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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 South 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:
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Drug Coverage
The BlueMedicare Value (PPO) plan has a $175 deductible for prescription drugs. Once you meet your deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic drugs and specialty tier drugs, you will pay no copay at standard mail. For standard generics and preferred brand drugs, you will pay 25% coinsurance. For non-preferred drugs, you will pay 30% coinsurance.
Additional Benefits
The BlueMedicare Value (PPO) plan offers a range of benefits with varying cost-sharing. For inpatient hospital stays, you'll pay a copay, but it decreases after the first few days. Outpatient services, including primary care, and some specialist visits, have copays, while many preventive services are covered at no cost. The plan includes coverage for emergency services, hearing, vision, and dental services, with some services having no copay. Home health, and skilled nursing facilities are covered, but the copays and coinsurance vary. The plan also offers coverage for medical equipment, and some diagnostic and radiological services, with some services having a copay or coinsurance.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you'll pay a $320 copay for days 1-6, and no copay for days 7-90, and for Inpatient Hospital Psychiatric, you'll pay a $318 copay for days 1-5, and no copay for days 6-90. Additional Days for Inpatient Hospital-Acute are covered with no copay 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 outpatient hospital services with a copay between $0 and $295, observation services with a $125 copay, ambulatory surgical center services with no copay, and outpatient substance abuse services with a $20 copay for individual and group sessions. Outpatient blood services are also covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Value (PPO) plan, but requires prior authorization. You will have a $20 copay for this benefit.
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 $250 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, including Worldwide Emergency Coverage and Worldwide Urgent Coverage, are covered under the BlueMedicare Value (PPO) plan. Emergency Services have a $125 copay with no coinsurance, Urgently Needed Services have a $40 copay with no coinsurance, and Worldwide Emergency Coverage and Worldwide Urgent Coverage each have a $125 copay. 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, Physician Specialist Services with a $45 copay, and Mental Health Specialty Services with a $20 copay for individual and group sessions. The plan also covers Other Health Care Professional with a copay between $0 and $20, Psychiatric Services with a $20 copay for individual and group sessions, Physical Therapy and Speech-Language Pathology Services with a copay between $0 and $40, Additional Telehealth Benefits with a copay between $0 and $45, and Opioid Treatment Program Services with a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
The BlueMedicare Value (PPO) plan covers Medicare-covered zero dollar preventive services, and additional preventive services, but does not cover annual physical exams. Other services, such as health education, in-home safety assessments, and more are not covered.
Hearing Services See details
Hearing Services are covered, including Hearing Exams with a $45 copay. Routine Hearing Exams and Fitting/Evaluation for Hearing Aids are also covered, with no copay. Prescription Hearing Aids are partially covered, and the plan does not cover Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear. OTC Hearing Aids are not covered.
Vision Services See details
The BlueMedicare Value (PPO) plan covers vision services, including eye exams with a copay between $0 and $45, and eyewear with a $0 copay. The plan also covers routine eye exams with no copay, and eyewear with a combined maximum plan benefit of $200 per year.
Dental Services See details
Dental Services are covered by the BlueMedicare Value (PPO) plan, including Medicare Dental Services with a $45 copay, and Other Dental Services with no copay. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable), and Oral and Maxillofacial Surgery are covered with no copay, while 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, including 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. Prior authorization is required.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Value (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment, including Durable Medical Equipment (DME), Prosthetics, Medical Supplies, and Diabetic Equipment, is covered by the BlueMedicare Value (PPO) plan. DME has no copay and a coinsurance between 0% and 20%, while Durable Medical Equipment for use outside the home is not covered. Medicare-covered Prosthetic Devices have a 20% coinsurance, and Medical Supplies have no coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with prior authorization required. Diagnostic Procedures/Tests have a copay between $0 and $75, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 and $150, while Therapeutic Radiological Services have a coinsurance of 20%. Outpatient X-Ray Services have a copay of $15.
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 for this benefit, but none of the sub-services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Value (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $57 every three months, and also includes Nicotine Replacement Therapy (NRT) and Naloxone coverage. Acupuncture, Meal Benefit, 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.
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