BlueMedicare Patriot (PPO) is a Medicare Advantage (Part C) Plan by Florida Blue.
This page features plan details for 2024 BlueMedicare Patriot (PPO) H5434 – 041 – 0 available in Alachua, Clay, Duval, Nassau & St. Johns counties.
IMPORTANT: This page has been updated with plan and premium data for 2024.
BlueMedicare Patriot (PPO) is offered in the following locations.
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) ?
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 |
Part B | Part C | Part B Give Back | Total |
---|---|---|---|
$174.70 | $0.00 | $75.00 | $99.70 |
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) ?
SMID: MULTIPLAN_HCIHNDOGMED01_M
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