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BlueMedicare Patriot (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Patriot (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Patriot (PPO) in 2025, please refer to our full plan details page.
BlueMedicare Patriot (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 Patriot (PPO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueMedicare Patriot (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 Patriot (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. Additionally, this plan comes with a Part B Premium reduction of $75.00. You must continue to pay paying your reduced Part B Premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $8950.00 (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 $8950.00 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
Prescription drugs are not covered by BlueMedicare Patriot (PPO).
Additional Benefits
The BlueMedicare Patriot (PPO) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have copays depending on the length of stay, while outpatient services, including substance abuse and blood services, have copays that range from $0-$300. Emergency services, primary care, and preventive services are covered with no copay, along with several other services, including routine eye exams, eyewear, and dental services. The plan also covers hearing, vision, and dental services with copays, as well as home infusion, dialysis, and medical equipment with copays or coinsurance. Ambulance services have a $250 copay, and skilled nursing facilities have no copay for the first 20 days, and then a $214 copay per day. The plan also includes coverage for OTC items and nicotine replacement therapy.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric inpatient hospital stays. For acute stays, there is a $350 copay for days 1-4, and no copay for days 5-90; additional days (91-999) have no copay. For psychiatric stays, there is 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 include coverage for all outpatient hospital services, with a copay between $0 and $300, observation services with a $125 copay, and ambulatory surgical center services with no copay. Outpatient substance abuse services include individual and group sessions, both with a $20 copay. Outpatient blood services are covered with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Patriot (PPO) plan, with a $20 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Patriot (PPO) plan. Ground and Air Ambulance Services have a $250 copay, but no coinsurance, while 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 by the BlueMedicare Patriot (PPO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $30 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
The BlueMedicare Patriot (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, and occupational therapy services with a $40 copay, and also covers physician specialist services with a $45 copay. Mental health specialty services, including individual and group sessions, have a $20 copay. Other health care professional services have a copay between $0 and $20, and psychiatric services, including individual and group sessions, have a $20 copay. 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. Opioid treatment program services have a $20 copay.
Preventive Services See details
The BlueMedicare Patriot (PPO) plan covers preventive services, including Medicare-covered services, with no copay. Additional services are partially covered; however, 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, 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 a Welcome Visit are covered with no copay. Support for Caregivers of Enrollees and the fitness benefit also 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 are covered, with a copay between $350 and $1825 for all types of prescription hearing aids, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams and eyewear. Eye exams have a copay between $0 and $45, and routine eye exams have no copay, while eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum benefit of $200 per year.
Dental Services See details
The BlueMedicare Patriot (PPO) plan covers dental services, including Medicare Dental Services with a $45 copay, and other dental services with no copay. Oral exams, Dental X-Rays, and Prophylaxis (Cleaning) are covered, while Fluoride Treatment, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Maxillofacial Prosthetics, Implant Services, Prosthodontics, fixed, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and other Medicare Part B Drugs with no copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Patriot (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment benefits are covered by the BlueMedicare Patriot (PPO) plan, including Durable Medical Equipment (DME) with no copay and 0-20% coinsurance, Prosthetics/Medical Supplies with no copay and coinsurance for Medicare-covered items, 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 are covered by the BlueMedicare Patriot (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay of at most $75, and Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services have a $15 copay.
Home Health Services See details
Home Health Services are covered by the BlueMedicare Patriot (PPO) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by the BlueMedicare Patriot (PPO) plan, but the specific services offered are not covered. Prior authorization is required for these services, and there is a copay, but the specific amount is not listed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Patriot (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items with a maximum benefit of $50 every three months, and it also includes Nicotine Replacement Therapy (NRT) as a Part C OTC benefit, but 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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