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 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 Charlotte & Lee counties. 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 $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 features an annual drug deductible of $615. Members benefit from no copay on Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care) drugs for both 1-month and 3-month fills at standard pharmacies and standard mail order. This ensures that many common maintenance and generic medications are available at no cost to you. For other brand-name and specialty medications, your costs are based on a percentage of the drug's cost. You will pay 21% coinsurance for Tier 3 (Preferred Brand) drugs and 30% coinsurance for Tier 4 (Non-Preferred) drugs. Tier 5 (Specialty) medications require a 25% coinsurance for a 1-month supply.
Additional Benefits
The BlueMedicare Value (PPO) plan offers comprehensive coverage for everyday medical needs, featuring no copay and no coinsurance for primary care doctor visits, preventive services, and home health care. Specialist visits range from no copay up to a $60 copay, while inpatient hospital stays require a daily copay of $385 for the first seven days with no coinsurance. Emergency room visits carry a $130 copay, which is waived if you are admitted within 48 hours. For routine wellness, the plan includes routine dental, vision, and hearing exams with no copay or coinsurance, plus a $200 annual allowance for eyewear. Prescription hearing aids and select dental services are covered with predictable copays and no coinsurance. Additionally, diabetic supplies are covered with no copay, while durable medical equipment and dialysis services are subject to a 20% coinsurance.
Inpatient Hospital See details
BlueMedicare Value (PPO) covers inpatient hospital services with no coinsurance, requiring a $385 daily copay for days 1-7 of acute stays and a $350 daily copay for days 1-6 of psychiatric stays, with no copay for subsequent days. Prior authorization is required, and the plan does not cover hospital upgrades, non-Medicare-covered stays, or additional psychiatric days.
Outpatient Services See details
BlueMedicare Value (PPO) covers outpatient services with no coinsurance, including outpatient hospital services for a $350 copay, observation services for a $130 copay per stay, and ambulatory surgical center services for a $295 copay. Outpatient substance abuse services require no coinsurance with a $40 copay for individual sessions and a $30 copay for group sessions, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
BlueMedicare Value (PPO) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required for these covered services.
Ambulance and Transportation Services See details
BlueMedicare Value (PPO) covers ambulance services with prior authorization, featuring no copay to a $360 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Transportation services are not covered.
Emergency Services See details
BlueMedicare Value (PPO) covers emergency services with a $130 copay (waived if admitted within 48 hours) and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Value (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $60 copay and no coinsurance. Additional benefits like physical therapy, occupational therapy, and mental health services require copays ranging from $0 to $45 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
BlueMedicare Value (PPO) partially covers preventive services with no copay and no coinsurance for covered care, including Medicare-covered preventive services, kidney disease education, select screenings, and a memory fitness benefit. Several supplemental services are not covered under this plan, such as annual physical exams, health education, in-home safety assessments, nutritional benefits, and personal emergency response systems.
Hearing Services See details
BlueMedicare Value (PPO) partially covers hearing services, offering routine exams and fitting evaluations once per year with no deductible, no copay, and no coinsurance. Prescription hearing aids are covered with no coinsurance and a copay ranging from $350.00 to $1,825.00, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Value (PPO), featuring no coinsurance and no copay for annual routine eye exams, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual maximum for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
BlueMedicare Value (PPO) dental services are partially covered, featuring a $60 copay and no coinsurance for Medicare-covered dental care, and no copay or coinsurance for preventive and select comprehensive services. Some services are not covered under this plan, including endodontics, periodontics, implants, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BlueMedicare Value (PPO), subject to prior authorization and step therapy requirements. Covered Part B insulin drugs carry a $35 copay and no coinsurance to 20% coinsurance, chemotherapy and radiation drugs require no coinsurance to 20% coinsurance, and 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
BlueMedicare Value (PPO) covers medical equipment, featuring no copay for all covered categories. Durable medical equipment, prosthetic devices, and medical supplies are subject to a 20% coinsurance and require prior authorization, while diabetic supplies and therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Value (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic procedures with no coinsurance and copays ranging from $0 to $75, while lab services have no copay. Radiological services include a $15 copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum 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, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueMedicare Value (PPO) with no coinsurance, though prior authorization is required. While some services are covered, standard cardiac rehabilitation ($35 copay), intensive cardiac ($50 copay), pulmonary ($15 copay), and SET for PAD ($25 copay) services are not covered in practice.
Skilled Nursing Facility (SNF) See details
BlueMedicare Value (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are not covered under the BlueMedicare Value (PPO) plan, as acupuncture, over-the-counter (OTC) items, and meal benefits are all excluded from coverage.
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