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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 Lake, Marion, & Sumter 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 $150.00 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 $150 deductible for prescription drugs. After the deductible, you will pay either a copay or coinsurance depending on the drug tier and pharmacy. For preferred generic and specialty drugs, there is no copay when using a standard or mail-order pharmacy. For other tiers, you will pay coinsurance, which varies based on the drug tier and whether you use a preferred or standard pharmacy.
Additional Benefits
The BlueMedicare Value (PPO) plan offers a range of benefits, including inpatient hospital stays with copays, and outpatient services with copays that vary by service. The plan also covers emergency services, primary care with no copay, and preventive services, along with hearing, vision, and dental services. Prescription hearing aids have copays between $350 and $1825, and vision services have a combined maximum plan benefit coverage of $200 per year. Other covered services include ambulance, home health, and skilled nursing facility stays, with varying copays and coinsurance. Medical equipment, diagnostic services, and home infusion are also included, along with coverage for OTC items up to $75 every three months. However, some services like cardiac rehabilitation, and certain therapies and treatments are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, you pay a $290 copay for days 1-6, and no copay for days 7-90; for Inpatient Hospital Psychiatric, you pay a $318 copay for days 1-5, and no copay for days 6-90. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, with a copay between $0 and $225. Observation services have a $125 copay per stay, Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services have a $20 copay for both individual and group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Value (PPO) plan, but requires prior authorization. You will have a $20 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by BlueMedicare Value (PPO). Ground and Air Ambulance Services have a $250 copay, and there is no coinsurance. Transportation Services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage are covered under the BlueMedicare Value (PPO) plan. Emergency Services and Worldwide Emergency Coverage have a $125 copay, and Urgently Needed Services has a $30 copay. Worldwide Urgent Coverage also has a $125 copay, while Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Value (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $40 copay, and physician specialist services with a $25 copay. Mental health specialty services, psychiatric services, and opioid treatment program services have a $20 copay for individual and group sessions. Physical therapy, speech-language pathology, and additional telehealth benefits have a copay between $0 and $40. Podiatry services are not covered.
Preventive Services See details
Preventive Services are covered, but 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
The BlueMedicare Value (PPO) plan covers hearing exams with a $25 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay, and prescription hearing aids with a copay between $350 and $1825. Prescription hearing aids for the inner ear, outer ear, and 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 between $0 and $25, and eyewear with a combined maximum plan benefit coverage of $200 per year. Routine eye exams, contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades all have no copay.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with a $25 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 also 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, and require prior authorization. For Medicare Part B Insulin Drugs, you pay a $35 copay and between 0% and 20% coinsurance, and for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, you pay between 0% and 20% coinsurance, with no copay.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Value (PPO) plan. There is a 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment coverage includes Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, and Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items. Diabetic Equipment includes Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts, both with no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered. Diagnostic Procedures/Tests have a copay between $0 and $75, Lab Services have no copay, Diagnostic Radiological Services have a copay up to $110, and Therapeutic Radiological Services have 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. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueMedicare Value (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the BlueMedicare Value (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100.
Other Services See details
Other Services for the BlueMedicare Value (PPO) plan includes coverage for Over-the-Counter (OTC) items, with a maximum benefit coverage amount of $75.00 every three months. 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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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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