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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 Central and South Florida 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 robust medical coverage with no copay for primary care visits and a $55 copay for specialists, all with no coinsurance. Inpatient hospital stays require a $385 daily copay for the first seven days, followed by no copay for subsequent days, while emergency room visits carry a $130 copay that is waived if you are admitted. Outpatient surgery ranges from a $300 to $350 copay depending on the facility, with no coinsurance required. For routine care, members enjoy no copays for annual routine hearing, vision, and select dental exams, alongside a $200 annual allowance for eyewear. The plan also includes a $50 quarterly allowance for over-the-counter items with no copay, while durable medical equipment requires a 20% coinsurance. Diagnostic labs and standard diabetic equipment are also fully covered with no copay or coinsurance, helping keep your out-of-pocket healthcare costs predictable.
Inpatient Hospital See details
BlueMedicare Patriot (PPO) covers inpatient acute hospital stays with no coinsurance and a $385 daily copay for days 1 to 7, followed by no copay for days 8 and beyond, though upgrades and non-Medicare-covered stays are not covered. Inpatient psychiatric stays are also covered with no coinsurance and a $350 daily copay for days 1 to 6, then no copay for days 7 to 90, with prior authorization required for both services.
Outpatient Services See details
BlueMedicare Patriot (PPO) covers outpatient hospital services with a $350 copay and ambulatory surgical center services with a $300 copay, both requiring prior authorization and no coinsurance. Outpatient observation services carry a $130 copay per stay, substance abuse services range from a $30 to $40 copay, and blood services have no copay, with all of these benefits featuring no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered by BlueMedicare Patriot (PPO) with a $50.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by BlueMedicare Patriot (PPO), with prior authorization required for ambulance transfers. Ground ambulance services require no coinsurance and a copay ranging from no copay to $275, while air ambulance services require a 20% coinsurance and no copay. For transportation, some services are covered, but transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
BlueMedicare Patriot (PPO) covers emergency services with a $130 copay, which is waived if admitted to the hospital 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 with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Patriot (PPO) offers primary care doctor visits with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Covered services like therapy, telehealth, and mental health sessions have copays ranging from $0 to $55 and no coinsurance, whereas podiatry is not covered, and some chiropractic services are covered but routine and other chiropractic services are not.
Preventive Services See details
Preventive services are partially covered by BlueMedicare Patriot (PPO) with no copay and no coinsurance for covered services like memory fitness, kidney disease education, and glaucoma screenings. Uncovered services include annual physical exams, health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, readmission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, enhanced disease management, telemonitoring, remote access, home safety modifications, and counseling.
Hearing Services See details
BlueMedicare Patriot (PPO) covers hearing exams with a $55 copay for Medicare-covered exams and no copay for annual routine exams and fittings, with no coinsurance required for either service. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $350 to $1,825 for up to two devices per year, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
BlueMedicare Patriot (PPO) provides partially covered vision services with no coinsurance and no deductibles, including eye exams with a copay ranging from $0 to $55 (no copay for routine exams) while other eye exam services are not covered. Eyewear benefits, including lenses and contact lenses, are covered with no copay up to a combined maximum of $200 per year.
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 preventive and comprehensive services like cleanings, exams, x-rays, removable prosthodontics, and oral surgery with no copay and no coinsurance. However, several services are not covered under this plan, including fluoride, restorative care, endodontics, periodontics, implants, and orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the BlueMedicare Patriot (PPO) plan with prior authorization required, featuring no coinsurance to 20% coinsurance for chemotherapy, radiation, and other Part B drugs. Other Part B drugs require no copay, while covered insulin under this benefit has a $35 copay and no coinsurance 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 medical equipment with no copays, though a 20% coinsurance applies to durable medical equipment and prosthetic devices. Standard medical supplies and diabetic equipment, including therapeutic shoes and 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 no coinsurance and no copay for lab services, while diagnostic procedures and tests carry a copay of $0 to $75. Outpatient X-rays require a $15 copay, diagnostic radiology has copays starting at $0, and therapeutic radiology services have a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered under BlueMedicare Patriot (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are offered by BlueMedicare Patriot (PPO) with no coinsurance, though only some services are covered in practice. Specifically, cardiac rehabilitation (with a $35 copay), intensive cardiac rehabilitation ($50 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for symptomatic peripheral artery disease services ($25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
BlueMedicare Patriot (PPO) covers skilled nursing facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed, and additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other services are partially covered by BlueMedicare Patriot (PPO), which includes an over-the-counter (OTC) benefit with no copay and no coinsurance up to $50 every three months. However, acupuncture, meal benefits, and other additional services are not covered under this plan.
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