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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 Alachua, Clay, Duval, Nassau & St. Johns 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.

Overview IconKey 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:

Regular visits to your primary care doctor are covered and will have a copay of $0.00 and coinsurance of 0% (no coinsurance).

Specialist Visits:

Visits to specialists are covered and will have a copay of $45.00 and coinsurance of 0% (no coinsurance). Specialist visits may require a referral from your primary care doctor or prior authorization.

Emergency Room:

Trips to the Emergency Room are covered, and will have a copay of $125.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Urgent Care:

Trips to Urgent Care arecovered and will have a copay of $30.00 and coinsurance of 0% (no coinsurance). Coverage may vary for in-network and out-of-network hospitals.

Sign up for BlueMedicare Patriot (PPO)

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Drug Coverage IconDrug Coverage

Prescription drugs are not covered by BlueMedicare Patriot (PPO).

Additional Benefits IconAdditional Benefits

The BlueMedicare Patriot (PPO) plan offers comprehensive coverage, including inpatient and outpatient hospital services with varying copays. Emergency, urgent, and ambulance services are covered, with copays ranging from $30 to $250. The plan also includes coverage for primary care, hearing, vision, and dental services, with specific copays and limitations on certain services. Additional benefits include coverage for partial hospitalization, home infusion, dialysis, medical equipment, and diagnostic services. Preventive services such as screenings and exams are covered, and the plan provides over-the-counter benefits. The plan has a $350 copay for inpatient hospital days 1-4, and no copay for days 5-90.

Inpatient Hospital See details

Inpatient Hospital benefits with the BlueMedicare Patriot (PPO) plan cover acute inpatient hospital services, with a copay of $350 for days 1-4, and no copay for days 5-90. Additional days for inpatient hospital-acute have no copay, while non-Medicare-covered stays and upgrades for inpatient hospital are not covered. Inpatient Hospital Psychiatric services have a copay of $318 for days 1-5 and no copay for days 6-90, and additional days and non-Medicare-covered stays for inpatient psychiatric are not covered.

Outpatient Services See details

Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a copay between $0 and $300, Observation Services have a $125 copay, and Ambulatory Surgical Center Services have no copay. Outpatient Substance Abuse Services have a $20 copay for both individual and group sessions, and Outpatient Blood Services have 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 there is 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 by the BlueMedicare Patriot (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $30 copay; there is no coinsurance for either. Worldwide Emergency Transportation is not covered, and Worldwide Urgent Coverage, and Worldwide Emergency Coverage have a $125 copay.

Primary Care See details

The BlueMedicare Patriot (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 $45 copay. The plan also covers mental health specialty services and psychiatric services with a $20 copay for individual and group sessions, and physical therapy and speech-language pathology services with a copay ranging from $0 to $40. Additionally, the plan covers additional telehealth benefits with a copay from $0 to $45 and opioid treatment program services with a $20 copay. Routine Chiropractic Care and Podiatry Services are not covered.

Preventive Services See details

Preventive Services, including Medicare-covered services, are covered. 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. Support for Caregivers of Enrollees, Kidney Disease Education Services, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, EKG following Welcome Visit, 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. Prescription hearing aids for the inner ear, outer ear, and over the ear, and 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, while routine eye exams have no copay. Eyewear, including contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades, have no copay, with a combined maximum plan benefit of $200 per year.

Dental Services See details

The BlueMedicare Patriot (PPO) plan covers Medicare dental services with a $45 copay, and other dental services with no copay. Oral exams, dental X-rays, prosthodontics, removable and oral and maxillofacial surgery are covered, while fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implant services, orthodontics, and prosthodontics, fixed, 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 Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%. Prior authorization is required.

Dialysis Services See details

Dialysis Services are covered by the BlueMedicare Patriot (PPO) plan with a coinsurance of 20%.

Medical Equipment See details

The BlueMedicare Patriot (PPO) plan covers medical equipment, including Durable Medical Equipment (DME) with a 0-20% coinsurance and Prosthetics/Medical Supplies with no copay and a coinsurance for some services. Diabetic supplies and Diabetic Therapeutic Shoes/Inserts have no copay.

Diagnostic and Radiological Services See details

Diagnostic and Radiological Services are covered, with a copay for some services and coinsurance for some services. Diagnostic Procedures/Tests have a copay between $0 and $75, while Lab Services have no copay. Diagnostic Radiological Services have a copay up to $75, and Therapeutic Radiological Services have a 20% coinsurance. 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. This benefit requires prior authorization.

Cardiac Rehabilitation Services See details

Cardiac Rehabilitation Services are covered by the BlueMedicare Patriot (PPO) plan, but the specific services are not covered. Prior authorization is required for Cardiac Rehabilitation Services.

Skilled Nursing Facility (SNF) See details

Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Patriot (PPO) plan, but require prior authorization. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered, and non-Medicare-covered stays, are not covered.

Other Services See details

The BlueMedicare Patriot (PPO) plan covers Over-the-Counter (OTC) Items with a maximum benefit coverage amount of $50.00 every three months, and also covers Nicotine Replacement Therapy (NRT) and Naloxone as an OTC benefit. 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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