Blue Medicare Advantage Valor PPO (PPO)
Medicare Advantage Plan H5900-006 • 2026 • Greene County, IA
Blue Medicare Advantage Valor PPO (PPO) Medicare Advantage Plan H5900-006 • 2026 • Greene County, IA
This Medicare Advantage PPO plan, identified by CMS Plan ID H5900-006, is offered by Wellmark Advantage Health Plan for the 2026 plan year. The plan uses a Preferred Provider Organization (PPO) provider network and comes without prescription coverage (Part D ).
Blue Medicare Advantage Valor PPO Overview
Plan Overview for H5900-006-0 |
|
|---|---|
| CMS Plan ID: | H5900-006-0 |
| Plan Type: | PPO |
| Plan Year: | 2026 |
| Monthly Premium: | $0.00 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $6750.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Not Included |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Greene County, IA |
| Enrollment (Nationwide) | 53 beneficiaries |
| Enrollment (CMS – Local) | 0 beneficiaries in Greene County |
| Provided By: | Wellmark Advantage Health Plan |
Plan Details for Blue Medicare Advantage Valor PPO
This Medicare Advantage Preferred Provider Organization (PPO) plan provides access to Medicare-approved providers and covers Medicare Part A and Part B services. The monthly premium is $0.00, with lower costs when using in-network providers.
Primary care visits have a $0 copay | Out-of-network: $25 copay, specialist visits come with a $50 copay | Out-of-network: $75 copay, lab services cost {lab_services_cost}, urgent care services carry a $50 copay, and ambulance transportation is $400 copay | Out-of-network: $400 copay. These costs apply toward the annual maximum out-of-pocket (MOOP) limit of $6750.00. Once this limit is reached, in-network services are fully covered.
This plan is listed by CMS under Plan ID {title_plan_id}. Cost-sharing details for key services are provided below.
Cost-Sharing Overview
Blue Medicare Advantage Valor PPO includes cost-sharing, which refers to out-of-pocket expenses for covered healthcare services. The table below outlines the most common in-network out-of-pocket costs associated with plan H5900-006.
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: $25 copay |
| Specialist: | In-network: $50 copay | Out-of-network: $75 copay |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0-$50 copay |
| Routine chiropractic: | In-network: $30 copay | Out-of-network: $0 copay, 0% coinsurance |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency): | Not covered |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $250 copay | Out-of-network: $300 copay |
| Lab services: | In-network: $15 copay | Out-of-network: $20 copay |
| Outpatient x-rays: | In-network: $20 copay | Out-of-network: $30 copay |
| Diagnostic tests and procedures: | In-network: $70 copay | Out-of-network: $95 copay |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $130 copay |
| Worldwide emergency care: | $130 copay |
| Urgent care: | $50 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $450 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | 40% per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-100 | Out-of-network: | $0 per day for days 1-20 | $230 per day for days 21-100 | $0 per stay |
| Ground ambulance: | In-network: $400 copay | Out-of-network: $400 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $50 copay | Out-of-network: $75 copay |
| Outpatient group therapy: | In-network: $50 copay | Out-of-network: $75 copay |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $450 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | 40% per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $50 copay | Out-of-network: $75 copay |
| Occupational therapy: | In-network: $50 copay | Out-of-network: $75 copay |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: $0 copay | Out-of-network: 20% coinsurance |
| Durable medical equipment: | In-network: 0%-20% coinsurance | Out-of-network: 30% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 20% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 30% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 30% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Periodontics: | In-network: 0%-25% coinsurance | Out-of-network: 0%-50% coinsurance |
| Endodontics: | In-network: 25% coinsurance | Out-of-network: 50% coinsurance |
| Restorative services: | In-network: 25% coinsurance | Out-of-network: 50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: 0%-25% coinsurance | Out-of-network: 0%-50% coinsurance |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Eyeglass frames only: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Eyeglass lenses only: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Upgrades: | In-network: $0 copay | Out-of-network: 50% coinsurance |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation: | Not covered |
| Prescription hearing aids: | Not covered |
| OTC hearing aids: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Certain preventive services are covered 100% by Blue Medicare Advantage Valor PPO as a Part B benefit.
Prescription Drug Coverage
This plan does not include a Medicare Part D plan for prescriptions.
CMS Star Ratings
Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.
| CMS Measure | Star Rating |
|---|---|
| 2026 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 |
Is there a monthly premium for this plan in 2026?
The plan’s monthly premium is $0.00 for 2026. The Part B premium is not included.
What is the MOOP for Blue Medicare Advantage Valor PPO in 2026?
The annual in-network MOOP is $6750.00 for 2026. After this limit is reached, covered in-network services are fully paid.
How many beneficiaries are enrolled in this plan?
Total enrollment is 53 beneficiaries based on the latest CMS data.
What is the Part D deductible for plan H5900-006?
The Part D deductible is $0.00.
Contact Information for Wellmark Advantage Health Plan
| Contact Type | Details |
|---|---|
| Website: | Wellmark Advantage Health Plan Plan Page |
| New Members: | 1-800-213-3771 |
| Existing Members: | 1-855-716-2544 |
| Plan Address: | P.O. Box 211501 | Eagan, MN 55121 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation..
- Wellmark Advantage Health Plan (official source), http://www.Wellmarkadvantagehealthplan.com — Last accessed October 13, 2025
- Medicare.gov, "Understanding Medicare Advantage Plans" — Last accessed 25 May, 2025
- AARP.org, "The Big Choice: Original Medicare vs. Medicare Advantage" — Last accessed 25 May, 2025
- Medicare.gov, "Compare Original Medicare & Medicare Advantage" — Last accessed 25 May, 2025
MedicarePlans.com operates as an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.
Data provenance documentation is maintained in alignment with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.