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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 South Dakota. 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 medical coverage with predictable cost-sharing and no coinsurance for many key services. Members benefit from no copay for primary care visits and covered preventive services, while specialist visits require a $50 copay. Inpatient hospital stays feature a $380 daily copay for days one through six and no copay for days seven through 90, while emergency room visits carry a $125 copay. This plan also provides valuable supplemental coverage, including routine dental and hearing exams with no copay. Vision benefits feature routine eye exams with a $0 to $50 copay and an $80 annual allowance for frames or contacts with no copay or deductible. Additionally, home health services require no copay, and skilled nursing facility stays have no copay for the first 20 days.
Inpatient Hospital See details
Blue Medicare Advantage Valor PPO (PPO) covers inpatient hospital services with no coinsurance, requiring a $380 daily copay for days 1 through 6 and no copay for days 7 through 90. Unlimited additional acute care days are covered with no copay, but additional psychiatric days, non-Medicare-covered stays, and upgrades are not covered.
Outpatient Services See details
Blue Medicare Advantage Valor PPO (PPO) covers outpatient hospital services with a $50 to $400 copay and observation services with a $350 copay per stay, both with no coinsurance. Ambulatory surgical center services require a $300 copay with no coinsurance, outpatient substance abuse sessions carry a $50 copay with no coinsurance, and outpatient blood services have no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization services are covered under the Blue Medicare Advantage Valor PPO (PPO) with a $105.00 copay and no coinsurance. Prior authorization is required to receive these services.
Ambulance and Transportation Services See details
Ambulance and transportation services are partially covered by Blue Medicare Advantage Valor PPO (PPO), requiring a $400 copay and no coinsurance for ground and air ambulance services, which require prior authorization. Transportation services to plan-approved or any health-related locations are not covered.
Emergency Services See details
Emergency services for the Blue Medicare Advantage Valor PPO (PPO) are covered with a $125 copay and no coinsurance, with the copay waived if you are admitted to the hospital within 24 hours. Urgently needed services have a $50 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered up to a $50,000 maximum with a $125 copay and no coinsurance.
Primary Care See details
Blue Medicare Advantage Valor PPO (PPO) provides primary care and opioid treatment services with no copay and no coinsurance, while specialist, psychiatric, and mental health services require a $50 copay with no coinsurance. Physical therapy has a $40 copay and occupational therapy has a $45 copay with no coinsurance, though podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive Services are partially covered under the Blue Medicare Advantage Valor PPO (PPO) with no copay and no coinsurance for covered services such as annual physical exams, kidney disease education, diabetes self-management, and select additional benefits like memory fitness. However, several preventive sub-services are not covered, including health education, in-home safety assessments, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, disease management, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Blue Medicare Advantage Valor PPO (PPO) provides coverage for one routine hearing exam per year and over-the-counter (OTC) hearing aids with no copay and no coinsurance, though prescription hearing aids and fitting evaluations are not covered. Covered OTC hearing aids have a maximum benefit of $30 per ear every three months for in-network services.
Vision Services See details
Vision services are partially covered under the Blue Medicare Advantage Valor PPO (PPO) plan, which offers one routine eye exam per year with a $0 to $50 copay and no coinsurance, while other eye exam services are not covered. Covered eyewear, including lenses, frames, and contact lenses, features no copay, no coinsurance, and no deductible, subject to an $80 annual maximum benefit for frames or contacts.
Dental Services See details
Dental services covered by Blue Medicare Advantage Valor PPO (PPO) include preventive care like exams and cleanings with no copay and no coinsurance, and Medicare-covered dental with a $50 copay and no coinsurance. Comprehensive services like restorative care, endodontics, periodontics, prosthodontics, implants, and oral surgery are partially covered with no copay and up to 50% coinsurance up to a $1,200 annual maximum, while fluoride, orthodontics, adjunctive general services, maxillofacial prosthetics, and other diagnostic or preventive services are not covered.
Home Infusion bundled Services See details
Blue Medicare Advantage Valor PPO (PPO) covers home infusion bundled services with no copay, subject to prior authorization and step therapy. Under this benefit, Medicare Part B insulin is covered with a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs require 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under 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 with no copays, though diabetic supplies and diabetic therapeutic shoes or inserts are not covered. Covered durable medical equipment incurs 0% to 20% coinsurance, prosthetic devices and medical supplies require 20% coinsurance, and diabetic equipment features no coinsurance.
Diagnostic and Radiological Services See details
Blue Medicare Advantage Valor PPO (PPO) covers diagnostic services with no coinsurance, requiring a $15 copay for lab services and a $50 copay for diagnostic procedures. Radiological services are also covered and require prior authorization, featuring a $20 copay for X-rays, a minimum $225 copay for diagnostic radiology, and a minimum 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by Blue Medicare Advantage Valor PPO (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Blue Medicare Advantage Valor PPO (PPO) covers Cardiac Rehabilitation Services with no coinsurance, but some services are covered while cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) 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 allowing admission without a prior three-day inpatient hospital stay. There is no copay for days 1 through 20, while days 21 through 100 require a $204 daily copay, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Blue Medicare Advantage Valor PPO (PPO) partially covers other services, offering an over-the-counter (OTC) benefit with no copay and no coinsurance up to a maximum of $30 every three months. Acupuncture, meal benefits, nicotine replacement therapy, and naloxone are not covered under this benefit.
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