A non-government entity
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 Southeast 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 $147.00. 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:
Sign up for BlueAdvantage Diamond (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BlueAdvantage Diamond (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs with this plan. During the initial coverage phase, you will pay a copay or coinsurance for your prescriptions. For example, a preferred generic drug has a $5 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the next coverage phase.
Additional Benefits
The BlueAdvantage Diamond (PPO) plan offers a range of benefits. The plan includes coverage for inpatient and outpatient services with varying copays, and covers emergency services, primary care, and preventive services. Additional benefits include hearing and vision services, with routine eye exams at no copay, and coverage for dental services. The plan also provides coverage for home health services, and dialysis services, as well as medical equipment.
Inpatient Hospital See details
The BlueAdvantage Diamond (PPO) plan covers Inpatient Hospital services, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. The plan also covers Additional Days for Inpatient Hospital-Acute, but does not cover Non-Medicare-covered Stay, or Upgrades for Inpatient Hospital-Acute, nor does it cover Additional Days or Non-Medicare-covered Stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services, offered by 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, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueAdvantage Diamond (PPO) plan, but requires prior authorization. The copay for this benefit is $35.
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; however, transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered under the BlueAdvantage Diamond (PPO) plan with a $140 copay, and Urgently Needed Services are covered with a $25 copay. Worldwide Emergency Services are also covered, with a $60 copay for Worldwide Emergency and Urgent Coverage, and a $175 copay and 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The BlueAdvantage Diamond (PPO) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $10 copay, Physician Specialist Services with a $20 copay, Mental Health Specialty Services, and Psychiatric Services with a copay ranging from $10-$20 depending on the service. The plan also covers Physical Therapy and Speech-Language Pathology Services with a $10 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services with a copay ranging from $10-$20.
Preventive Services See details
The BlueAdvantage Diamond (PPO) plan covers preventive services including annual physical exams and additional services like 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 a Welcome Visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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 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, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision services include routine eye exams with no copay, and eyewear with a combined maximum benefit of $250 every year for both in-network and out-of-network services. Contact lenses and eyeglasses (lenses and frames) are covered once per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services under the BlueAdvantage Diamond (PPO) plan include Medicare Dental Services with a $20 copay, as well as other dental services. Other dental services have a maximum plan benefit coverage of $4500 per year, and cover oral exams (2 per year), dental x-rays (1 preventative x-ray per 12 months, and 1 diagnostic x-ray per 36 months), other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), other preventative dental services, and have coverage for orthodontic services. Restorative services, endodontics, periodontics, prosthodontics (removable), implant services, prosthodontics (fixed), and oral and maxillofacial surgery are covered, but adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and coinsurance between 0% and 20%. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueAdvantage Diamond (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
Medical equipment is covered by the BlueAdvantage Diamond (PPO) plan, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 15% coinsurance, and Durable Medical Equipment for use outside the home is not covered; Prosthetics/Medical Supplies has a 15% coinsurance; Diabetic Supplies has a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including diagnostic procedures and tests, lab services, and radiological services, are covered. Diagnostic Procedures/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, and Therapeutic Radiological Services have a copay of at most $30, while 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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueAdvantage Diamond (PPO) plan. This includes 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.
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, and for days 21-100, the copay is $214. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF, are not covered.
Other Services See details
The BlueAdvantage Diamond (PPO) plan's other services include coverage for Over-the-Counter (OTC) items, with a maximum benefit of $155.00 every three months, and meal benefits for chronic illnesses. Acupuncture, Dual Eligible SNPs, EPSDT, Private Duty Nursing Services, Case Management, Institution for Mental Disease Services, Services in an Intermediate Care Facility, Case Management, Tobacco Cessation Counseling, 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 are not covered.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved