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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 Florida Panhandle. 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 comprehensive medical coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care physician visits. Specialist visits require a $55 copay with no coinsurance, while inpatient hospital stays require a $385 daily copay for days 1 through 7 and no copay for subsequent days. Outpatient hospital services carry a $350 copay, and emergency room visits require a $130 copay, both with no coinsurance. For routine health needs, members benefit from no copays and no coinsurance on preventive services, select dental cleanings and exams, routine hearing tests, and routine eye exams. Prescription hearing aids feature a copay of $350 to $1,825, while eyeglasses and contacts are covered up to a $200 annual limit with no copay or deductible. Additionally, the plan covers durable medical equipment with a 20% coinsurance and no copay, and provides a $50 quarterly over-the-counter allowance with no copay.
Inpatient Hospital See details
BlueMedicare Patriot (PPO) covers inpatient acute hospital stays with no coinsurance, requiring a $385 daily copay for days 1 to 7 and no copay for days 8 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric care is also covered with no coinsurance, featuring a $350 daily copay for days 1 to 6 and no copay for days 7 to 90, but additional psychiatric days and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueMedicare Patriot (PPO) covers outpatient services with no coinsurance, featuring a $350 copay for outpatient hospital services, a $130 copay per stay for observation services, and a $300 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 to $40 copay with no coinsurance, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered under the BlueMedicare Patriot (PPO) plan with a $50 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
BlueMedicare Patriot (PPO) covers ground ambulance services with a copay ranging from no copay to $275 plus coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Additionally, some transportation 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 (waived if admitted within 48 hours) and urgently needed services with a $50 copay, both featuring no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Patriot (PPO) offers primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Additional covered benefits, such as physical, occupational, mental health, and psychiatric therapies, have copays ranging from $0 to $40 with no coinsurance, while chiropractic and podiatry services are not covered.
Preventive Services See details
BlueMedicare Patriot (PPO) preventive services are partially covered with no copay and no coinsurance for eligible services, including Medicare-covered preventive care, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, EKGs, and a memory fitness benefit. However, sub-services such as annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling are not covered.
Hearing Services See details
BlueMedicare Patriot (PPO) provides partially covered hearing services with no deductibles and no coinsurance. Medicare-covered exams require a $55 copay, routine exams and fitting evaluations have no copay, and covered prescription hearing aids have a copay of $350 to $1,825, while inner ear, outer ear, over-the-ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueMedicare Patriot (PPO), offering eye exams with a $0 to $55 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Covered eyewear, including contacts and eyeglasses, features no copay, no coinsurance, and no deductible up to a $200 annual combined limit.
Dental Services See details
BlueMedicare Patriot (PPO) offers partially covered dental services, featuring Medicare-covered dental care for a $55 copay and no coinsurance, as well as select exams, cleanings, x-rays, removable prosthodontics, and oral surgery with no copay and no coinsurance. Sub-services that are not covered under this plan include fluoride, restorative services, endodontics, periodontics, implants, fixed prosthodontics, orthodontics, other diagnostic services, and other preventive services.
Home Infusion bundled Services See details
BlueMedicare Patriot (PPO) covers home infusion bundled services with prior authorization, featuring Medicare Part B chemotherapy and radiation drugs with a copayment and coinsurance ranging from no coinsurance to 20%. Other Part B drugs carry no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
Dialysis services are covered by the BlueMedicare Patriot (PPO) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Patriot (PPO) covers medical equipment with no copays across all categories. Durable medical equipment and prosthetic devices are subject to a 20% coinsurance, while medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts feature no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Patriot (PPO) covers diagnostic and radiological services with prior authorization, offering lab services and diagnostic radiology with no copay and no coinsurance. Diagnostic tests have a copay of $0 to $75, outpatient X-rays require a $15 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
BlueMedicare Patriot (PPO) covers home health services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
BlueMedicare Patriot (PPO) covers Cardiac Rehabilitation Services with no coinsurance, although prior authorization is required. While some services are covered, standard Cardiac Rehabilitation (which carries a $35 copay), Intensive Cardiac Rehabilitation ($50 copay), Pulmonary Rehabilitation ($15 copay), and Supervised Exercise Therapy for Symptomatic Peripheral Artery Disease ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
BlueMedicare Patriot (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and a $218 copayment for days 21 through 100, though additional days beyond the standard Medicare-covered period are not covered.
Other Services See details
Other services are partially covered by BlueMedicare Patriot (PPO), which features an over-the-counter (OTC) benefit of $50 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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