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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 Northeast & Central Florida. 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. Members enjoy 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 plan offers excellent cost savings on essential everyday medications. For higher-tier medications, costs are structured as coinsurance rather than flat copayments. Tier 3 (Preferred Brand) drugs require a 21% coinsurance, and Tier 4 (Non-Preferred) drugs carry a 30% coinsurance for 1-month and 3-month fills. Specialty Tier (Tier 5) medications are covered with a 25% coinsurance for a 1-month supply.
Additional Benefits
The BlueMedicare Value (PPO) plan offers robust medical coverage with no copays for primary care doctor visits, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $385 daily copay for the first seven days, while outpatient hospital visits carry a $370 copay. Emergency room visits require a $115 copay, which is waived if admitted, and urgent care is available with a $40 copay. This plan also provides valuable dental, vision, and hearing benefits, including no copays for routine dental cleanings, annual eye exams, and hearing evaluations. Members can take advantage of a $200 annual allowance for eyewear and prescription hearing aid coverage with copays ranging from $350 to $1,825. For specialized recovery, skilled nursing facility care features no copay for the first 20 days, followed by a $218 daily copay up to day 100.
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, followed by no copay for additional days. Inpatient psychiatric care is also covered with no coinsurance and a $416 daily copay for days 1 to 5, though upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueMedicare Value (PPO) covers outpatient services with no coinsurance, featuring a $370 copay for outpatient hospital visits, a $115 copay per stay for observation services, and a $320 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $50 copay with no coinsurance, 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 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
BlueMedicare Value (PPO) covers ambulance services with prior authorization, featuring a copay ranging from no copay to $335 for ground ambulance services (with no coinsurance) and a 20% coinsurance for air ambulance services (with no copay). These costs are not waived if you are admitted to the hospital, and transportation services are not covered under this plan.
Emergency Services See details
BlueMedicare Value (PPO) covers emergency services with a $115 copay, which is 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 lifetime maximum with a $115 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Value (PPO) offers primary care doctor visits with no copay and no coinsurance, and specialist visits with copays ranging from no copay to $55 and no coinsurance. Other covered benefits, including physical therapy, mental health, and telehealth services, feature copays ranging from no copay to $55 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by BlueMedicare Value (PPO) with no copay and no coinsurance for covered services, which include Medicare-covered preventive care, kidney disease education, and memory fitness. Sub-services such as annual physical exams, health education, in-home safety assessments, personal emergency response systems, and alternative therapies are not covered.
Hearing Services See details
BlueMedicare Value (PPO) covers routine hearing exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $350.00 to $1,825.00, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Value (PPO) with no deductibles and no coinsurance, offering one annual routine eye exam with no copay, while other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a combined maximum of $200 per year for contacts, eyeglasses, lenses, frames, and upgrades.
Dental Services See details
BlueMedicare Value (PPO) covers dental services with a $55 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered services such as exams, cleanings, and select surgeries. The dental benefit is partially covered, as other diagnostic services, endodontics, periodontics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered under the BlueMedicare Value (PPO) plan, requiring prior authorization and step therapy. Covered Medicare Part B insulin carries a $35 copay and 0% to 20% coinsurance, while chemotherapy, radiation, and other Part B drugs have 0% to 20% coinsurance and no copay.
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 with no copays for all covered categories, though coinsurance varies depending on the item. Durable medical equipment incurs 0% to 20% coinsurance, prosthetic devices and medical supplies carry a 20% coinsurance, and diabetic equipment and supplies are provided with no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Value (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $75 copay for diagnostic tests. Radiological services are also covered, requiring a $15 copay for outpatient X-rays, copays starting at $0 for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiological services.
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
Cardiac Rehabilitation Services are covered by BlueMedicare Value (PPO) with no copay and no coinsurance, although prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
BlueMedicare Value (PPO) covers Skilled Nursing Facility (SNF) care with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though 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, with acupuncture, over-the-counter (OTC) items, and meal benefits all excluded from coverage.
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