A non-government entity
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 West Coast Florida. 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:
Sign up for BlueMedicare Value (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BlueMedicare Value (PPO) plan has an enhanced alternative drug benefit. The plan has a $175 deductible. After the deductible, you'll pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, you will pay no copay for preferred generic drugs at a standard mail pharmacy, but 25% coinsurance for standard generic drugs. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Value (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay, outpatient services, and emergency care. You can also expect coverage for primary care with no copay, preventive services, and vision and dental services, along with home health services with no copay. This plan includes additional benefits like hearing exams, home infusion, and medical equipment, with varying copays and coinsurance depending on the service. The plan also covers ambulance services with a copay, as well as diagnostic and radiological services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, with a copay of $320 for days 1-6 and no copay for days 7-90 for Inpatient Hospital-Acute. Additional days for Inpatient Hospital-Acute have no copay for days 91-999. Inpatient Hospital Psychiatric has a copay of $318 for days 1-5 and no copay for days 6-90. Non-Medicare-covered stays 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 BlueMedicare Value (PPO), including outpatient hospital services with a copay between $0 and $295, observation services with a $125 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services have a $20 copay for both individual and group sessions, and outpatient blood services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will pay a $20 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Value (PPO) plan. Ground and Air Ambulance Services have a $260 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 Value (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Urgent Coverage is also covered with a $125 copay, while 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 with a $40 copay. The plan also covers physician specialist services with a $45 copay, mental health specialty services with a $20 copay for individual and group sessions, and physical therapy and speech-language pathology services with a copay between $0 and $40. Additional telehealth benefits have a copay between $0 and $45, and Opioid Treatment Program Services has a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services are covered, including Medicare-covered zero dollar preventive services, kidney disease education services, and other preventive services. Additional preventive services, support for caregivers of enrollees, and fitness benefits are also covered with no copay. Annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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 benefits, home-based palliative care, in-home support services, additional sessions of smoking and tobacco cessation counseling, enhanced disease management, telemonitoring services, remote access technologies, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
The BlueMedicare Value (PPO) plan covers hearing exams with a $45 copay, routine hearing exams once per year with no copay, and fitting/evaluation for hearing aids once per year with no copay; however, prescription hearing aids - inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered. Prescription hearing aids (all types) have a copay between $350.00 and $1825.00.
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 for both in and out-of-network services.
Dental Services See details
The BlueMedicare Value (PPO) plan covers dental services, including Medicare dental services with a $45 copay, and other dental services with no copay. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are also covered with 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. Insulin has a $35 copay with a coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%, and no copay.
Dialysis Services See details
Dialysis Services are covered under the BlueMedicare Value (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by BlueMedicare Value (PPO), including Durable Medical Equipment with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with no coinsurance, and Diabetic Equipment with no copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueMedicare Value (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $75, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $75 and $150, while Therapeutic Radiological Services have a 20% coinsurance, and Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered under the BlueMedicare Value (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under the BlueMedicare Value (PPO) plan, but specific services like Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. Prior authorization is required, and more copay information is available.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the BlueMedicare Value (PPO) plan, with a $0 copay for days 1-20 and a $214 copay per day for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered. Prior authorization is required.
Other Services See details
Under the BlueMedicare Value (PPO) plan, acupuncture, meal benefits, 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. Over-the-counter (OTC) items are covered with a maximum plan benefit coverage amount of $47.00 every three months.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved