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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 2026, 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 2026.
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 $100.00. You must continue to pay paying your reduced 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.
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 $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
Prescription drugs are not covered by BlueMedicare Patriot (PPO).
Additional Benefits
The BlueMedicare Patriot (PPO) plan offers affordable medical coverage with no copay and no coinsurance for primary care visits and routine preventive services. Specialists are accessible for a $55 copay, while inpatient hospital stays require a daily copay of $385 for the first seven days of acute stays with no coinsurance. Emergency care is available with a $130 copay, which is waived if you are admitted to the hospital within 48 hours. Beneficiaries also enjoy valuable everyday benefits, including routine dental cleanings, annual hearing exams, and routine vision exams with no copay. Additionally, the plan covers eyewear up to a $200 annual limit and provides a $50 quarterly allowance for over-the-counter items with no copay or coinsurance. Other essential services like home health care feature no copay, while durable medical equipment and dialysis require a 20% coinsurance.
Inpatient Hospital See details
BlueMedicare Patriot (PPO) covers inpatient hospital services with no coinsurance, requiring a $385 daily copay for days 1-7 of acute stays and a $350 daily copay for days 1-6 of psychiatric stays, followed by no copay for remaining covered days. Prior authorization is required, and sub-services such as hospital upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services under BlueMedicare Patriot (PPO) are covered with no coinsurance, including outpatient hospital visits for a $350 copay, observation services for a $130 copay per stay, and ambulatory surgical center services for a $300 copay. Outpatient substance abuse services require a $30 to $40 copay with no coinsurance, while outpatient blood services are fully covered with no copay and no coinsurance.
Partial Hospitalization See details
BlueMedicare Patriot (PPO) covers partial hospitalization services with a $50.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
BlueMedicare Patriot (PPO) covers ambulance services with prior authorization, requiring coinsurance and a copay of no copay to $275 for ground services, and a 20% coinsurance plus a copay for air services. For transportation benefits, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
BlueMedicare Patriot (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 48 hours, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency services are partially covered up to a $25,000 maximum with a $130 copay and no coinsurance for emergency and urgent care, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Patriot (PPO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Additional covered services like physical therapy, telehealth, and mental health care have copays ranging from $0 to $55 and no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive Services under BlueMedicare Patriot (PPO) are partially covered, offering key services like Medicare-covered zero-dollar preventive care, kidney disease education, and memory fitness with no copay and no coinsurance. However, several benefits are not covered, including an annual physical exam, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
BlueMedicare Patriot (PPO) covers hearing services, featuring a $55 copay and no coinsurance for Medicare-covered exams, and annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are partially covered with a $350 to $1,825 copay and no coinsurance for up to two aids per year, though OTC hearing aids and inner ear, outer ear, or over the ear prescription aids are not covered.
Vision Services See details
Vision services under BlueMedicare Patriot (PPO) are partially covered, offering eye exams with no coinsurance and a copay ranging from no copay to $55, although other eye exam services are not covered. Eyewear is covered with no copay, no coinsurance, and a combined annual maximum benefit of $200 for both in- and out-of-network contacts, lenses, and frames.
Dental Services See details
Dental services are partially covered under the BlueMedicare Patriot (PPO) plan, with Medicare-covered dental requiring a $55 copay and no coinsurance. Other covered services—including exams, cleanings, X-rays, oral surgery, and removable prosthodontics—have no copay and no coinsurance, while fluoride, restorative, endodontic, periodontic, and implant services are not covered.
Home Infusion bundled Services See details
BlueMedicare Patriot (PPO) covers home infusion bundled services with prior authorization and step therapy, featuring a $35 copay and 0% to 20% coinsurance for Medicare Part B insulin. Other covered Part B chemotherapy, radiation, and miscellaneous drugs have a 0% to 20% coinsurance, with no copay required for miscellaneous Part B drugs.
Dialysis Services See details
Dialysis services are covered under the BlueMedicare Patriot (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Patriot (PPO) covers medical equipment, featuring no copay and a 20% coinsurance for durable medical equipment (DME) and prosthetic devices, which both require prior authorization. Medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Patriot (PPO) covers diagnostic services with no coinsurance, featuring no copay for lab services and a $0 to $75 copay for diagnostic procedures and tests. Covered radiological services require prior authorization and include diagnostic radiological services starting at no copay, outpatient X-rays for a $15 copay plus coinsurance, and therapeutic radiological services with a copay and a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under the BlueMedicare Patriot (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueMedicare Patriot (PPO) with no coinsurance and required prior authorization, although only some services are covered. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, requiring copays of $35, $50, $15, and $25 respectively.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is partially covered by BlueMedicare Patriot (PPO) with no coinsurance, featuring no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, and while a prior three-day hospital stay is not required, additional days beyond the standard Medicare-covered benefit are not covered.
Other Services See details
BlueMedicare Patriot (PPO) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $50 every three months. Acupuncture, meal benefits, and other additional services are not covered.
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