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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 Citrus & Hernando 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 has an annual prescription drug deductible of $615. Under this plan, you will enjoy no copay for 1-month and 3-month supplies of Tier 1 preferred generic, Tier 2 generic, and Tier 6 select care drugs at standard pharmacies and standard mail order. For other drug tiers, you will pay a percentage of the cost rather than a flat copayment. Tier 3 preferred brand drugs require a 21% coinsurance, Tier 4 non-preferred drugs require a 30% coinsurance, and Tier 5 specialty drugs require a 25% coinsurance for a 1-month supply.
Additional Benefits
The BlueMedicare Value (PPO) plan offers robust coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for primary care visits, preventive services, and home health care. For specialist visits, copays range from $0 to $60, while inpatient hospital stays require a $385 daily copay for the first seven days. Emergency care is accessible with a $130 copay, and urgent care visits require a $50 copay, with no coinsurance for either service. This plan also includes valuable supplemental benefits, providing no-copay routine dental cleanings, annual vision exams with a $200 eyewear allowance, and routine hearing tests. Prescription hearing aids are partially covered with copays between $350 and $1,825, and members receive a $30 quarterly allowance for over-the-counter items with no copay. Additionally, diagnostic lab tests and diabetic supplies are fully covered with no copays or coinsurance.
Inpatient Hospital See details
BlueMedicare Value (PPO) covers inpatient hospital services with no coinsurance, requiring a $385 copay for days 1 to 7 of acute stays (with no copay for days 8 and beyond) and a $350 copay for days 1 to 6 of psychiatric stays (with no copay for days 7 to 90). Non-Medicare-covered stays, upgrades, and additional psychiatric days are not covered under this benefit.
Outpatient Services See details
Outpatient services are covered by BlueMedicare Value (PPO) with no coinsurance, featuring a $350 copay for outpatient hospital services, a $130 copay per stay for observation services, and a $295 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 to $40 copay with no coinsurance, while outpatient blood services are provided 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 to receive this covered benefit.
Ambulance and Transportation Services See details
Ambulance services under BlueMedicare Value (PPO) require prior authorization, offering ground ambulance services with a copay of $0 to $340 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
BlueMedicare Value (PPO) covers emergency services with a $130 copay and no coinsurance, with the copay waived if admitted to the hospital within 48 hours, 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 benefit with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Value (PPO) covers primary care physician services with no copay and no coinsurance, and specialist visits with a $0 to $60 copay and no coinsurance. Other services like physical therapy, occupational therapy, and mental health services feature copays ranging from $0 to $60 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by BlueMedicare Value (PPO) with no copay and no coinsurance, including Medicare-covered zero-dollar preventive services, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, EKGs, and a memory fitness benefit. However, this coverage is partial, as annual physical exams and several supplemental services—such as health education, in-home safety assessments, and nutritional benefits—are not covered.
Hearing Services See details
BlueMedicare Value (PPO) covers hearing services with no copay, no coinsurance, and no deductible for annual routine exams and fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and a copay of $350.00 to $1,825.00 for up to two devices per year, though inner ear, outer ear, over the ear, and over-the-counter hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Value (PPO), offering no copay and no coinsurance for one annual routine eye exam and up to $200 per year for eyewear, though other eye exam services are not covered. Covered eyewear, including contacts, eyeglasses, frames, lenses, and upgrades, also features no copay and no coinsurance.
Dental Services See details
BlueMedicare Value (PPO) provides partially covered dental services, with Medicare-covered dental requiring a $60 copay and no coinsurance, while covered preventive and comprehensive services like exams, cleanings, fillings, dentures, and oral surgery have no copay and no coinsurance. Sub-services such as other diagnostic services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BlueMedicare Value (PPO) subject to prior authorization and step therapy. Part B insulin requires a $35 copay and 0% to 20% coinsurance, while other covered Part B drugs require no copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by BlueMedicare Value (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Value (PPO) covers medical equipment with no copays, though coinsurance and prior authorization requirements apply to certain items. Durable medical equipment incurs a 0% to 20% coinsurance, prosthetics and medical supplies require a 20% coinsurance, and diabetic supplies and therapeutic shoes are available with no copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Value (PPO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance and no copay for lab services, and a $0 to $75 copay for diagnostic procedures. Radiological services include outpatient X-rays for a $15 copay, diagnostic radiological services with no copay, and therapeutic radiological services with a minimum 20% coinsurance.
Home Health Services See details
BlueMedicare Value (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
BlueMedicare Value (PPO) covers cardiac rehabilitation services with 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
Skilled Nursing Facility (SNF) care is covered by BlueMedicare Value (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days beyond the Medicare-covered limit.
Other Services See details
BlueMedicare Value (PPO) partially covers other services, offering 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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