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BlueMedicare Select (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueMedicare Select (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueMedicare Select (PPO) in 2026, please refer to our full plan details page.
BlueMedicare Select (PPO) is a PPO plan offered by Guidewell Mutual Holding Corporation available for enrollment in 2025 to people living in Select counties in S.FL/ W.FL/N.E. FL/N.W FL. This plan received an overall rating of 3.5 out of 5 stars in 2026.
It's important to know that BlueMedicare Select (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueMedicare Select (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 Select (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $58.20. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan has a $1500.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $615.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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
The BlueMedicare Select (PPO) plan features an annual prescription drug deductible of $615. Beneficiaries enjoy no copay for Tier 1 (Preferred Generic), Tier 2 (Generic), and Tier 6 (Select Care Drugs) prescriptions filled for 1-month or 3-month supplies at standard pharmacies or through standard mail order. For higher-tier medications, cost-sharing is based on coinsurance, with Tier 3 (Preferred Brand) drugs requiring a 21% coinsurance and Tier 4 (Non-Preferred Drug) prescriptions requiring a 30% coinsurance. Additionally, Tier 5 (Specialty Tier) medications incur a 25% coinsurance for a 1-month supply when using standard pharmacy or standard mail-order services.
Additional Benefits
The BlueMedicare Select (PPO) plan offers robust coverage for essential medical services, featuring no copay and no coinsurance for primary care doctor visits, routine dental cleanings, and annual routine eye exams. Specialist visits require a $55 copay, while emergency room visits carry a $130 copay with no coinsurance. For inpatient hospital stays, members pay a daily copay for the first several days of their stay, after which there is no copay. Other notable benefits include home health services and diabetic supplies, which are provided with no copay and no coinsurance. Skilled nursing facility care is also highly accessible, requiring no copay for the first 20 days. However, certain services like acupuncture, over-the-counter items, meal benefits, and routine transportation are not covered under this plan.
Inpatient Hospital See details
BlueMedicare Select (PPO) partially covers inpatient hospital services with no coinsurance, requiring prior authorization for both acute and psychiatric stays. Acute stays incur a $385 daily copay for days 1-7 and no copay for days 8 and beyond, while psychiatric stays require a $350 daily copay for days 1-6 and no copay for days 7-90. Upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueMedicare Select (PPO) covers outpatient hospital services with a copay ranging from no copay up to $325 and a 20% coinsurance, while ambulatory surgical center services require a $275 copay and no coinsurance. Outpatient substance abuse services have copays between $30 and $150 with no coinsurance, and outpatient blood services are provided with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by BlueMedicare Select (PPO) with a $50.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
BlueMedicare Select (PPO) covers ground ambulance services with a copay of $0 to $285 and coinsurance, and air ambulance services with a 20% coinsurance and a copay, both requiring prior authorization. Transportation services are not covered in practice, as transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
BlueMedicare Select (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 48 hours, and urgently needed services with a $50 copay and no coinsurance. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum benefit limit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
Primary care benefits under BlueMedicare Select (PPO) are covered with no copay and no coinsurance for primary care physician visits, while specialist visits require a $55 copay and no coinsurance. Additional services like therapy, mental health, and telehealth are covered with copays ranging from $0 to $150 and no coinsurance, whereas chiropractic and podiatry services are not covered.
Preventive Services See details
BlueMedicare Select (PPO) provides partial coverage for preventive services with no copay and no coinsurance, including Medicare-covered zero-dollar preventive services, kidney disease education, memory fitness, and specific screenings. However, several benefits are not covered under this plan, including annual physical exams, health education, and in-home safety assessments.
Hearing Services See details
Hearing services covered by BlueMedicare Select (PPO) include one routine exam and fitting evaluation annually with no copay and no coinsurance, while Medicare-covered exams require a $55 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $350 to $1,825 and no coinsurance for up to two devices per year, though over-the-counter (OTC), inner ear, outer ear, and over-the-ear models are not covered.
Vision Services See details
Vision services under BlueMedicare Select (PPO) are partially covered, offering one routine eye exam per year with no copay, no coinsurance, and no deductible, while other eye exam services are not covered. For eyewear, some services are covered with no copay, no coinsurance, and no deductible, but contact lenses, eyeglasses, lenses, frames, and upgrades are not covered.
Dental Services See details
BlueMedicare Select (PPO) offers partially covered dental services, with a $55 copay and no coinsurance for Medicare-covered dental, and no copay and no coinsurance for covered cleanings, exams, x-rays, removable prosthodontics, and oral surgery. Sub-services such as fluoride, restorative care, endodontics, periodontics, implants, fixed prosthodontics, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueMedicare Select (PPO) covers home infusion bundled services with prior authorization, offering Medicare Part B insulin for a $35 copay and no coinsurance to 20% coinsurance. Other covered Part B drugs require no copay and no coinsurance to 20% coinsurance, while chemotherapy and radiation drugs require a copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
BlueMedicare Select (PPO) covers Dialysis Services with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Select (PPO) covers medical equipment, featuring durable medical equipment (DME) and prosthetics with no copay and up to 20% coinsurance. Diabetic equipment, supplies, and therapeutic shoes are also covered with no copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Select (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests range from no copay to a $50 copay with no coinsurance, lab services feature no copay, outpatient X-rays require a $50 copay, and therapeutic radiological services have a minimum 20% coinsurance.
Home Health Services See details
Home health services are covered by BlueMedicare Select (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered under BlueMedicare Select (PPO) with no coinsurance and prior authorization required, although only some services are covered. Standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered in practice, carrying copays of $30, $50, $15, and $25 respectively.
Skilled Nursing Facility (SNF) See details
BlueMedicare Select (PPO) covers Skilled Nursing Facility care 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 additional days beyond the standard 100-day Medicare benefit period are not covered.
Other Services See details
BlueMedicare Select (PPO) does not provide coverage for Other Services, meaning acupuncture, over-the-counter (OTC) items, and meal benefits are not covered under this plan.
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