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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 Alachua, Clay, Duval, Nassau & St. Johns 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 comprehensive coverage with many everyday healthcare services featuring no copay and no coinsurance. You will pay no copay and no coinsurance for primary care doctor visits, home health services, and routine preventive care. For specialized medical needs, specialist visits require a $55 copay, while emergency room services have a $130 copay with no coinsurance. Additional benefits like routine dental exams, cleanings, and routine vision exams are available with no copay and no coinsurance, along with a $200 annual eyewear allowance. For inpatient hospital stays, there is a daily copay of $385 for the first seven days of acute care, followed by no copay for subsequent days. Members also receive an over-the-counter allowance of up to $50 every three months with no copay and no coinsurance.
Inpatient Hospital See details
Inpatient hospital services are covered by BlueMedicare Patriot (PPO) with no coinsurance and prior authorization required, featuring 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 subsequent days. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueMedicare Patriot (PPO) covers outpatient hospital services with a $350 copay and no coinsurance, observation services with a $130 copay per stay and no coinsurance, and ambulatory surgical center services with a $300 copay and no coinsurance. Outpatient substance abuse services require no coinsurance and a $40 copay for individual or $30 copay for group sessions, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
Partial hospitalization services are covered by the BlueMedicare Patriot (PPO) plan with a $50.00 copay and no coinsurance. Prior authorization is required to receive coverage for these services.
Ambulance and Transportation Services See details
Ambulance services are covered by BlueMedicare Patriot (PPO) with prior authorization, requiring a $0 to $275 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. Plan-approved and general health-related transportation services are 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 urgent care with a $50 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum with a $130 copay and no coinsurance, but worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Patriot (PPO) offers primary care physician services with no copay and no coinsurance, while specialist visits require a $55 copay and no coinsurance. Additional benefits like telehealth, physical therapy, and mental health services feature no coinsurance and copays ranging from $0 to $55, though chiropractic and podiatry services are not covered.
Preventive Services See details
BlueMedicare Patriot (PPO) partially covers preventive services with no copay and no coinsurance for covered options like Medicare-covered preventive services, kidney disease education, memory fitness, and glaucoma screenings. However, several sub-services are not covered, including annual physical exams, health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
BlueMedicare Patriot (PPO) covers hearing services, including Medicare-covered exams for a $55 copay and no coinsurance, and routine exams and fittings with no copay or coinsurance. Prescription hearing aids are partially covered with no coinsurance and copays between $350 and $1,825, while inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
BlueMedicare Patriot (PPO) provides partially covered vision services with no deductibles and no coinsurance. Routine eye exams (one per year) and eyewear—including contacts and eyeglasses—are available with no copay and a $200 annual maximum allowance, though other eye exam services are not covered.
Dental Services See details
Dental services are partially covered by BlueMedicare Patriot (PPO), featuring a $55 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered oral exams, cleanings, x-rays, removable prosthodontics, and oral surgery. However, other diagnostic services, fluoride, restorative services, endodontics, periodontics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueMedicare Patriot (PPO) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin for a $35 copay and 0% to 20% coinsurance. Other Medicare Part B drugs, including chemotherapy and radiation, are covered with 0% to 20% coinsurance and no copay for other 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 durable medical equipment and prosthetic devices with no copay and a 20% coinsurance, requiring 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
Diagnostic and radiological services are covered by BlueMedicare Patriot (PPO) with prior authorization required. Diagnostic tests and lab services feature no coinsurance, with lab services requiring no copay and other diagnostic procedures costing between $0 and $75. Outpatient X-rays have a $15 copay, diagnostic radiology has no copay, and therapeutic radiological services require a minimum 20% coinsurance.
Home Health Services See details
BlueMedicare Patriot (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under BlueMedicare Patriot (PPO) with no coinsurance and require prior authorization, though only some services are covered. Sub-services that are not covered in practice include cardiac rehabilitation ($35 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) ($25 copay).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by BlueMedicare Patriot (PPO) with no coinsurance and no requirement for a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 through 20, while days 21 through 100 require a $218 daily copay, and additional days beyond Medicare-covered limits are not covered.
Other Services See details
BlueMedicare Patriot (PPO) partially covers other services, offering an over-the-counter (OTC) benefit of up to $50 every three months with no copay and no coinsurance. Acupuncture, meal benefits, and other additional services are not covered under this benefit.
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