BlueMedicare Patriot (PPO) Plan Details for Bay County, FL
This Florida Blue plan has an overall rating of 4.0 (Good) out of 5 stars.
BlueMedicare Patriot (PPO) is a Medicare Advantage plan without a prescription drug plan. The 2025 enrollment period begins Oct. 15.
See more Medicare Advantage Plans in Bay County, Florida.
2025 BlueMedicare Patriot Cost and Coverage Notification
The 2025 cost and coverage information for BlueMedicare Patriot will not be available until early October. We'll notify you as soon as it is available from CMS.
Sign-Up for 2025 Medicare Plan Notification. The 2025 Annual Enrollment Period begins October 15.
BlueMedicare Patriot Basic Details
Plan Basics | |
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Plan ID: | H5434-040-0 |
Plan Type: | Local PPO |
Plan Year: | 2024 |
Premium: | $0.00/mo Plus your Medicare Part B premium. |
Health Plan Deductible: | $0.00 |
Out-of-Pocket Maximum: | $5,500/yr |
Part B Reduction: | $75.00/mo |
Drug Plan Benefit: | Not Included |
Rx Gap Coverage: | No |
Supplemental Benefits: | Vision, Hearing |
Availability: | Bay County, FL |
Insured By: | Florida Blue |
Summary of Benefits |
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Florida Blue Out-of-Pocket Costs
This Florida Blue Part C plan has cost-sharing. These are costs you pay out-of-pocket when you use approved health services. The following table summarizes the most common in-network out-of-pocket costs in plan H5434-040-0.
NOTE: Most preventive services are covered 100% by the plan as a Part B benefit.
Healthcare Service | Member Cost |
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Doctor Visits (In-Network) | |
Primary: | $10 Copay |
Specialist: | $45 Copay |
Wellness programs (e.g., fitness, nursing hotline): | None |
Preventive care: | $0 |
Foot Care (In-Network) | |
Foot exams and treatment (Medicare-covered): | $35 Copay |
Routine foot care: | Not Covered |
Chiropractic Care (In-Network) | |
Medicare-covered chiropractic care: | $20 Copay |
Routine chiropractic care: | Not Covered |
Emergency Care / Urgent Care | |
Emergency room care: | $120 Copay |
Urgent care: | $30 Copay |
Ground ambulance: | $250 Copay |
Inpatient hospital coverage: | $350.00 per day for days 1 through 4 $0.00 per day for days 5 and beyond |
Outpatient hospital coverage: | $300 Copay Prior Authorization Required |
Skilled Nursing Facility: | $0.00 per day for days 1 through 20 $160.00 per day for days 21 and beyond |
Optional supplemental benefits: | |
Mental Health Services (In-Network) | |
Outpatient individual therapy visit with a psychiatrist: | $20 Copay |
Outpatient group therapy visit with a psychiatrist: | $20 Copay |
Inpatient hospital - psychiatric: | $318.00 per day for days 1 through 5 $0.00 per day for days 6 and beyond |
Outpatient group therapy visit: | $20 Copay |
Outpatient individual therapy visit: | $0 |
Rehabilitation Services (In-Network) | |
Physical therapy and speech and language therapy visit: | $40 Copay Prior Authorization Required |
Occupational therapy visit: | $40 Copay Prior Authorization Required |
Medical Equipment / Supplies (In-Network) | |
Diabetes supplies: | $0 Copay |
Durable medical equipment (e.g., wheelchairs, oxygen): | 20% Coinsurance Prior Authorization Required |
Prosthetics (e.g., braces, artificial limbs): | 20% Coinsurance |
Diagnostic Procedures / Lab Services / Imaging (In-Network) | |
Diagnostic radiology services (e.g., MRI): | $75 Copay Prior Authorization Required |
Lab services: | $40 Copay Prior Authorization Required |
Outpatient x-rays: | $150 Copay Prior Authorization Required |
Diagnostic tests and procedures: | $75 Copay Prior Authorization Required |
Medicare Part B Drugs (In-Network) | |
Chemotherapy: | 20% Coinsurance |
Other Part B drugs (Medicare-covered) | 20% Coinsurance |
Feel free to download our BlueMedicare Patriot Summary of Benefits information.
Supplemental Benefits
The following is a summary of the supplemental benefits Florida Blue includes with this plan:
Supplemental Healthcare Service | Member Cost |
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Preventive Dental | |
Oral exam (In-Network) | Not Covered |
Fluoride treatment (In-Network) | Not Covered |
Dental x-ray(s) (In-Network) | Not Covered |
Cleaning (In-Network) | Not Covered |
Comprehensive Dental | |
Periodontics (In-Network) | Not Covered |
Non-routine services (In-Network) | Not Covered |
Diagnostic services (In-Network) | Not Covered |
Extractions (In-Network) | Not Covered |
Endodontics (In-Network) | Not Covered |
Restorative services (In-Network) | Not Covered |
Prosthodontics, other oral/maxillofacial surgery, other services (In-Network) | Not Covered |
Hearing Aids | |
Fitting/evaluation (In-Network) | $0 Copay |
Hearing aids (In-Network) | Covered Limits may apply |
Hearing exam (In-Network) | $0 Copay |
Vision | Maximum vision benefit: | $200.00 Every year |
Eyeglasses (frames and lenses) (In-Network) | $0 Copay |
Routine eye exam (In-Network) | $0 Copay |
Contact lenses (In-Network) | $0 Copay |
Additional Benefits
None specified.
Prescription Drug Plan Costs & Benefits
This plan does not include a Medicare Part D plan for prescriptions.
CMS 5-Star Rating Marks
Each year the Centers for Medicare & Medicaid Services (CMS) rates health plans (Part C) and drug plans (Part D) in several major categories using a 5-star rating system. These ratings are designed to help you understand the quality of care and service you can expect if you join BlueMedicare Patriot.
CMS Measure | Star Rating |
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2024 Overall Rating | |
Staying Healthy: Screenings, Tests, Vaccines | |
Managing Chronic (Long Term) Conditions | |
Member Experience with Health Plan | |
Complaints and Changes in Plans Performance | |
Health Plan Customer Service | |
Drug Plan Customer Service | |
Complaints and Changes in the Drug Plan | |
Member Experience with the Drug Plan | |
Drug Safety and Accuracy of Drug Pricing |
Additional Plan Options
The Medicare Part C program offers a myriad of HMO, PPO, and PFFS plan options, including these plans:
- BlueMedicare Patriot
- BlueMedicare Value
- BlueMedicare Patriot
- BlueMedicare Patriot
- BlueMedicare Patriot
- BlueMedicare Value
- BlueMedicare Value
If you are enrolled in a Part C plan with prescription drug coverage, you cannot be enrolled in a stand-alone Medicare Part D plan, regardless of your chosen insurance company.
You cannot be enrolled in a Part C health plan and simultaneously hold Medicare Supplement Insurance (Medigap). Medicare Supplement plans are only compatible with Medicare Parts A and B.
Contact Florida Blue
Plan Website: | http://FloridaBlue.com/medicare |
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Formulary Information: | http://FloridaBlue.com/medicare |
Pharmacy Information: | Florida Blue Pharmacy Page |
Prospective Members: | (855)601-9465 |
TTY Users: | (800)955-8770 |
If you qualify for Medicare benefits but have not yet enrolled or verified your enrollment status, you can do so on the Social Security Administration website. You can learn more about the Medicare Part C program on www.medicare.gov or call 1-800-MEDICARE.
Citations & References
- Florida Blue, http://FloridaBlue.com/medicare, Last Accessed February 20, 2024
- Medicare.gov, "Understanding Medicare Advantage Plans", Last Accessed January 21, 2024
- Medicare.gov, "Compare Original Medicare & Medicare Advantage", Last Accessed February 19, 2024
- Medicare.gov, "Medicare & You in Different Formats", Last Accessed February 19, 2024
- Medicare.gov, "Is Your Test, Item, or Service Covered?", Last Accessed June 3, 2023
- CMS.gov, Landscape Source Files, Last Accessed February 21, 2024
- CMS.gov, Medicare Part C & D Performance, Last Accessed February 21, 2024
- CMS.gov, Plan Benefits Package, Last Accessed February 21, 2024
Plans Offered
Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Aspire Health Plan, Baylor Scott & White Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, Freedom Health, GlobalHealth, Health Care Service Corporation, Healthy Blue, HealthSun, Humana, Molina Healthcare, Mutual of Omaha, Medica Central Health Plan, Optimum HealthCare, Premera Blue Cross, SCAN Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint.