BlueMedicare Patriot (PPO)
H5434 - 040 - 0
(3.5 / 5)
BlueMedicare Patriot (PPO) is a Medicare Advantage (Part C) Plan by Florida Blue.
This page features plan details for 2024 BlueMedicare Patriot (PPO) H5434 – 040 – 0 available in Florida Panhandle.
IMPORTANT: This page has been updated with plan and premium data for 2024.
Locations
BlueMedicare Patriot (PPO) is offered in the following locations.
Plan Overview
BlueMedicare Patriot (PPO) offers the following coverage and cost-sharing.
| Insurer: | Florida Blue |
| Health Plan Deductible: | $0.00 |
| MOOP: | $8,950 In and Out-of-network $5,500 In-network |
| Drugs Covered: | No |
Ready to sign up for BlueMedicare Patriot (PPO) ?
Medicare Part B Give Back Benefit
The Part B Premium Reduction (Medicare Part B Give Back Benefit) lowers the cost of some Medicare Advantage plans.
BlueMedicare Patriot (PPO) qualifies for a monthly Medicare Give Back Benefit of $75.00.
| Premium Reduction: | $75.00 |
Premium Breakdown
BlueMedicare Patriot (PPO) has a monthly premium of $0.00. This amount includes your Part C premium but does not include your Part B premium.| Part B | Part C | Part B Give Back | Total |
|---|---|---|---|
| $174.70 | $0.00 | $75.00 | $99.70 |
- Your Part B premium may differ based on factors including late enrollment, income, and disability status.
Additional Benefits
BlueMedicare Patriot (PPO) also provides the following benefits.
| $0 |
| In-network | No |
| $8,950 In and Out-of-network $5,500 In-network |
| No |
| In-network | No |
| In-network | $300 copay per visit (Authorization is required.) (Referral is not required.) |
| out-of-network | 45% coinsurance per visit (Authorization is required.) (Referral is not required.) |
| In-network Primary | $10 copay per visit (Not applicable.) (Not applicable.) |
| out-of-network Primary | 45% coinsurance per visit (Not applicable.) (Not applicable.) |
| In-network Specialist | $45 copay per visit (Authorization is not required.) (Referral is not required.) |
| out-of-network Specialist | 45% coinsurance per visit (Authorization is not required.) (Referral is not required.) |
| In-network | $0 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network | 45% coinsurance (Authorization is not required.) (Referral is not required.) |
| Emergency | $120 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| Urgent care | $30 copay per visit (always covered) (Not applicable.) (Not applicable.) |
| In-network Diagnostic tests and procedures | $0-75 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic tests and procedures | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Lab services | $0-40 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Lab services | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Diagnostic radiology services (e.g., MRI) | $0-75 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Diagnostic radiology services (e.g., MRI) | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient x-rays | $15-150 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient x-rays | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Hearing exam | $45 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing exam | 45% coinsurance (Authorization is not required.) (Referral is not required.) |
| In-network Fitting/evaluation | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Fitting/evaluation | 45% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Hearing aids | $350-1,825 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Hearing aids | 45% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Office visit | $0.00 (Authorization is not required.) (Referral is not required.) |
| out-of-network Office visit | 45% coinsurance (Authorization is not required.) (Referral is not required.) |
| Oral exam | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Cleaning | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Fluoride treatment | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Dental x-ray(s) | Covered under office visit (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Non-routine services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Diagnostic services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Restorative services | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Endodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| Periodontics | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Extractions | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Extractions | 45% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Prosthodontics, other oral/maxillofacial surgery, other services | $0 copay (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| out-of-network Prosthodontics, other oral/maxillofacial surgery, other services | 45% coinsurance (Limits may apply.) (Authorization is required.) (Referral is not required.) |
| In-network Routine eye exam | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Routine eye exam | 45% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| Other | Not covered (There are no limits.) (Not applicable.) (Not applicable.) |
| In-network Contact lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Contact lenses | 45% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglasses (frames and lenses) | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Eyeglasses (frames and lenses) | 45% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass frames | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Eyeglass frames | 45% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Eyeglass lenses | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Eyeglass lenses | 45% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Upgrades | $0 copay (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| out-of-network Upgrades | 45% coinsurance (Limits may apply.) (Authorization is not required.) (Referral is not required.) |
| In-network Occupational therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Occupational therapy visit | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Physical therapy and speech and language therapy visit | $40 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Physical therapy and speech and language therapy visit | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network | $250 copay (Not applicable.) (Not applicable.) |
| out-of-network | $250 copay (Not applicable.) (Not applicable.) |
| Not covered (Not applicable.) (Not applicable.) |
| In-network Foot exams and treatment | $35 copay (Authorization is not required.) (Referral is not required.) |
| out-of-network Foot exams and treatment | 45% coinsurance (Authorization is not required.) (Referral is not required.) |
| Routine foot care | Not covered (Not applicable.) (Not applicable.) |
| In-network Durable medical equipment (e.g., wheelchairs, oxygen) | 0-20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Durable medical equipment (e.g., wheelchairs, oxygen) | 45% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Prosthetics (e.g., braces, artificial limbs) | 20% coinsurance per item (Authorization is required.) (Not applicable.) |
| out-of-network Prosthetics (e.g., braces, artificial limbs) | 45% coinsurance per item (Authorization is required.) (Not applicable.) |
| In-network Diabetes supplies | $0 copay (Authorization is not required.) (Not applicable.) |
| out-of-network Diabetes supplies | 45% coinsurance per item (Authorization is not required.) (Not applicable.) |
| Covered (Authorization is not required.) (Referral is not required.) |
| In-network Chemotherapy | 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Chemotherapy | 45% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Other Part B drugs | $5 copay or 0-20% coinsurance (Authorization is required.) (Not applicable.) |
| out-of-network Other Part B drugs | 45% coinsurance (Authorization is required.) (Not applicable.) |
| In-network Part B Insulin drugs | 0-20% coinsurance (up to $35) (Authorization is required.) (Not applicable.) |
| out-of-network Part B Insulin drugs | 45% coinsurance (Authorization is required.) (Not applicable.) |
| In-network | $350 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 90 and beyond (Authorization is required.) (Referral is not required.) |
| out-of-network | 45% per stay (Authorization is required.) (Referral is not required.) |
| In-network Inpatient hospital – psychiatric | $318 per day for days 1 through 5 $0 per day for days 6 through 90 (Authorization is required.) (Referral is not required.) |
| out-of-network Inpatient hospital – psychiatric | 45% per stay (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit with a psychiatrist | $20 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit with a psychiatrist | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit with a psychiatrist | $20 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit with a psychiatrist | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient group therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient group therapy visit | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network Outpatient individual therapy visit | $20 copay (Authorization is required.) (Referral is not required.) |
| out-of-network Outpatient individual therapy visit | 45% coinsurance (Authorization is required.) (Referral is not required.) |
| In-network | $0 per day for days 1 through 20 $160 per day for days 21 through 100 (Authorization is required.) (Referral is not required.) |
| out-of-network | 45% per stay (Authorization is required.) (Referral is not required.) |
Ready to sign up for BlueMedicare Patriot (PPO) ?
Table of Contents
SMID: MULTIPLAN_HCIHNDOGMED01_M
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