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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 2026, 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 3.5 out of 5 stars in 2026.
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 $6750.00 (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 $6750.00 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 no copay for primary care visits and no coinsurance for inpatient hospital stays, though a daily copay of $450 applies for the first six days of acute care. Outpatient hospital services require a copay ranging from $50 to $400, while specialist visits and therapies carry a $50 copay. Emergency room visits have a $130 copay, which is waived if you are admitted within 24 hours, and urgent care is available for a $50 copay. This plan also features key supplemental benefits, including routine hearing exams, OTC hearing aids, and preventive dental care with no copays or coinsurance. Vision services include an annual routine eye exam with a copay ranging from no copay to $50, plus up to $80 annually for eyewear with no copay. Additionally, members receive a $30 quarterly over-the-counter allowance with no copay, alongside home health services and diabetic equipment covered with no copay and no coinsurance.
Inpatient Hospital See details
Blue Medicare Advantage Valor PPO (PPO) covers inpatient hospital services with no coinsurance, though prior authorization is required. Inpatient acute stays require a $450 daily copay for days 1 to 6 and no copay for days 7 and beyond, while psychiatric stays require a $390 daily copay for days 1 to 6 and no copay for days 7 to 90. Upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Blue Medicare Advantage Valor PPO (PPO) covers outpatient services with no coinsurance, though copays and prior authorization may be required. Under this plan, outpatient hospital services carry a $50 to $400 copay, ambulatory surgical center visits cost a $300 copay, outpatient substance abuse sessions require a $50 copay, and outpatient blood services are covered with no copay.
Partial Hospitalization See details
Blue Medicare Advantage Valor PPO (PPO) covers partial hospitalization services with a $140.00 copay and no coinsurance. Prior authorization is required to receive coverage for this benefit.
Ambulance and Transportation Services See details
Blue Medicare Advantage Valor PPO (PPO) covers Medicare-covered ground and air ambulance services with a $400 copay and no coinsurance, subject to prior authorization. Transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
Blue Medicare Advantage Valor PPO (PPO) covers emergency services with a $130 copay and no coinsurance, which is waived if admitted to the hospital within 24 hours. Urgently needed services require a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with a $130 copay and no coinsurance up to a $50,000 maximum limit.
Primary Care See details
Blue Medicare Advantage Valor PPO (PPO) partially covers primary care and specialty services with no coinsurance, although podiatry services are not covered. Patients pay no copay for primary care doctor visits and opioid treatment, a $15 to $30 copay for chiropractic care, and a $50 copay for specialists, mental health services, and physical, occupational, or speech therapies.
Preventive Services See details
Blue Medicare Advantage Valor PPO (PPO) offers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management. Additional preventive benefits are partially covered with no copay or coinsurance for memory fitness, remote access technologies, and personal emergency response systems, while services such as health education, weight management, and in-home support are not covered.
Hearing Services See details
Blue Medicare Advantage Valor PPO (PPO) hearing services include one annual routine hearing exam and OTC hearing aids with no copay and no coinsurance. Hearing aid fittings, evaluations, and prescription hearing aids are not covered by this plan.
Vision Services See details
Vision services are partially covered by Blue Medicare Advantage Valor PPO (PPO), offering one routine eye exam per year with a $0 to $50 copay and no coinsurance, while other eye exam services are not covered. Eyewear, including contacts and eyeglasses, is covered with no copay and no coinsurance up to an $80 annual maximum benefit.
Dental Services See details
Blue Medicare Advantage Valor PPO (PPO) offers partially covered dental services, featuring a $50 copay and no coinsurance for Medicare-covered dental, and no copay or coinsurance for preventive care. Covered comprehensive services have no copay, 0% to 25% coinsurance, and a $1,000 annual limit, but implants, prosthodontics, orthodontics, and adjunctive services are not covered.
Home Infusion bundled Services See details
Blue Medicare Advantage Valor PPO (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and a coinsurance ranging from no coinsurance up to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by the Blue Medicare Advantage Valor PPO (PPO) with no copay and a 20% coinsurance.
Medical Equipment See details
Blue Medicare Advantage Valor PPO (PPO) partially covers medical equipment, offering durable medical equipment with no copay and 0% to 20% coinsurance, and prosthetics and medical supplies with no copay and 20% coinsurance. Diabetic equipment has no copay and no coinsurance, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Blue Medicare Advantage Valor PPO (PPO) covers diagnostic and radiological services, with prior authorization required. Diagnostic procedures and lab services have no coinsurance and require copays of $70 and $15 respectively, while radiological services range from a $20 copay for X-rays to a $250 copay for diagnostic radiology and 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered under the Blue Medicare Advantage Valor PPO (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are offered with no coinsurance under Blue Medicare Advantage Valor PPO (PPO), though only some services are covered. Specifically, cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $50 copay), pulmonary rehabilitation (with a $35 copay), and supervised exercise therapy for symptomatic peripheral artery disease (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Blue Medicare Advantage Valor PPO (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Blue Medicare Advantage Valor PPO (PPO) partially covers other services, featuring an over-the-counter (OTC) benefit with no copay and no coinsurance. This OTC benefit provides up to $30 every three months for catalog orders, while acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
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