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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 Charlotte & Lee counties. 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. In the initial coverage phase, after you meet the deductible, you will pay either a copay or coinsurance depending on the drug tier and the pharmacy you use. For example, in the initial coverage phase, you will have no copay for preferred generic drugs and specialty tier drugs at standard and mail order pharmacies. Standard generic and preferred brand drugs will have a 25% coinsurance, and non-preferred drugs will have a 30% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for Part D covered drugs.
Additional Benefits
The BlueMedicare Value (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay that varies depending on the length of stay, and outpatient services with copays for services like outpatient hospital and observation. Emergency, urgent, and ambulance services are covered with copays, and preventive services have no copay for many Medicare-covered services, such as screenings. The plan also covers primary care with no copay, specialist visits with a copay, and certain therapies. Hearing and vision services are included, with coverage for exams and eyewear. Dental services, home infusion, dialysis, medical equipment, diagnostic, and home health services are also covered, with varying cost-sharing arrangements.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you pay a $320 copay for days 1-6 and no copay for days 7-90, while additional days 91-999 have no copay; Non-Medicare-covered stays and upgrades are not covered. For Inpatient Hospital Psychiatric, you pay a $318 copay for days 1-5 and no copay for days 6-90; additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services are covered by the BlueMedicare Value (PPO) plan, with the following cost sharing: Outpatient Hospital Services have a copay between $0 and $295, Observation Services have a $125 copay, Ambulatory Surgical Center (ASC) Services have no copay, Individual and Group Sessions for Outpatient Substance Abuse have a copay between $20 and $20, and Outpatient Blood Services have no copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueMedicare Value (PPO) plan. This benefit requires prior authorization and has a $20 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services for the BlueMedicare Value (PPO) plan cover both ground and air ambulance services with a $250 copay, and no coinsurance. Transportation services to health-related locations 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, and Urgently Needed Services has a $30 copay, and there is no coinsurance for any of these services. 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 services with a $40 copay. The plan also covers 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. Additional telehealth benefits are covered with a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by the BlueMedicare Value (PPO) plan, with no copay for Medicare-covered services like Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit. Annual Physical Exams, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), and several other services are not covered.
Hearing Services See details
Hearing Services are covered by the BlueMedicare Value (PPO) plan, including Hearing Exams with a $45 copay, Routine Hearing Exams with no copay, and Fitting/Evaluation for Hearing Aid with no copay. Prescription Hearing Aids are partially covered, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
The BlueMedicare Value (PPO) plan covers vision services, including eye exams with a copay ranging from $0 to $45. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, are covered with a $0 copay, and a combined maximum benefit of $200 per year.
Dental Services See details
Dental Services are covered by BlueMedicare Value (PPO), including Medicare Dental Services with a $45 copay, and other dental services with no copay. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable), and oral and maxillofacial surgery are also covered, but 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 insulin, Medicare Part B chemotherapy/radiation drugs, and other Medicare Part B drugs. Insulin has a $35 copay and a coinsurance between 0% and 20%, while other Medicare Part B drugs have no copay and a coinsurance between 0% and 20%.
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 benefits are covered, including durable medical equipment with a coinsurance between 0% and 20%, and prosthetics and medical supplies with no copay and a coinsurance for some services. Diabetic equipment is covered with no copay for diabetic supplies and diabetic therapeutic shoes/inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueMedicare Value (PPO) plan. Diagnostic Procedures/Tests have a minimum copay of $0 and a maximum copay of $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $75 and $150, and Therapeutic Radiological Services have a 20% coinsurance. 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. However, 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. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
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.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $61 every three months; however, 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.
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