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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 Westcoast 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, including coverage for inpatient hospital stays with a copay, outpatient services with varying copays, and emergency services with a $125 copay. The plan also covers primary care physician services with no copay, hearing and vision services with copays, and dental services with copays. Additional benefits of this plan include coverage for home infusion services, dialysis, and medical equipment, each with specific cost-sharing arrangements like copays or coinsurance. The plan also covers services like skilled nursing facilities and cardiac rehabilitation, with specific copays. This plan also offers over-the-counter items with a quarterly maximum benefit.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services. For Inpatient Hospital-Acute, you pay a $350 copay for days 1-4, and no copay for days 5-90, with no coinsurance. For Inpatient Hospital Psychiatric, you pay a $318 copay for days 1-5, and no copay for days 6-90, with no coinsurance.
Outpatient Services See details
Outpatient Services include coverage for outpatient hospital services with a copay of $0 - $300, observation services with a $125 copay, and ambulatory surgical center services with no copay. This plan also covers outpatient substance abuse services with a $20 copay for both individual and group sessions, and outpatient blood services 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.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueMedicare Patriot (PPO) plan. Ground and air ambulance services each have a $250 copay, with no coinsurance, but 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, while 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. This plan also covers physician specialist services with a $45 copay, and mental health specialty services, psychiatric services, and opioid treatment program services with a $20 copay for individual and group sessions. Physical therapy and speech-language pathology services are covered with a copay between $0 and $40, and additional telehealth benefits are covered with a copay between $0 and $45. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services are covered by the BlueMedicare Patriot (PPO) plan, including Medicare-covered preventive services with no copay. Some services, such as annual physical exams, health education, and several others are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $45 copay, routine hearing exams with no copay for one exam per year, fitting/evaluation for hearing aids with no copay for one exam per year, and prescription hearing aids (all types) with a copay between $350 and $1825 for two aids per year. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The BlueMedicare Patriot (PPO) plan covers vision services, including eye exams with a copay between $0 and $45, and eyewear with a $0 copay and a combined maximum benefit of $200 per year for both in-network and out-of-network services. Routine eye exams are limited to 1 per year with no copay, while contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, and upgrades are covered with no copay and unlimited benefits.
Dental Services See details
Dental Services includes coverage for Medicare Dental Services with a $45 copay, and Other Dental Services with no copay. Oral Exams, Dental X-Rays, Prophylaxis (Cleaning), Prosthodontics (removable), and Oral and Maxillofacial Surgery are covered, with no copay for Prosthodontics and Oral and Maxillofacial Surgery. However, 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 under the BlueMedicare Patriot (PPO) plan. Home Infusion bundled Services include coverage for Insulin and other Medicare Part B drugs; Medicare Part B Insulin Drugs have a $35 copay and 0-20% coinsurance, while Other Medicare Part B Drugs and Medicare Part B Chemotherapy/Radiation Drugs have 0-20% coinsurance with no copay.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Patriot (PPO) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment is covered by the BlueMedicare Patriot (PPO) plan. Durable Medical Equipment (DME) has no copay and a coinsurance of 0% to 20%, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies - Non-Medicare benefit has no copay and the coinsurance varies, and Medical Supplies has no coinsurance. Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts have no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests with a copay between $0 and $75. Lab services have no copay, while therapeutic radiological services have a 20% coinsurance and 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover the sub-services of Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for this benefit, and there is a copay.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueMedicare Patriot (PPO) plan. There is no copay for days 1-20, and the copay is $214 per day for days 21-100.
Other Services See details
The BlueMedicare Patriot (PPO) plan covers Over-the-Counter (OTC) Items, with a maximum benefit coverage amount of $50 every three months. Other services, including acupuncture, meal benefits, and several additional services, are not covered.
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