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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 Florida Panhandle. 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 $13900.00 (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 $13900.00 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 Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) prescriptions filled at standard pharmacies or through standard mail order for both 1-month and 3-month supplies. This makes managing everyday maintenance medications highly affordable for members. For higher-tier medications, the plan transitions to a coinsurance model for standard pharmacies and mail orders. You will pay a 21% coinsurance for Tier 3 (Preferred Brand) drugs and a 30% coinsurance for Tier 4 (Non-Preferred) drugs for 1-month or 3-month supplies. Tier 5 (Specialty) drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The BlueMedicare Value (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. Specialist visits range from no copay up to a $55 copay, while inpatient hospital stays require a $385 daily copay for the first seven days and no copay thereafter. Outpatient hospital services and emergency care are also covered with set copays and no coinsurance, ensuring predictable costs for major medical needs. For auxiliary care, the plan provides routine dental, vision, and hearing exams with no copay or coinsurance, alongside a $200 annual allowance for prescription eyewear. Skilled nursing facility stays feature no copay for the first 20 days, and essential medical equipment like diabetic supplies are covered with no copay. While some services like dialysis and durable medical equipment require a 20% coinsurance, this plan overall minimizes out-of-pocket costs for everyday health services.
Inpatient Hospital See details
BlueMedicare Value (PPO) covers inpatient acute hospital stays with no coinsurance and a $385 daily copay for days 1 to 7, with no copay for days 8 and beyond. Inpatient psychiatric hospital stays are also covered with no coinsurance and a $416 daily copay for days 1 to 5, though additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueMedicare Value (PPO) covers outpatient services with no coinsurance, including outpatient hospital services for a $360 copay, observation services for a $115 copay per stay, and ambulatory surgical center services for a $310 copay. Outpatient substance abuse sessions have a $50 copay, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
BlueMedicare Value (PPO) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered under BlueMedicare Value (PPO), as transportation services to plan-approved or any other health-related locations are not covered. Prior authorization is required for ambulance services, with ground ambulance requiring a copay of up to $380 and coinsurance, and air ambulance requiring a 20% coinsurance and a copay.
Emergency Services See details
BlueMedicare Value (PPO) covers emergency services with a $115 copay (waived if admitted to the hospital within 48 hours) and urgently needed services with a $40 copay, both with no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum benefit limit with a $115 copay and no coinsurance, but 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 a $0 to $55 copay and no coinsurance. Additional services like mental health, psychiatric, and physical therapies are covered with no coinsurance and copays ranging up to $55, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are partially covered under BlueMedicare Value (PPO) with no copay and no coinsurance for covered options like kidney disease education, glaucoma screenings, diabetes self-management, digital rectal exams, EKGs, and a memory fitness benefit. Uncovered services include annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, tobacco cessation, disease management, telemonitoring, remote access technologies, safety devices, and counseling.
Hearing Services See details
BlueMedicare Value (PPO) partially covers hearing services, providing routine hearing exams and fitting evaluations with no copay and no coinsurance. Covered prescription hearing aids have no coinsurance and a copay ranging from $350 to $1,825, but over-the-counter (OTC) hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Value (PPO), which features no copay, no coinsurance, and no deductible for one routine annual eye exam and prescription eyewear. Other eye exam services are not covered, but the plan provides a $200 combined annual maximum benefit for contacts, frames, and lenses.
Dental Services See details
BlueMedicare Value (PPO) partially covers dental services, offering routine exams, cleanings, X-rays, removable prosthodontics, and oral surgery with no copay and no coinsurance, while Medicare-covered dental services require a $55 copay and no coinsurance. Specific sub-services not covered under this plan include fluoride treatments, restorative services, endodontics, periodontics, implants, and fixed prosthodontics.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BlueMedicare Value (PPO) with prior authorization, requiring a $35 copay and no coinsurance to 20% coinsurance for insulin. Medicare Part B chemotherapy and radiation drugs require a copay and no coinsurance to 20% coinsurance, while other Part B drugs have no copay and no coinsurance to 20% coinsurance.
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
Medical equipment is covered by BlueMedicare Value (PPO), featuring diabetic supplies and therapeutic shoes with no copay and no coinsurance. Durable medical equipment, prosthetics, and medical supplies are also covered with no copay and a 20% coinsurance, though prior authorization is required.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by BlueMedicare Value (PPO) with prior authorization required. Diagnostic tests and procedures range from no copay to a $75 copay with no coinsurance, lab services have no copay, and radiological services require a $15 copay for X-rays, starting at no copay for diagnostic radiology, and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the BlueMedicare Value (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueMedicare Value (PPO) covers some cardiac rehabilitation services with no coinsurance, although prior authorization is required. Standard cardiac rehabilitation ($30 copay), intensive cardiac rehabilitation ($40 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by BlueMedicare Value (PPO) with no coinsurance, requiring prior authorization but no 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, while days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered by the BlueMedicare Value (PPO) plan, meaning supplemental benefits such as acupuncture, over-the-counter (OTC) items, and meal benefits are not available.
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