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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 Florida Panhandle. 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.

Overview IconKey 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:

Regular visits to your primary care doctor are covered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a copay of $45.00 and coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a copay of $125.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care arecovered and will have a copay of $30.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for BlueMedicare Value (PPO)

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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 IconDrug Coverage

The BlueMedicare Value (PPO) plan has a $175 deductible for prescription drugs. After you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy used. For the initial coverage phase, you may pay a $5 copay for preferred generic drugs at a standard or mail pharmacy. Standard generic drugs and preferred brand drugs have a 25% coinsurance, while non-preferred drugs have a 30% coinsurance. Specialty tier drugs have no copay. Once your total drug costs reach $2000, you enter the next coverage phase.

Additional Benefits IconAdditional Benefits

The BlueMedicare Value (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay depending on the length of stay, while outpatient services can have copays from $0 to $295. Emergency services have a $125 copay, and primary care visits are covered with no copay, with specialist visits costing $45. Preventive services and many dental services have no copay, while hearing and vision services have copays for exams and some hearing aids. The plan also covers home health services with no copay, and durable medical equipment with no copay. The plan offers additional benefits such as over-the-counter items with a quarterly allowance.

Inpatient Hospital See details

Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, there is a $320 copay for days 1-6, and no copay for days 7-90, with no coinsurance. For Inpatient Hospital Psychiatric, there is a $318 copay for days 1-5, and no copay for days 6-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute are covered with no copay and no coinsurance for days 91-999. 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 Value (PPO) plan, including all 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 copay of $20 for both individual and group sessions, while outpatient blood services have no copay.

Partial Hospitalization See details

Partial Hospitalization is covered by the BlueMedicare Value (PPO) plan, with a $20 copay. Prior authorization is required for this benefit.

Ambulance and Transportation Services See details

Ambulance and Transportation Services are covered by the BlueMedicare Value (PPO) plan. Air and ground ambulance services have a $250 copay, and there is 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 and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $30 copay; all have 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, 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 are covered under the BlueMedicare Value (PPO) plan. The plan covers Medicare-covered zero-dollar preventive services, and other preventive services including Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay.

Hearing Services See details

Hearing exams are covered under the BlueMedicare Value (PPO) plan, with a $45 copay. Routine hearing exams and fitting/evaluation for hearing aids have no copay. Prescription hearing aids are partially covered, but not for inner ear, outer ear, or over the ear hearing aids, and have a copay between $350 and $1825.

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, including contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades, with a combined maximum benefit of $200 per year. Routine eye exams have no copay and are covered once per year.

Dental Services See details

The BlueMedicare Value (PPO) plan covers Medicare Dental Services with a $45 copay, and other dental services, restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery with no copay. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, and oral and maxillofacial surgery have limits on the number of visits covered per year or per a certain time period. 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 under the BlueMedicare Value (PPO) plan. The plan covers Medicare Part B Insulin Drugs with a $35 copay and 0-20% coinsurance, Medicare Part B Chemotherapy/Radiation Drugs with 0-20% coinsurance, and Other Medicare Part B Drugs with 0-20% coinsurance and no copay.

Dialysis Services See details

Dialysis Services are covered by the BlueMedicare Value (PPO) plan. The coinsurance for dialysis services is 20%.

Medical Equipment See details

Medical Equipment benefits are covered, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered devices and supplies, 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, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $110, and Therapeutic Radiological Services have a coinsurance of at least 20%. 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. Additional hours of care and personal care services are not covered.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are not covered by the BlueMedicare Value (PPO) plan. Prior authorization is required, but no services are covered.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered under the BlueMedicare Value (PPO) plan, with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.

Other Services See details

Other Services offered by BlueMedicare Value (PPO) include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $48 every three months, including nicotine replacement therapy and Naloxone coverage, but acupuncture, meal benefits, Dual Eligible SNPs with Highly Integrated Services, and a variety of other services are not covered.

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