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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 Hillsborough & Polk 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. After the deductible, you'll pay either a copay or coinsurance depending on the drug tier and whether you use a preferred or standard pharmacy. For example, you'll pay no copay for preferred generic drugs and specialty tier drugs at a standard pharmacy, and 25% coinsurance for standard generic and preferred brand drugs at a standard pharmacy. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Value (PPO) plan offers a range of benefits with varying costs. For hospital stays, you'll encounter copays, such as $320 for acute inpatient stays (days 1-6), and $318 for psychiatric stays (days 1-5). Outpatient services have copays ranging from $0 to $295, and other services like ambulance, emergency, and specialist visits have copays as well. This plan provides coverage for primary care with no copay, and also includes hearing, vision, and dental benefits, some with no copays. Preventive services are covered without a copay for Medicare-covered services. Home infusion services have a $35 copay for some drugs, and medical equipment is covered with no copay for DME.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a copay of $320 for days 1-6, and no copay for days 7-90, and for days 91-999, you will have no copay. For Inpatient Hospital Psychiatric, you will pay a copay of $318 for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades are not covered for Inpatient Hospital-Acute, and additional days and non-Medicare-covered stays are not covered for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient services are covered under the BlueMedicare Value (PPO) plan. Outpatient Hospital Services have a copay between $0 and $295, Observation Services have a $125 copay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services also have no copay. Individual and Group Sessions for Outpatient Substance Abuse have a copay of $20.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Value (PPO) plan, but requires prior authorization. The copay for this benefit is $20.
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 $295 copay, with 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 by the BlueMedicare Value (PPO) plan, with a $125 copay and no coinsurance. Urgently Needed Services have a $40 copay and no coinsurance, and Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care Physician Services have no copay. Chiropractic Services have a $20 copay, but Routine Chiropractic Care is not covered. Occupational Therapy Services have a $40 copay. Physician Specialist Services have a $45 copay. Mental Health Specialty Services have a copay of $20 for individual and group sessions. Other Health Care Professional services have a copay between $0 and $20. Psychiatric Services have a copay of $20 for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $40. Additional Telehealth Benefits have a copay between $0 and $45. Opioid Treatment Program Services have a copay of $20.
Preventive Services See details
Preventive Services are covered by the BlueMedicare Value (PPO) plan, with no copay for Medicare-covered services such as Glaucoma Screenings, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKGs following a Welcome Visit. Annual physical exams, Health Education, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefits, Home-Based Palliative Care, In-Home Support Services, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline), Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services for BlueMedicare Value (PPO) include hearing exams with a $45 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, with a copay between $350 and $1825 for all types, but inner ear, outer ear, and over the ear hearing aids are not covered; 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 no copay and a combined maximum plan benefit of $200 every year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay.
Dental Services See details
The BlueMedicare Value (PPO) plan covers 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 covered with no copay. Adjunctive general services, maxillofacial prosthetics, implant services, orthodontics, and prosthodontics (fixed) are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs. You will pay a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0-20% for all of these services.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Value (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetic Devices with 20% coinsurance, Medical Supplies with no coinsurance, and Diabetic Equipment with no copay for Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, Lab Services, and Radiological Services, are covered. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay between $50 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, but Additional Hours of Care and Personal Care Services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueMedicare Value (PPO) plan. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueMedicare Value (PPO), but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for over-the-counter (OTC) items, with a maximum benefit of $56 every three months. 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, 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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