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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 2025, 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 2025.
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 $28.00. 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 $950.00 health deductible. This means, every calendar year, you pay this amount towards covered services before your insurance coverage kicks in.
This plan has a $590.00 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 has an enhanced alternative drug benefit. The plan has a deductible of $590. Once you meet your deductible, you will pay a copay or coinsurance depending on the drug tier and pharmacy. In the initial coverage phase, you'll pay a $10 copay for preferred generic drugs at a standard or mail-order pharmacy. For standard generic drugs, you will pay 21% coinsurance. Specialty tier drugs have no copay at a standard pharmacy. After your total drug costs reach $2000, you will enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BlueMedicare Select (PPO) plan offers coverage for a wide range of services, including inpatient hospital stays with varying copays depending on the length of stay, outpatient services with copays and coinsurance, and emergency services with copays. Primary care physician services have no copay, and preventive services are covered with no copay for many services. Additional benefits include hearing, vision, and dental services, each with specific copays and coverage details. The plan also covers home infusion, dialysis, and medical equipment, with varying cost-sharing arrangements. Skilled nursing facility stays are covered with a copay after the first 20 days, and home health services are covered with no copay.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, the copay is $345 for days 1-5, and no copay for days 6-90, while for Inpatient Hospital Psychiatric, the copay is $318 for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered with no copay for days 91-999, but Non-Medicare-covered stays and upgrades are not covered for both Inpatient Hospital-Acute and Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, observation services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. Outpatient Hospital Services have a 20% coinsurance and a copay between $0 and $150, while Observation Services have a $125 copay. Ambulatory Surgical Center Services have no copay, and Outpatient Blood Services have no copay. Outpatient Substance Abuse Services, including both individual and group sessions, have a copay between $20 and $150.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueMedicare Select (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 Select (PPO) plan. Ground and air ambulance services have a $155 copay, with no coinsurance, while 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 Select (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $50 copay, and Worldwide Emergency Coverage has a $125 copay. Worldwide Emergency Transportation is not covered.
Primary Care See details
Primary Care services include no copay for Primary Care Physician Services. Chiropractic Services have a $15 copay, but routine care is not covered. Occupational Therapy Services have a $40 copay. Physician Specialist Services have a $49 copay. Mental Health and Psychiatric Specialty Services have a $20 copay for individual and group sessions. Physical Therapy and Speech-Language Pathology Services have a copay between $0 and $40. Additional Telehealth Benefits have a copay between $0 and $150. Opioid Treatment Program Services have a $20 copay.
Preventive Services See details
Preventive Services are covered, with no copay for many services. The plan does not cover annual physical exams, and some services such as Health Education, In-Home Safety Assessment, Personal Emergency Response System (PERS), Medical Nutrition Therapy (MNT), and others are also not covered.
Hearing Services See details
Hearing Services include coverage for hearing exams with a $49 copay, routine hearing exams with no copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $350 and $1825, but 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
Vision Services include coverage for eye exams with a copay between $0 and $49, and routine eye exams with no copay. Eyewear is covered, but contact lenses, eyeglasses, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services include coverage for Medicare Dental Services with a $49 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, while fluoride treatment, restorative services, adjunctive general services, endodontics, periodontics, maxillofacial prosthetics, implant services, prosthodontics (fixed), and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Other Medicare Part B Drugs with no copay. Medicare Part B Chemotherapy/Radiation Drugs are covered, and all drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueMedicare Select (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a coinsurance of 0% to 20% and no copay, Prosthetics/Medical Supplies with no copay and a coinsurance for Medicare-covered devices and supplies, and Diabetic Equipment with no copay for Diabetic Supplies and Therapeutic Shoes/Inserts. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, and radiological services. Diagnostic Procedures/Tests have a copay between $0 and $50, and Lab Services have no copay. Diagnostic Radiological Services have a copay between $30 and $150, and Therapeutic Radiological Services have 20% coinsurance. Outpatient X-Ray Services have a $50 copay.
Home Health Services See details
Home Health Services are covered by BlueMedicare Select (PPO) with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueMedicare Select (PPO) plan. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueMedicare Select (PPO), but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
Other Services are not covered by the BlueMedicare Select (PPO) plan, including acupuncture, over-the-counter items, meal benefits, and other listed services. No authorization or referral is required for these services.
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