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BlueMedicare Patriot (PPO) Medicare Advantage Plan H5434-042 • 2027

CMS Rating: ☆☆☆☆☆ (3.0 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$6750.00In-network
Part B Giveback
−$100.00 reduction
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
See List
Total Enrollment
165 beneficiaries
Last update:

BlueMedicare Patriot (PPO) Introduction

BlueMedicare Patriot is a Medicare Advantage PPO plan offered by Florida Blue. It uses a Preferred Provider Organization (PPO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $6750.00 in-network maximum out-of-pocket. CMS Plan ID H5434-042 identifies this plan.

Plan Benefits

BlueMedicare Patriot has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H5434-042.

Compare 2027 plan benefits with 2026.

Office Visits

Office visit costs by plan year.
Covered Service 2027 2026
Primary care In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Specialist In-network: $55 copay
Out-of-network: 50% coinsurance		 In-network: $55 copay
Out-of-network: 50% coinsurance

Preventive and Wellness Services

Preventive and wellness service costs and benefits by plan year.
Covered Service 2027 2026
Annual wellness exam Not covered Not covered
Telehealth benefit In-network: $0-$55 copay In-network: $0-$55 copay
Routine chiropractic Not covered Not covered
Fitness benefits Coming soon In-network: $0 copay
Out-of-network: $0 copay, 0% coinsurance
Health education Not covered Not covered
Counseling services Not covered Not covered
Over-the-counter drug benefits In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Health transportation (non-emergency) Coming soon Not covered

Diagnostic, Lab, and Imaging Services

Diagnostic, laboratory, and imaging service costs by plan year.
Covered Service 2027 2026
Diagnostic radiology services In-network: $0-$250 copay
Out-of-network: 50% coinsurance		 In-network: $0-$250 copay
Out-of-network: 50% coinsurance
Lab services In-network: $0-$40 copay
Out-of-network: 50% coinsurance		 In-network: $0-$40 copay
Out-of-network: 50% coinsurance
Outpatient x-rays In-network: $15-$150 copay
Out-of-network: 50% coinsurance		 In-network: $15-$150 copay
Out-of-network: 50% coinsurance
Diagnostic tests and procedures In-network: $0-$75 copay
Out-of-network: 50% coinsurance		 In-network: $0-$75 copay
Out-of-network: 50% coinsurance

Emergency and Urgent Care Services

Emergency, urgent care, hospital, ambulance, and skilled nursing costs by plan year.
Covered Service 2027 2026
Emergency room care $130 copay $130 copay
Worldwide emergency care Coming soon $130 copay
Urgent care $50 copay $50 copay
Inpatient hospital care In-network:
Tier 1
$385 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
50% per stay		 In-network:
Tier 1
$385 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
50% per stay
Skilled Nursing Facility In-network:
Tier 1
$0 per day for days 1-20
$221 per day for days 21-100
Out-of-network:
50% per stay		 In-network:
Tier 1
$0 per day for days 1-20
$218 per day for days 21-100
Out-of-network:
50% per stay
Ground ambulance In-network: $0-$275 copay
Out-of-network: $275 copay		 In-network: $0-$275 copay
Out-of-network: $275 copay

Mental Health Services

Mental health therapy and inpatient psychiatric care costs by plan year.
Covered Service 2027 2026
Outpatient individual therapy In-network: $40 copay
Out-of-network: 50% coinsurance		 In-network: $40 copay
Out-of-network: 50% coinsurance
Outpatient group therapy In-network: $30 copay
Out-of-network: 50% coinsurance		 In-network: $30 copay
Out-of-network: 50% coinsurance
Inpatient psychiatric hospital care In-network:
Tier 1
$385 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
50% per stay		 In-network:
Tier 1
$385 per day for days 1-7
$0 per day for days 8-90
$0 per stay
Out-of-network:
50% per stay

Rehabilitation Services

Physical, speech, and occupational therapy costs by plan year.
Covered Service 2027 2026
Physical therapy and speech and language therapy In-network: $0-$40 copay
Out-of-network: 50% coinsurance		 In-network: $0-$40 copay
Out-of-network: 50% coinsurance
Occupational therapy In-network: $40 copay
Out-of-network: 50% coinsurance		 In-network: $40 copay
Out-of-network: 50% coinsurance

Medical Equipment and Supplies

Diabetes supplies, durable medical equipment, and prosthetic costs by plan year.
Covered Service 2027 2026
Diabetes supplies In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Durable medical equipment In-network: 20% coinsurance
Out-of-network: 50% coinsurance		 In-network: 20% coinsurance
Out-of-network: 50% coinsurance
Prosthetics In-network: 20% coinsurance
Out-of-network: 50% coinsurance		 In-network: 20% coinsurance
Out-of-network: 50% coinsurance

Medicare Part B Drugs

Chemotherapy and other Medicare Part B-covered drug costs by plan year.
Covered Service 2027 2026
Chemotherapy In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance		 In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance
Other Part B drugs (Medicare-covered) In-network: 0%-20% coinsurance
Out-of-network: 50% coinsurance		 In-network: $0 copay, 0%-20% coinsurance
Out-of-network: 50% coinsurance

Dental Services

Preventive and comprehensive dental service costs by plan year.
Covered Service 2027 2026
Oral exam In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Cleaning In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Periodontics Not covered Not covered
Endodontics Not covered Not covered
Restorative services Not covered Not covered
Implant services Not covered Not covered
Orthodontics Not covered Not covered
Oral/Maxillofacial surgery In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance

Vision Services

Routine eye exams, contact lenses, and eyewear costs by plan year.
Covered Service 2027 2026
Routine eye exam In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Contact lenses In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglass frames only In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglass lenses only In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Eyeglasses (frames & lenses) In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Upgrades In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance

Hearing Services

Hearing exams, fittings, and hearing aid costs by plan year.
Covered Service 2027 2026
Hearing exam In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Fitting/evaluation In-network: $0 copay
Out-of-network: 50% coinsurance		 In-network: $0 copay
Out-of-network: 50% coinsurance
Prescription hearing aids In-network: $350-$1825 copay
Out-of-network: 50% coinsurance		 In-network: $350-$1825 copay
Out-of-network: 50% coinsurance
OTC hearing aids Not covered Not covered

Additional and Special Needs Services

Additional and special needs service costs and benefits by plan year.
Covered Service 2027 2026
Adult day health services Not covered Not covered
Home-based palliative care Not covered Not covered
Personal emergency response system Coming soon Not covered
Weight management programs Not covered Not covered
Wigs for chemotherapy-related hair loss Coming soon Not covered
Alternative therapies Not covered Not covered
Massage therapy Not covered Not covered
Home/bathroom safety devices Not covered Not covered

Certain preventive services are covered 100% by BlueMedicare Patriot as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H5434)

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.

2027 Medicare Star Ratings for Contract H5434
CMS Measure Star Rating
2027 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 ☆☆☆☆☆

Frequently Asked Questions

Here are some of the most frequently asked questions about this plan (click to open).

Frequently Asked Questions About BlueMedicare Patriot (PPO)

How much does plan H5434-042 cost per month?

The plan’s monthly premium is $0.00 for 2027. The Part B premium is not included.

What is the annual out-of-pocket maximum (MOOP) for this plan?

The annual in-network MOOP is $6750.00 for 2027. After this limit is reached, covered in-network services are fully paid.

How many beneficiaries are enrolled in this plan?

CMS reports 165 beneficiaries enrolled in this plan.

What is the prescription drug deductible for 2027?

For 2027, the prescription drug deductible is $0.00.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher CMS Version
Landscape Source Files Centers for Medicare & Medicaid Services CY2027 Landscape (202609.1)
Medicare Part C & D Performance Centers for Medicare & Medicaid Services 2027 Star Ratings Data Tables
Plan Benefits Package Centers for Medicare & Medicaid Services PBP Benefits-2027
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services 2026-09

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Florida Blue (official source) http://FloridaBlue.com/medicare October 4, 2026
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Explore your Medicare coverage options 25 May, 2025

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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.