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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 Select counties in N.E, N.W., W.C & Southern FL. 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 $75.00. 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 affordable coverage for core healthcare services, featuring no copays or coinsurance for primary care doctor visits and Medicare-covered preventive care. Specialist visits require a $55 copay, while emergency room care is subject to a $130 copay and urgent care costs $50, with no coinsurance or deductibles for either. For hospital care, inpatient stays require a $385 daily copay for the first seven days, with no copays for the remaining covered days. Beyond basic medical care, the plan provides excellent supplemental benefits, including routine dental, vision, and hearing exams with no copays or coinsurance. Members also benefit from a $200 annual eyewear allowance and a $50 over-the-counter allowance every three months, both featuring no copays. Furthermore, home health services and the first 20 days of skilled nursing facility care are covered with no copays or coinsurance.
Inpatient Hospital See details
BlueMedicare Patriot (PPO) inpatient hospital benefits are partially covered with no coinsurance, requiring a $385 daily copay for days 1 through 7 of acute stays and a $350 daily copay for days 1 through 6 of psychiatric stays, with no copay for remaining covered 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 visits, a $130 copay per stay for observation services, and a $300 copay for ambulatory surgical center services. Outpatient substance abuse services require a $30 to $40 copay with no coinsurance, while outpatient blood services are covered with no copay and no deductible.
Partial Hospitalization See details
Partial hospitalization is covered by BlueMedicare Patriot (PPO) with a $50 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
BlueMedicare Patriot (PPO) covers ambulance services with prior authorization, featuring ground ambulance costs ranging from no copay to a $275 copay plus coinsurance, and air ambulance services requiring a 20% coinsurance plus a copay. For transportation benefits, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
BlueMedicare Patriot (PPO) covers emergency services with a $130 copay and no coinsurance (waived if admitted within 48 hours), and urgent care with a $50 copay and no coinsurance, neither of which are subject to a deductible. Worldwide emergency and urgent services are partially covered up to a $25,000 maximum benefit with a $130 copay and no coinsurance, though worldwide emergency transportation is not covered.
Primary Care See details
BlueMedicare Patriot (PPO) features primary care physician services with no copay and no coinsurance, and specialist visits with a $55 copay and no coinsurance. Additional benefits like therapy, telehealth, and mental health services have no coinsurance and copays ranging from $0 to $55, while podiatry is not covered. For chiropractic care, some services are covered with a $15 copay and no coinsurance, but routine and other chiropractic services are not covered.
Preventive Services See details
BlueMedicare Patriot (PPO) partially covers preventive services with no copay and no coinsurance for Medicare-covered preventive care, kidney disease education, glaucoma screenings, diabetes training, digital rectal exams, EKGs, and a memory fitness benefit. Annual physical exams and several supplemental services—including health education, in-home safety assessments, PERS, medical nutrition therapy, medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, extra smoking cessation, disease management, telemonitoring, remote access, home safety modifications, and counseling—are not covered.
Hearing Services See details
BlueMedicare Patriot (PPO) offers partially covered hearing services, featuring Medicare-covered exams for a $55 copay and no coinsurance, alongside annual routine exams and fitting evaluations with no copay and no coinsurance. Prescription hearing aids are covered with a copay ranging from $350 to $1,825 and no coinsurance, though inner ear, outer ear, over-the-ear, and over-the-counter hearing aids are not covered.
Vision Services See details
BlueMedicare Patriot (PPO) provides partially covered vision services, featuring one routine eye exam per year with no copay and no coinsurance, though other eye exam services are not covered. Eyewear, including lenses, frames, contacts, and upgrades, is covered with no copay and no coinsurance up to a combined maximum benefit of $200 every year.
Dental Services See details
BlueMedicare Patriot (PPO) provides partially covered dental services, with Medicare-covered dental requiring a $55 copay and no coinsurance, and other covered services like exams, cleanings, x-rays, removable prosthodontics, and oral surgery having no copay and no coinsurance. Several sub-services are not covered, including fluoride, other diagnostic or preventive services, restorative care, endodontics, periodontics, implants, fixed prosthodontics, and orthodontics.
Home Infusion bundled Services See details
BlueMedicare Patriot (PPO) covers Home Infusion bundled services with prior authorization, featuring a $35 copay and 0% to 20% coinsurance for insulin drugs. Medicare Part B chemotherapy and radiation drugs require a copayment and 0% to 20% coinsurance, while other Part B drugs carry no copay and 0% to 20% coinsurance.
Dialysis Services See details
BlueMedicare Patriot (PPO) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
BlueMedicare Patriot (PPO) covers medical equipment with no copays across all categories, although coinsurance requirements vary. Durable medical equipment and prosthetic devices require prior authorization and are subject to a 20% coinsurance, while medical supplies and diabetic equipment are covered with no coinsurance.
Diagnostic and Radiological Services See details
BlueMedicare Patriot (PPO) covers diagnostic and radiological services, requiring prior authorization for all services. There is no copay or coinsurance for lab services and diagnostic radiological services, while diagnostic tests carry a $0 to $75 copay, outpatient X-rays cost a $15 copay, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under the BlueMedicare Patriot (PPO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the BlueMedicare Patriot (PPO) plan, including standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services.
Skilled Nursing Facility (SNF) See details
BlueMedicare Patriot (PPO) covers skilled nursing facility (SNF) care with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, though a prior three-day hospital stay is not, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other Services are partially covered by BlueMedicare Patriot (PPO), which offers Over-the-Counter (OTC) items with no copay and no coinsurance up to a $50 limit every three months. Acupuncture, meal benefits, and other additional services are not covered.
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