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BlueAdvantage Diamond (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueAdvantage Diamond (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueAdvantage Diamond (PPO) in 2025, please refer to our full plan details page.
BlueAdvantage Diamond (PPO) is a PPO plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2025 to people living in Middle and West Tennessee. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BlueAdvantage Diamond (PPO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueAdvantage Diamond (PPO).
Plan Costs:
The cost of a Medicare Advantage Plan is made up of four main parts.
- First, the monthly premium — the amount you pay every month.
- Second, the deductible — the amount you pay out of pocket for covered services before the plan starts paying.
- Third, the copayments and coinsurance — the amounts you pay out of pocket for covered services, usually after meeting the deductible (if applicable). Copays are fixed dollar amounts; coinsurance is a percentage of the cost.
- Fourth, the Out-of-Pocket Maximum — the maximum amount you could have to pay out of pocket in a year. This may be different for in-network and out-of-network services.
For BlueAdvantage Diamond (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $157.00. This is the amount you must pay every month.
This plan does not come with a Part B Premium reduction. You must continue to pay your Part B premium.
Deductibles
This plan does not have a health deductible. Your insurance coverage on covered health services will start immediately.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a combined Maximum Out-Of-Pocket cost of $5750.00 (in-network or out-of-network combined). You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5750.00 for covered services, the plan will pay 100% of covered costs for the rest of the year.
The plan may have separate out-pocket-maximums for in-network and out-of-network services. See our full plan details page for more information.
You can see below for the coinsurance and specific copayments for in the Additional Benefits section below, or refer to our Plan Details page for more details.
Common Services:
Doctor Visits:
Specialist Visits:
Emergency Room:
Urgent Care:
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Drug Coverage
The BlueAdvantage Diamond (PPO) plan has an enhanced alternative drug benefit. The plan has no deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $5 copay at a preferred pharmacy, while preferred brand drugs have 50% coinsurance. After your total drug costs reach $2000, you enter the next coverage phase.
Additional Benefits
The BlueAdvantage Diamond (PPO) plan offers comprehensive coverage with a variety of benefits. This plan includes coverage for inpatient and outpatient services, with copays varying by service. You'll also find coverage for primary care, preventive services, hearing, vision, and dental. Additional benefits include coverage for home health, skilled nursing, and home infusion services. This plan also offers an over-the-counter (OTC) allowance and a meal benefit for chronic illness. However, this plan does not cover cardiac rehabilitation services or some other services, such as acupuncture, family planning, and private duty nursing.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered by the BlueAdvantage Diamond (PPO) plan, but Non-Medicare-covered Stay for Inpatient Hospital-Acute, Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric are not covered. Additional Days for Inpatient Hospital-Acute has unlimited coverage.
Outpatient Services See details
Outpatient Services for the BlueAdvantage Diamond (PPO) plan include coverage for Outpatient Hospital Services with a $175 copay, Observation Services with a $150 copay, Ambulatory Surgical Center (ASC) Services with a $125 copay, Individual Sessions for Outpatient Substance Abuse with a $20 copay, and Group Sessions for Outpatient Substance Abuse with a $10 copay. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueAdvantage Diamond (PPO) plan, with a $35 copay. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueAdvantage Diamond (PPO) plan, with prior authorization required for all ambulance services. Ground Ambulance Services have a $175 copay, while Air Ambulance Services have a 20% coinsurance, but Transportation Services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the BlueAdvantage Diamond (PPO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $25 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $60 copay, and Worldwide Emergency Transportation has a 20% coinsurance and a $175 copay.
Primary Care See details
The BlueAdvantage Diamond (PPO) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, while occupational therapy services have a $10 copay. Physician specialist services and individual sessions for mental health and psychiatric specialty services have a $20 copay, and group sessions for mental health and psychiatric specialty services have a $10 copay. Physical therapy and speech-language pathology services have a $10 copay, while the minimum copay for opioid treatment program services is $10, and the maximum is $20. Routine chiropractic care is not covered.
Preventive Services See details
The BlueAdvantage Diamond (PPO) plan covers a variety of preventive services, including Medicare-covered services, annual physical exams, health education, nutritional/dietary benefits, in-home support services, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, kidney disease education, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following Welcome Visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, re-admission prevention, wigs for hair loss, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, support for caregivers, additional smoking cessation counseling, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing Services include hearing exams with a $10 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $99 and $599 for all types, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams once per year, contact lenses (1 pair per year), and eyeglasses (lenses and frames) once per year, with a combined maximum benefit of $250 per year for eyewear. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueAdvantage Diamond (PPO) plan covers dental services, including oral exams with a $20 copay, and dental x-rays, with a maximum plan benefit of $4500 per year. Other services such as adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueAdvantage Diamond (PPO) plan, and prior authorization is required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueAdvantage Diamond (PPO) plan. The coinsurance for Dialysis Services is 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 15% coinsurance and Prosthetics/Medical Supplies with 15% coinsurance; Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay. Durable Medical Equipment for use outside the home is not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, including diagnostic procedures and tests, lab services, and radiological services. Diagnostic procedures and tests have a copay between $0 and $100, while lab services have no copay and a coinsurance of at most 20%. Diagnostic radiological services have a copay of at most $175, therapeutic radiological services have a copay of at most $30, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the BlueAdvantage Diamond (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueAdvantage Diamond (PPO) plan. Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services are all not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueAdvantage Diamond (PPO) plan, but require prior authorization. For days 1-20, there is no copay, but for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BlueAdvantage Diamond (PPO) plan does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, and Self-Directed Personal Assistance Services. This plan covers Over-the-Counter (OTC) Items with a maximum benefit of $130.00 every three months. The plan also covers a Meal Benefit for chronic illness.
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