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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 2026, 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 Northeast Tennessee. This plan received an overall rating of 4 out of 5 stars in 2026.
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 $89.00. 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 a $250.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
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) Medicare plan features an annual drug deductible of $250. Under this plan, Tier 1 preferred generic drugs have no copay when filled through preferred pharmacies or preferred mail order services. Tier 2 generic drugs are also highly affordable, costing a low $5 copay for a 1-month, 2-month, or 3-month supply at preferred locations. For Tier 3 preferred brand drugs, the 1-month copay starts at $28 at preferred pharmacies and increases to $33 at standard pharmacies. Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs carry a 30% coinsurance for a 1-month supply. Choosing preferred pharmacies and mail-order options provides the most cost-effective prescription coverage under this plan.
Additional Benefits
The BlueAdvantage Diamond (PPO) plan offers robust medical coverage with no copay and no coinsurance for primary care visits, telehealth, and preventive services. Specialist visits require a $20 copay, while outpatient hospital services feature a $175 copay and no coinsurance. For inpatient hospital stays, members pay a $150 daily copay for the first four days and no copay for days 5 through 90. Additional benefits include dental coverage up to a $3,500 annual limit with no copay for preventive care, and vision services offering routine exams and eyewear with no copay. Hearing care is also partially covered, featuring routine exams for a $10 copay and prescription hearing aids with copays ranging from $99 to $599. Members also benefit from home health services with no copay, alongside an over-the-counter allowance of up to $81 every three months.
Inpatient Hospital See details
BlueAdvantage Diamond (PPO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $150 daily copay for days 1 through 4 and no copay for days 5 through 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueAdvantage Diamond (PPO) covers outpatient services with no coinsurance, featuring a $175 copay for outpatient hospital services, a $150 copay per stay for observation services, and a $125 copay for ambulatory surgical center services. Outpatient substance abuse services require a $10 to $20 copay with no coinsurance, while outpatient blood services are fully covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered under the BlueAdvantage Diamond (PPO) plan with a $35.00 copay and no coinsurance. Prior authorization is required to receive this benefit.
Ambulance and Transportation Services See details
BlueAdvantage Diamond (PPO) covers ground ambulance services with a $175 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, with prior authorization required. Some transportation services are covered, but trips to plan-approved or any health-related locations are not covered.
Emergency Services See details
BlueAdvantage Diamond (PPO) covers emergency services with a $150 copay and urgently needed services with a $25 copay, both featuring no coinsurance and waived copays if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are also covered with a $60 copay and no coinsurance, while worldwide emergency transportation requires a $175 copay and 20% coinsurance.
Primary Care See details
BlueAdvantage Diamond (PPO) covers primary care visits and telehealth services with no copay and no coinsurance, while specialist visits cost a $20 copay with no coinsurance. Physical, occupational, and speech therapies require a $10 copay with no coinsurance, mental health, psychiatric, and opioid treatment services have a $10 to $20 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
BlueAdvantage Diamond (PPO) covers preventive services, annual physical exams, and kidney disease education with no copay and no coinsurance. Additional preventive benefits are partially covered, including memory fitness and remote access technologies, while excluding services such as health education, in-home safety assessments, and personal emergency response systems.
Hearing Services See details
BlueAdvantage Diamond (PPO) provides partially covered hearing services, featuring routine hearing exams for a $10.00 copay and no coinsurance, plus unlimited fitting evaluations. Prescription hearing aids are covered with no coinsurance and a copay ranging from $99.00 to $599.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
BlueAdvantage Diamond (PPO) partially covers vision services with no copay and no coinsurance, offering one routine eye exam per year and up to a $300 combined maximum every two years for contacts and eyeglasses. Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
BlueAdvantage Diamond (PPO) partially covers dental services up to a $3,500 annual limit, with no copay and no coinsurance for preventive care, a $20 copay and no coinsurance for Medicare-covered dental, and no copay with 20% coinsurance for restorative and surgical services. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BlueAdvantage Diamond (PPO) with no copay, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no coinsurance to 20% coinsurance, while Medicare Part B insulin has a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the BlueAdvantage Diamond (PPO) plan with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
BlueAdvantage Diamond (PPO) covers durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and 0% to 50% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay.
Diagnostic and Radiological Services See details
BlueAdvantage Diamond (PPO) covers diagnostic and radiological services with prior authorization, offering radiological services with no coinsurance and copays ranging from $30 for therapeutic to $175 for diagnostic radiology, and no copay for X-rays. Outpatient diagnostic procedures and tests have copays from $0 to $100 plus coinsurance, while lab services feature no copay and a minimum 20% coinsurance.
Home Health Services See details
BlueAdvantage Diamond (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
BlueAdvantage Diamond (PPO) covers some cardiac rehabilitation services with no copay and no coinsurance, but standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
BlueAdvantage Diamond (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, offering no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and while a prior three-day inpatient hospital stay is not required, additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
Other Services are partially covered by BlueAdvantage Diamond (PPO), offering chronic illness meals and over-the-counter (OTC) items up to $81 every three months with no copay and no coinsurance. Acupuncture and other additional services are not covered under this plan.
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