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Blue Medicare Advantage Valor PPO (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for Blue Medicare Advantage Valor PPO (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on Blue Medicare Advantage Valor PPO (PPO) in 2025, please refer to our full plan details page.
Blue Medicare Advantage Valor PPO (PPO) is a PPO plan offered by Blue Cross Blue Shield of Michigan Mutual Ins. Co. available for enrollment in 2025 to people living in Iowa. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that Blue Medicare Advantage Valor PPO (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 Blue Medicare Advantage Valor PPO (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 Blue Medicare Advantage Valor PPO (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.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
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 $5000.00 (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 $5000.00 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 Blue Medicare Advantage Valor PPO (PPO).
Additional Benefits
The Blue Medicare Advantage Valor PPO (PPO) plan offers comprehensive coverage with a range of benefits. This plan includes no copay for primary care, preventive services, home health services, and hearing exams. The plan also covers inpatient hospital stays, outpatient services, emergency services, and other services with various copays and coinsurance amounts. Additional benefits include coverage for vision, dental, and hearing services, with specific copays and limitations. The plan provides coverage for ambulance services, home infusion, dialysis, and medical equipment. Various diagnostic, radiological, and skilled nursing facility services are also covered, with specific cost-sharing requirements.
Inpatient Hospital See details
Inpatient Hospital services are covered, with a copay of $380 for days 1-6, and no copay for days 7-90. Additional days for Inpatient Hospital-Acute are covered with no copay, while Non-Medicare-covered stays and upgrades are not covered. Inpatient Hospital Psychiatric services are also covered, with a copay of $380 for days 1-6 and no copay for days 7-90, however, additional days and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with a copay of $50-$400, observation services with a copay of $300, ambulatory surgical center services with a copay of $300, individual and group sessions for outpatient substance abuse with a copay of $50, and outpatient blood services with no copay.
Partial Hospitalization See details
Partial Hospitalization is covered by the Blue Medicare Advantage Valor PPO (PPO) plan. You will pay a $105 copay for this service, and prior authorization is required.
Ambulance and Transportation Services See details
The Blue Medicare Advantage Valor PPO (PPO) plan covers ambulance services with a $400 copay for both ground and air ambulance services, and has no coinsurance. Transportation services to health-related locations are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the Blue Medicare Advantage Valor PPO (PPO) plan. Emergency Services have a $125 copay, Urgently Needed Services have a $55 copay, and Worldwide Emergency Coverage and Urgent Coverage have a $120 copay while Worldwide Emergency Transportation has a $400 copay.
Primary Care See details
The Blue Medicare Advantage Valor PPO (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $45 copay, physician specialist services with a $50 copay, and physical and speech therapy services with a $50 copay. This plan also covers mental health and psychiatric services, other health care professional services, and opioid treatment program services. Additionally, additional telehealth benefits are covered with a copay ranging from $0 to $55.
Preventive Services See details
Preventive services include annual physical exams with no copay, and additional preventive services including Fitness Benefit, Personal Emergency Response System, Remote Access Technologies, Glaucoma Screening, Diabetes Self-Management Training, Barium Enemas, Digital Rectal Exams, and EKG following Welcome Visit, all with no copay. Health Education, In-Home Safety Assessment, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Re-admission Prevention, Wigs for Hair Loss Related to Chemotherapy, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Nutritional/Dietary Benefit, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Additional Sessions of Smoking and Tobacco Cessation Counseling, Enhanced Disease Management, Telemonitoring Services, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services are covered under the Blue Medicare Advantage Valor PPO (PPO) plan. Hearing exams have no copay, but routine hearing exams and fitting/evaluation for hearing aids are not covered. OTC hearing aids are covered up to $50 per ear every three months for in-network services.
Vision Services See details
The Blue Medicare Advantage Valor PPO (PPO) plan covers vision services including eye exams with a copay of $0-$50, and eyewear, including contact lenses, eyeglass lenses, eyeglass frames, and upgrades. Contact lenses are limited to 1 pair per year with a maximum benefit of $100, while eyeglass lenses and frames are limited to 1 per year with a maximum benefit of $100 for frames. Eyeglasses (lenses and frames) are not covered.
Dental Services See details
Dental services include a $50 copay for Medicare dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered. Restorative services and endodontics have a 25% coinsurance. Periodontics and oral and maxillofacial surgery have a coinsurance between 0% and 25%. Orthodontic services have a maximum benefit of $1,500 per year. Adjunctive general services, prosthodontics (removable and fixed), maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the Blue Medicare Advantage Valor PPO (PPO) plan, with prior authorization required. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the Blue Medicare Advantage Valor PPO (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
The Blue Medicare Advantage Valor PPO (PPO) plan covers Durable Medical Equipment with a 20% coinsurance and no copay, while Durable Medical Equipment for use outside the home is not covered. The plan also covers Prosthetics/Medical Supplies and Diabetic Equipment.
Diagnostic and Radiological Services See details
The Blue Medicare Advantage Valor PPO (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests with a $50 copay, lab services with a $15 copay, diagnostic radiological services with a $200 copay, therapeutic radiological services with 20% coinsurance, and outpatient X-ray services with a $20 copay. Prior authorization is required for all diagnostic and radiological services.
Home Health Services See details
Home Health Services are covered under the Blue Medicare Advantage Valor PPO (PPO) plan 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 Blue Medicare Advantage Valor PPO (PPO) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the Blue Medicare Advantage Valor PPO (PPO) plan. You will have no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services include coverage for Over-the-Counter (OTC) Items, with a maximum benefit of $50 every three months, and Meal Benefits with no copay and prior authorization required; however, acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services are not covered.
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