BlueMedicare Patriot (PPO) H5434-042 is a 2023 Medicare Advantage Plan or Part-C by Florida Blue available to residents in Florida. This plan does not provide extra prescription drug (Part-D) coverage. Florida Blue BlueMedicare Patriot (PPO) has a monthly premium of $0 and has an in-network maximum out-of-pocket limit of $5,500 (MOOP). This means that if you get sick or need a high-cost procedure the co-pays are capped once you pay $5,500 out-of-pocket. This can be an extremely nice safety net.

Florida Blue works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BlueMedicare Patriot (PPO) you still retain Original Medicare. But you will get extra Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Florida Blue and not Original Medicare. With 2023 Medicare Advantage Plan you are always covered for urgently needed and emergency care. Plus, you receive all the benefits of Original Medicare from Florida Blue except hospice care. Original Medicare still provides you with hospice care if you sign up for Medicare Advantage in Florida.

2023 Florida Blue Medicare Advantage Plan Overview

What type of plan is BlueMedicare Patriot (PPO)

BlueMedicare Patriot (PPO) is a Local PPO *. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network, but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

How much does BlueMedicare Patriot (PPO) cost?

Part-C Premium

A monthly premium is the fee you pay to the plan in exchange for coverage. Florida Blue charges a $0 premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

MOOP

The maximum out-of-pocket (MOOP) is a yearly limit on your out-of-pocket costs. BlueMedicare Patriot (PPO) by Florida Blue MOOP is $5,500. Once you spend $5,500 you will pay nothing for Part A or Part B covered services. Copayments and coinsurance for Medicare approved services apply toward your out-of-pocket limit. Remember Original Medicare (Parts A and B) doesn’t have a MOOP.

2023 Summary of Benefits

The benefit information provided is a summary of what BlueMedicare Patriot (PPO) covers and what you pay (such as copayments and coinsurance amounts) for certain common medical events. The Summary of Benefits from Florida Blue helps get an idea of how much financial protection the plan is generally expected to provide for common health conditions. This section also contains information on coverage for in-network and out-of-network providers.

Wellness programs (e.g., fitness, nursing hotline)	Covered

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Contact lenses

Out-of-Network Vision	47% coinsurance
In-Network Vision	$0 copay

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Eyeglass frames

Out-of-Network Vision	47% coinsurance
In-Network Vision	$0 copay

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Eyeglass lenses

Out-of-Network Vision	47% coinsurance
In-Network Vision	$0 copay

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Eyeglasses (frames and lenses)

In-Network Vision	$0 copay
Out-of-Network Vision	47% coinsurance

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Other

Vision	Not covered

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Routine eye exam

In-Network Vision	$0 copay
Out-of-Network Vision	47% coinsurance

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Upgrades

Out-of-Network Vision	47% coinsurance
In-Network Vision	$0 copay

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Transportation	Not covered
Out-of-Network Skilled Nursing Facility	47% per stay
In-Network Skilled Nursing Facility	$0 per day for days 1 through 20 $160 per day for days 21 through 100

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Occupational therapy visit

In-Network Rehabilitation services	$40 copay
Out-of-Network Rehabilitation services	47% coinsurance

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Physical therapy and speech and language therapy visit

Out-of-Network Rehabilitation services	47% coinsurance
In-Network Rehabilitation services	$40 copay

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Cleaning

Out-of-Network Preventive dental	47% coinsurance
In-Network Preventive dental	$0 copay

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Dental x-ray(s)

Out-of-Network Preventive dental	47% coinsurance
In-Network Preventive dental	$0 copay

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Fluoride treatment

Preventive dental	Not covered

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Oral exam

In-Network Preventive dental	$0 copay
Out-of-Network Preventive dental	47% coinsurance

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In-Network Preventive care	$0 copay
Out-of-Network Preventive care	47% coinsurance
In-Network Outpatient hospital coverage	$300 copay per visit
Out-of-Network Outpatient hospital coverage	47% coinsurance per visit
In-Network Other health plan deductibles?	No
Optional supplemental benefits	No

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Inpatient hospital - psychiatric

In-Network Mental health services	$318 per day for days 1 through 5 $0 per day for days 6 through 90
Out-of-Network Mental health services	47% per stay

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Outpatient group therapy visit

Out-of-Network Mental health services	47% coinsurance
In-Network Mental health services	$20 copay

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Outpatient group therapy visit with a psychiatrist

In-Network Mental health services	$20 copay
Out-of-Network Mental health services	47% coinsurance

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Outpatient individual therapy visit

In-Network Mental health services	$20 copay
Out-of-Network Mental health services	47% coinsurance

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Outpatient individual therapy visit with a psychiatrist

In-Network Mental health services	$20 copay
Out-of-Network Mental health services	47% coinsurance

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Chemotherapy

Out-of-Network Medicare Part B drugs	47% coinsurance
In-Network Medicare Part B drugs	20% coinsurance

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Other Part B drugs

In-Network Medicare Part B drugs	$5 copay or 20% coinsurance
Out-of-Network Medicare Part B drugs	47% coinsurance

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Diabetes supplies

In-Network Medical equipment/supplies	$0 copay
Out-of-Network Medical equipment/supplies	47% coinsurance per item

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Durable medical equipment (e.g., wheelchairs, oxygen)

In-Network Medical equipment/supplies	0-20% coinsurance per item
Out-of-Network Medical equipment/supplies	47% coinsurance per item

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Prosthetics (e.g., braces, artificial limbs)

In-Network Medical equipment/supplies	20% coinsurance per item
Out-of-Network Medical equipment/supplies	47% coinsurance per item

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Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)	$8,950 In and Out-of-network $5,500 In-network
Out-of-Network Inpatient hospital coverage	47% per stay
In-Network Inpatient hospital coverage	$350 per day for days 1 through 4 $0 per day for days 5 through 90 $0 per day for days 91 and beyond

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Fitting/evaluation

In-Network Hearing	$0 copay
Out-of-Network Hearing	47% coinsurance

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Hearing aids

In-Network Hearing	$0 copay
Out-of-Network Hearing	47% coinsurance

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Hearing exam

In-Network Hearing	$45 copay
Out-of-Network Hearing	47% coinsurance

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Health plan deductible	$0
Out-of-Network Ground ambulance	$250 copay
In-Network Ground ambulance	$250 copay

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Foot exams and treatment

In-Network Foot care (podiatry services)	$35 copay
Out-of-Network Foot care (podiatry services)	47% coinsurance

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Routine foot care

Foot care (podiatry services)	Not covered

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Emergency

Emergency care/Urgent care	$90 copay per visit (always covered)

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Urgent care

Emergency care/Urgent care	$30 copay per visit (always covered)

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Primary

In-Network Doctor visits	$10 copay per visit
Out-of-Network Doctor visits	47% coinsurance per visit

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Specialist

In-Network Doctor visits	$45 copay per visit
Out-of-Network Doctor visits	47% coinsurance per visit

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Diagnostic radiology services (e.g., MRI)

Out-of-Network Diagnostic procedures/lab services/imaging	47% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$0-75 copay

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Diagnostic tests and procedures

In-Network Diagnostic procedures/lab services/imaging	$0-75 copay
Out-of-Network Diagnostic procedures/lab services/imaging	47% coinsurance

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Lab services

In-Network Diagnostic procedures/lab services/imaging	$0-40 copay
Out-of-Network Diagnostic procedures/lab services/imaging	47% coinsurance

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Outpatient x-rays

Out-of-Network Diagnostic procedures/lab services/imaging	47% coinsurance
In-Network Diagnostic procedures/lab services/imaging	$15-150 copay

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Diagnostic services

Comprehensive dental	Not covered

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Endodontics

Comprehensive dental	Not covered

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Extractions

Out-of-Network Comprehensive dental	47% coinsurance
In-Network Comprehensive dental	$0 copay

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Non-routine services

Comprehensive dental	Not covered

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Periodontics

Comprehensive dental	Not covered

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Prosthodontics, other oral/maxillofacial surgery, other services

Out-of-Network Comprehensive dental	47% coinsurance
In-Network Comprehensive dental	$0 copay

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Restorative services

Comprehensive dental	Not covered

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In-Network Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?	No

BlueMedicare Patriot (PPO) Reviews

Is BlueMedicare Patriot (PPO) a good plan? BlueMedicare Patriot (PPO) received a 3.5 overall star rating from the CMS. The CMS uses a Star Rating System to measure how well Medicare Advantage and Part D plans perform. Plans are rated on a one-to-five scale, with one star representing poor performance and five stars representing excellent performance. Medicare Advantage with prescription drug (Part D) coverage (MA-PD) contracts are rated on up to 38 unique quality and performance measures. You can use the CMS star rating to compare BlueMedicare Patriot Reviews among several different plans.

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with H5434-042 Health Plan

Member Complaints and Changes in Plans Performance

Health Plan Customer Service Rating for Florida Blue

Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Coverage Area

(Click county or state to compare all available Advantage plans)

The availability of Medicare Advantage Plans will vary according to your region. This is why the Coverage Area matters in terms of Medicare eligibility. You will always be eligible for Original Medicare, but eligibility for BlueMedicare Patriot (PPO) requires you to live in that plan’s service area. The service area is listed below:

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Source:CMS. Data as of Oct 1, 2022.

Last updated on December 03, 2022

Notes: Data are subject to change as contracts are finalized. For 2023, enhanced alternative may offer extra cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2023 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.