 annual limit and provides a $30 quarterly allowance for over-the-counter items with no copay. For emergency and major medical needs, emergency room visits carry a $130 copay, while urgent care visits require a $50 copay. Inpatient hospital stays require a daily copay of $385 for the first seven days with no coinsurance, whereas home health services and skilled nursing facility stays for the first 20 days feature no copay. Durable medical equipment and dialysis services are covered with a 20% coinsurance and no copay, helping you manage ongoing health needs affordably.
Inpatient Hospital See details
BlueMedicare Value (PPO) covers inpatient hospital services with no coinsurance, requiring a $385 daily copay for days 1 to 7 of acute stays and a $350 daily copay for days 1 to 6 of psychiatric stays, with no copay thereafter. Prior authorization is required, and specific services such as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueMedicare Value (PPO) outpatient services are covered with no coinsurance, featuring a $0 to $350 copay for outpatient hospital services, a $130 copay per stay for observation services, and no copay for ambulatory surgical center and blood services. Outpatient substance abuse services also carry no coinsurance, with individual sessions requiring a $40 copay and group sessions requiring a $30 copay.
Partial Hospitalization See details
BlueMedicare Value (PPO) covers partial hospitalization benefits with a $50 copay and no coinsurance. Prior authorization is required to access this covered service.
Ambulance and Transportation Services See details
BlueMedicare Value (PPO) covers ambulance services with prior authorization, featuring no copay to a $330 copay and coinsurance for ground transport, and a 20% coinsurance and a copay for air transport. For transportation benefits, some services are covered, but transportation to plan-approved health-related locations and 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 no coinsurance, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum limit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Value (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $60 copay and no coinsurance. Other covered benefits, including physical therapy ($0 to $45 copay) and telehealth ($0 to $60 copay), have no coinsurance but require prior authorization, whereas podiatry, routine chiropractic, and other chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under BlueMedicare Value (PPO) with no copays and no coinsurance for covered benefits like glaucoma screenings, diabetes self-management training, and memory fitness. However, several services are not covered, including annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, and weight management programs.
Hearing Services See details
BlueMedicare Value (PPO) covers Medicare-covered hearing exams for a $60 copay and no coinsurance, while annual routine exams and fitting evaluations are covered with no copay or coinsurance. Prescription hearing aids are partially covered with a copay of $350 to $1,825 and no coinsurance for up to two aids per year, but inner ear, outer ear, over the ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
BlueMedicare Value (PPO) covers vision services with no coinsurance and no deductibles, offering one routine eye exam per year with no copay, though other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is also covered with no copay up to a combined annual maximum of $200 for both in-network and out-of-network services.
Dental Services See details
BlueMedicare Value (PPO) partially covers dental services, offering preventive care, fillings, dentures, and oral surgery with no copay and no coinsurance, while Medicare-covered dental services require a $60 copay and no coinsurance. Several sub-services are not covered under this plan, including endodontics, periodontics, implants, fixed prosthodontics, orthodontics, and other diagnostic dental services.
Home Infusion bundled Services See details
BlueMedicare Value (PPO) covers home infusion bundled services, which require prior authorization and step therapy. Part B insulin requires a $35 copay and no coinsurance to 20% coinsurance, other Part B drugs require no copay and no coinsurance to 20% coinsurance, and chemotherapy drugs require a copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by BlueMedicare Value (PPO) 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, supplies, and therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under BlueMedicare Value (PPO) with prior authorization required. Diagnostic procedures and tests have a copay ranging from $0 to $75 with no coinsurance, lab services feature no copay, and radiological services include a $15 copay for outpatient X-rays and a 20% coinsurance for therapeutic services.
Home Health Services See details
Home Health Services are covered by BlueMedicare Value (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by BlueMedicare Value (PPO) with no coinsurance and required prior authorization, though some services are covered while standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. These non-covered services require copayments ranging from $15 to $50 depending on the specific therapy.
Skilled Nursing Facility (SNF) See details
BlueMedicare Value (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BlueMedicare Value (PPO) partially covers Other Services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a $30 allowance every three months, while acupuncture and meal benefits are not covered.
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