BlueMedicare Value (PPO)

3.5 out of 5 stars* for plan year 2024
$0.00 Monthly Premium

BlueMedicare Value (PPO) is a PPO Medicare Advantage (Medicare Part C) plan offered by Florida Blue

Plan ID: H5434-024-000

$0.00 Monthly Premium

Florida Medicare beneficiaries may want to consider reviewing their Medicare Advantage (Medicare Part C) plan options. A Medicare Advantage plan combines your Original Medicare (Part A and Part B) benefits into a single plan.

Most Medicare Advantage plans cover prescription drugs, and many plans may offer other extra benefits Original Medicare doesn’t cover.

Learn more about Florida Medicare Advantage plans like the one below and find a plan that offers the benefits you want at an affordable price.

Basic Costs and Coverage

Coverage Details
Monthly plan premium$0.00
Vision coverage
Dental coverage
Hearing coverage
Prescription drugs
Medical deductible$150.00
Out-of-pocket maximum$4,900.00
Initial drug coverage limit$0.00
Catastrophic drug coverage limit$8,000.00
Primary care doctor visit
Out-of-Network:

Doctor Office Visit:
Coinsurance for Medicare Covered Primary Care Office Visit 45%
Specialty doctor visit
Out-of-Network:

Doctor Specialty Visit:
Coinsurance for Medicare Covered Physician Specialist Office Visit 45%
Inpatient hospital careIn-Network:

Acute Hospital Services:
$275.00 per day for days 1 to 6
$0.00 per day for days 7 to 90
Prior Authorization Required for Acute Hospital Services
Urgent care
Urgent Care:
Copayment for Urgent Care $30.00

Worldwide Coverage:
Copayment for Worldwide Urgent Coverage $120.00
Maximum Plan Benefit of $25,000
Emergency room visit
Emergency Care:
Copayment for Emergency Care $120.00
Copayment for Medicare Covered Emergency Care waived if you are admitted to the hospital within 48 hours

Worldwide Coverage:
Copayment for Worldwide Emergency Coverage $120.00
Maximum Plan Benefit of $25,000
Ambulance transportationIn-Network:

Ground Ambulance:
Copayment for Ground Ambulance Services $260.00

Air Ambulance:
Copayment for Air Ambulance Services $260.00

Please see Evidence of Coverage for Prior Authorization rules

Health Care Services and Medical Supplies

BlueMedicare Value (PPO) covers a range of additional benefits. Learn more about BlueMedicare Value (PPO) benefits, some of which may not be covered by Original Medicare (Part A and Part B).

Coverage Details
Chiropractic servicesIn-Network:

Chiropractic Services:
Copayment for Medicare-covered Chiropractic Services $20.00
Diabetes supplies, training, nutrition therapy and monitoring
Out-of-Network:

Diabetic Supplies and Services:
Coinsurance for Medicare Covered Diabetic Supplies and Services 45%
Durable medical equipment (DME)
Out-of-Network:

Durable Medical Equipment:
Coinsurance for Medicare Covered Durable Medical Equipment 45%
Diagnostic tests, lab and radiology services, and X-rays
Out-of-Network:

Outpatient Diag Procs/Tests/Lab Services:
Coinsurance for Medicare Covered Diagnostic Procedures/Tests 45%
Coinsurance for Medicare Covered Lab Services 45%
Coinsurance for Medicare Covered Diagnostic Radiological Services 45%
Coinsurance for Medicare Covered Therapeutic Radiological Services 45%
Coinsurance for Medicare Covered Outpatient X-Ray Services 45%
Home health care
Out-of-Network:

Home Health Services:
Coinsurance for Medicare Covered Home Health 45%
Mental health inpatient careIn-Network:

Psychiatric Hospital Services:
$318.00 per day for days 1 to 5
$0.00 per day for days 6 to 90
Prior Authorization Required for Psychiatric Hospital Services
Mental health outpatient care
Out-of-Network:

Outpatient Mental Health Services:
Coinsurance for Medicare Covered Individual Sessions 45%
Coinsurance for Medicare Covered Group Sessions 45%
Outpatient services/surgery
Out-of-Network:

Outpatient Hospital and ASC Services:
Coinsurance for Medicare Covered Outpatient Hospital Services 45%
Coinsurance for Medicare Covered Ambulatory Surgical Center Services 45%
Outpatient substance abuse careIn-Network:

Outpatient Substance Abuse Services:
Copayment for Medicare-covered Individual Sessions $20.00
Copayment for Medicare-covered Group Sessions $20.00
Prior Authorization Required for Outpatient Substance Abuse Services
Over-the-counter items
Out-of-Network:

Over-The-Counter (OTC) Items:
Copayment for Non-Medicare Covered Over-The-Counter (OTC) Items $0.00
Maximum Plan Benefit of $65.00
Podiatry services
Out-of-Network:

Podiatry Services:
Coinsurance for Medicare Covered Podiatry Services 45%
Skilled Nursing Facility (SNF) care
Out-of-Network:
Coinsurance for Skilled Nursing Facility Services per Stay 45%

Dental Benefits

The following dental services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Dental care
Out-of-Network:

Medicare Covered Dental Services:
Coinsurance for Medicare Covered Comprehensive Dental 45%
Non-Medicare Covered Dental Services:
Coinsurance for Non-Medicare Covered Preventive Dental 45%
Coinsurance for Non-Medicare Covered Comprehensive Dental 45%

Vision Benefits

The following vision services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Vision benefitsIn-Network:

Eye Exams:
Copayment for Medicare Covered Benefits $0.00 to $44.00
Copayment for Routine Eye Exams $0.00
  • Maximum 1 Routine Eye Exam every year

Eyewear:
Copayment for Medicare-Covered Benefits $0.00
Maximum Plan Allowance of $200.00 every year for all Non-Medicare covered eyewear for in and out of network services combined

Hearing Benefits

The following hearing services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Hearing benefits
Out-of-Network:

Medicare Covered Hearing Services:
Coinsurance for Medicare Covered Hearing Exams 45%
Non-Medicare Covered Hearing Services:
Coinsurance for Non-Medicare Covered Hearing Exams 45%
Coinsurance for Non-Medicare Covered Hearing Aids 45%

Preventive Services and Health/Wellness Education Programs

The following services are covered, though there may be provider network restrictions. See the plan Evidence of Coverage.

Coverage Details
Preventive services and health/wellness education programs
Out-of-Network:

Medicare-covered Zero Dollar Preventive Services:
Coinsurance for Medicare Covered Medicare-covered Preventive Services 45%

Prescription Drug Costs and Coverage

The BlueMedicare Value (PPO) offers prescription drug coverage, with an annual drug deductible of $150.00 (excludes Tiers 1, 2 and 6)

Coverage
Cost
Coverage & Cost
Annual drug deductible$150.00 (excludes Tiers 1, 2 and 6)
Tier 1
  • Standard retail $0.00
  • Standard mail order $0.00
  • Tier 2
  • Standard retail $0.00
  • Standard mail order $0.00
  • Tier 6
  • Standard retail $0.00
  • Standard mail order $0.00
  • Annual drug deductible$150.00 (excludes Tiers 1, 2 and 6)
    Tier 1
  • Standard retail N/A
  • Standard mail order N/A
  • Tier 2
  • Standard retail N/A
  • Standard mail order N/A
  • Tier 6
  • Standard retail N/A
  • Standard mail order N/A
  • Annual drug deductible$150.00 (excludes Tiers 1, 2 and 6)
    Tier 1
  • Standard retail $0.00
  • Standard mail order $0.00
  • Tier 2
  • Standard retail $0.00
  • Standard mail order $0.00
  • Tier 6
  • Standard retail $0.00
  • Standard mail order $0.00
  • When reviewing Florida Medicare plans, be sure to find out if your doctors are part of the plan network. If a Medicare Advantage plan covers prescription drugs, make sure the plan formulary (list of drugs covered by the plan) includes your drugs.

    You may be able to find plans in your part of Florida that offer similar benefits at similar or lower prices than the plan above. Call 1-800-557-6059 TTY 711, 24/7 to speak with a licensed insurance agent who can help you compare plans.

    Plan Documents

    Links to plan documents

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