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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 Hillsborough & Polk 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:
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Drug Coverage
The BlueMedicare Value (PPO) plan features an annual prescription drug deductible of $615. For Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs), members enjoy no copay for both 1-month and 3-month supplies filled at standard pharmacies or through standard mail order. This ensures that many common medications are accessible with zero out-of-pocket copayments. For higher-tier medications, costs are structured as coinsurance percentages at standard pharmacies and standard mail order. Tier 3 (Preferred Brand) drugs require a 21% coinsurance, Tier 4 (Non-Preferred) drugs carry a 30% coinsurance, and Tier 5 (Specialty) drugs require a 25% coinsurance for a 1-month supply. This clear cost-sharing structure helps you easily estimate your prescription drug expenses with the BlueMedicare Value (PPO) plan.
Additional Benefits
The BlueMedicare Value (PPO) plan offers affordable healthcare coverage with no copay and no coinsurance for primary care doctor visits and covered preventive services. Specialist visits are available with a $60 copay, while inpatient hospital stays require a $385 daily copay for the first seven days of your stay. Emergency room visits carry a $130 copay, which is waived if you are admitted, and urgently needed care is accessible with a $50 copay. This plan also features robust extra benefits, including no copay and no coinsurance for routine dental, routine vision, and home health services. Routine hearing exams are also available with no copay, and prescription hearing aids are covered with copays starting at $350. Additionally, diabetic supplies have no copay, while durable medical equipment is covered with a 20% coinsurance and no copay.
Inpatient Hospital See details
BlueMedicare Value (PPO) covers inpatient hospital care with no coinsurance, requiring a $385 copay per day for days 1 through 7 of acute stays and a $350 copay per day for days 1 through 6 of psychiatric stays, with no copay for remaining covered days. The benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueMedicare Value (PPO) covers outpatient hospital services with no coinsurance and copays ranging from $0 to $350, and ambulatory surgical center services with a $295 copay and no coinsurance. Outpatient substance abuse services carry a $30 to $40 copay with no coinsurance, while outpatient blood services are available with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by BlueMedicare Value (PPO) with a $50.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
BlueMedicare Value (PPO) covers ground ambulance services with no copay to a $330 copay and coinsurance, and air ambulance services with a 20% coinsurance and a copay, with prior authorization required. Transportation services to health-related locations are not covered.
Emergency Services See details
BlueMedicare Value (PPO) covers emergency services with a $130 copay (waived if admitted within 48 hours) and no coinsurance, and urgently needed services with a $50 copay and 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) provides primary care physician services with no copay and no coinsurance, and specialist visits with a $60 copay and no coinsurance. Covered therapy, mental health, and telehealth services have copays ranging from $0 to $60 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services are partially covered by BlueMedicare Value (PPO), offering covered options like memory fitness, kidney disease education, and glaucoma screenings with no copay and no coinsurance. However, the plan does not cover annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, and therapeutic massage. Also excluded are adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, remote access, home modifications, and counseling.
Hearing Services See details
Hearing services are covered by BlueMedicare Value (PPO), which features a $60 copay and no coinsurance for Medicare-covered exams, and no copay or coinsurance for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with copays ranging from $350 to $1,825 and no coinsurance for up to two aids per year, though OTC hearing aids as well as inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
BlueMedicare Value (PPO) partially covers vision services with no deductibles, offering routine eye exams and eyewear with no copay and no coinsurance. Eyewear is covered up to a $200 annual combined limit, but other eye exam services are not covered.
Dental Services See details
BlueMedicare Value (PPO) dental services are covered with a $60 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for other covered preventive and comprehensive services. This benefit is partially covered, as it excludes other diagnostic services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BlueMedicare Value (PPO) with prior authorization, featuring a $35 copay and 0% to 20% coinsurance for insulin. Chemotherapy and radiation drugs require a 0% to 20% coinsurance, while other Medicare Part B drugs carry a 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
Medical equipment is covered by BlueMedicare Value (PPO), with durable medical equipment, prosthetics, and medical supplies featuring no copay and a 20% coinsurance. Diabetic equipment, including diabetic supplies and therapeutic shoes or inserts, is covered with no copay and 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 and procedures. Radiological services are also covered, requiring a $15 copay and coinsurance for outpatient X-rays, a $0 minimum copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology, with prior authorization required.
Home Health Services See details
Home Health Services are covered under the BlueMedicare Value (PPO) plan with no copay and no coinsurance. Prior authorization is required to access these covered home health benefits.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueMedicare Value (PPO) with no copay and no coinsurance, though prior authorization is required. While some services are covered, standard cardiac, intensive cardiac, pulmonary, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
BlueMedicare Value (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, though additional days beyond the Medicare-covered limit are not covered. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, with prior authorization required and no prior 3-day hospital stay necessary.
Other Services See details
BlueMedicare Value (PPO) partially covers Other Services, providing over-the-counter (OTC) items with no copay and no coinsurance up to a $30 maximum benefit every three months. Acupuncture and meal benefits are not covered under this plan.
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