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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 Westcoast 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 coverage for a wide range of medical services with many key benefits featuring no copays or coinsurance. You will pay no copay for primary care doctor visits, routine vision and hearing exams, home health services, and preventive care. For other medical needs, the plan utilizes predictable copays, such as a $55 copay for specialists and daily copays for the initial days of inpatient hospital stays. Emergency room visits carry a $130 copay, while urgent care visits require a $50 copay, both with no coinsurance. Additionally, routine dental cleanings and exams feature no copay, and the plan provides a $50 quarterly allowance for over-the-counter items with no copay or coinsurance. Major medical needs like durable medical equipment and dialysis services require a 20% coinsurance with no copay.
Inpatient Hospital See details
BlueMedicare Patriot (PPO) partially covers inpatient hospital services with no coinsurance, requiring a $385 copay for days 1-7 of an acute stay and a $350 copay for days 1-6 of a psychiatric stay, with no copay for subsequent days. Prior authorization is required, and upgrades, non-Medicare-covered stays, and additional psychiatric days 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 $40 copay for individual sessions and a $30 copay for group sessions, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
BlueMedicare Patriot (PPO) covers partial hospitalization benefits with a $50.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
BlueMedicare Patriot (PPO) covers ground ambulance services with a copay of $0 to $275 and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Prior authorization is required for ambulance services, and routine transportation services to health-related locations are 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 with no coinsurance. Worldwide emergency and urgent care are partially covered up to a $25,000 maximum limit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Patriot (PPO) provides 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, occupational, mental health, psychiatric, and telehealth therapies feature no coinsurance and copays ranging from $0 to $55, while podiatry and chiropractic services are not covered.
Preventive Services See details
BlueMedicare Patriot (PPO) partially covers preventive services with no copay and no coinsurance for covered benefits, which include Medicare-covered zero-dollar preventive services, kidney disease education, memory fitness, glaucoma screenings, and diabetes self-management. However, several services are not covered under this plan, including annual physical exams, health education, in-home safety assessments, and personal emergency response systems (PERS).
Hearing Services See details
BlueMedicare Patriot (PPO) covers hearing services, including one routine exam and fitting evaluation annually with no copay or coinsurance, and Medicare-covered exams for a $55 copay and no coinsurance. Prescription hearing aids are partially covered for up to two devices per year with a copay of $350 to $1,825 and no coinsurance, but OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
BlueMedicare Patriot (PPO) offers partially covered vision services with no coinsurance, including one routine eye exam annually with no copay, though other eye exam services are not covered. Eyewear is covered with no copay and no deductible up to a combined maximum of $200 per year.
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 exams, cleanings, x-rays, removable prosthodontics, and oral surgery. Sub-services that are not covered under this plan include fluoride, restorative, endodontics, periodontics, implants, fixed prosthodontics, orthodontics, adjunctive general, maxillofacial prosthetics, and other diagnostic or preventive dental services.
Home Infusion bundled Services See details
BlueMedicare Patriot (PPO) covers Home Infusion bundled Services with prior authorization, featuring Medicare Part B insulin drugs for a $35 copay and 0% to 20% coinsurance. Other covered Part B drugs require no copay and 0% to 20% coinsurance, while chemotherapy and radiation drugs are subject to a copay and up to 20% coinsurance.
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, which require prior authorization. Medical supplies, diabetic supplies, and diabetic therapeutic shoes or inserts are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Patriot (PPO) covers diagnostic and radiological services, offering lab services with no copay or coinsurance and diagnostic tests with no coinsurance and a copay ranging from $0 to $75. Outpatient X-rays require a $15 copay plus coinsurance, diagnostic radiological services have copays starting at $0, and therapeutic radiological services require a copay and a minimum 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
Cardiac Rehabilitation Services are covered by BlueMedicare Patriot (PPO) with no coinsurance and prior authorization required, but some services are covered while others are not. Standard cardiac rehabilitation ($35 copay), intensive cardiac ($50 copay), pulmonary ($15 copay), and supervised exercise therapy for symptomatic peripheral artery disease ($25 copay) services are not covered.
Skilled Nursing Facility (SNF) See details
BlueMedicare Patriot (PPO) covers skilled nursing facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day hospital stay is not necessary, additional days beyond the standard 100 days 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 $50 maximum benefit every three months. Acupuncture, meal benefits, and other additional services are not covered under this plan.
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