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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 Citrus & Hernando 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 is met, you will pay either a copay or coinsurance for your medications, depending on the drug tier and pharmacy. For example, for a standard generic drug at a standard pharmacy, you will pay 25% coinsurance. For a specialty tier drug, you will have no copay.
Additional Benefits
The BlueMedicare Value (PPO) plan offers a variety of benefits with varying costs. For inpatient hospital stays, you'll pay a copay, with no copay after the first few days. Outpatient services have copays depending on the service, while emergency services and primary care visits have their own copays. This plan also includes coverage for hearing, vision, and dental services, with no copays for routine eye exams and other dental services. Additional benefits include coverage for home health services with no copay, and medical equipment with coinsurance.
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 $320 copay for days 1-6, and no copay for days 7-90, with no coinsurance. For Inpatient Hospital Psychiatric, you will pay a $318 copay for days 1-5, and no copay for days 6-90, with no coinsurance. Additional Days for Inpatient Hospital-Acute are covered with no copay and no coinsurance for days 91-999. Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services are covered by the BlueMedicare Value (PPO) plan and include Outpatient Hospital Services with a copay between $0 and $295, Observation Services with a $125 copay, Ambulatory Surgical Center (ASC) Services with no copay, Outpatient Substance Abuse Services with a $20 copay for both individual and group sessions, and Outpatient Blood Services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Value (PPO) plan, but requires prior authorization. You will pay a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the BlueMedicare Value (PPO) plan. Ground and Air Ambulance Services have a $250 copay, with no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Coverage are covered under the BlueMedicare Value (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, while Urgently Needed Services have a $30 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Value (PPO) plan offers primary care services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $45 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $20 copay for individual and group sessions. Physical therapy and speech-language pathology services have a copay between $0 and $40, and additional telehealth benefits have a copay between $0 and $45. Podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, and additional preventive services, though annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, 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, home and bathroom safety devices and modifications, and counseling services are not covered. Kidney disease education services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit have no copay. Support for Caregivers of Enrollees and Fitness Benefit have no copay.
Hearing Services See details
Hearing Services 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 (all types) are covered with a copay between $350 and $1825, while Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered, and OTC Hearing Aids are not covered.
Vision Services See details
The BlueMedicare Value (PPO) plan covers vision services, including eye exams with a copay of $0-$45, and eyewear with no copay. Routine eye exams are covered with no copay for one visit every year.
Dental Services See details
The BlueMedicare Value (PPO) plan covers Medicare and other dental services, with a $45 copay for Medicare dental services. Other dental services have no copay. Oral exams, dental x-rays, prophylaxis (cleaning), fluoride treatments, 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, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay and between 0% and 20% coinsurance, while Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have between 0% and 20% coinsurance, and no copay.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Value (PPO) plan. The plan has a coinsurance of 20% for dialysis services.
Medical Equipment See details
Medical Equipment benefits are covered, including Durable Medical Equipment with a 0-20% coinsurance and Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies. Diabetic Equipment is covered with a copay for Medicare-covered Diabetes Supplies and Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
The BlueMedicare Value (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a copay between $0 and $75, and lab services with no copay. Diagnostic radiological services have a copay of up to $150, therapeutic radiological services have a coinsurance of at least 20%, and 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. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but none of the specific services are covered. Prior authorization is required for these services, but the plan does not specify the copay or coinsurance.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Value (PPO) plan with prior authorization required. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services include Over-the-Counter (OTC) Items, which are covered with a maximum benefit coverage amount of $51 every three months, as well as Nicotine Replacement Therapy (NRT) and Naloxone. Acupuncture, Meal Benefit, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), 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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