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BlueAdvantage Ruby (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueAdvantage Ruby (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueAdvantage Ruby (PPO) in 2025, please refer to our full plan details page.
BlueAdvantage Ruby (PPO) is a PPO plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2025 to people living in West Tennessee. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BlueAdvantage Ruby (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 Ruby (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 Ruby (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $96.00. 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 Ruby (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $5 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. If you qualify for the low-income subsidy, your monthly premium is $31.00.
Additional Benefits
The BlueAdvantage Ruby (PPO) plan offers a range of benefits, including coverage for inpatient and outpatient services, with varying copays. Emergency and primary care services are covered, with specific copays for different services. The plan includes coverage for vision, dental, and hearing services, with specific limits and cost-sharing details for each. Additional benefits include home health services with no copay, and coverage for durable medical equipment, diagnostic and radiological services, and dialysis services, each with coinsurance or copay requirements. The plan also provides coverage for home infusion services, and some other services like over-the-counter items and a meal benefit for chronic illnesses. However, it's important to note that some services, such as cardiac rehabilitation and others, are not covered.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $235 for days 1-4, and no copay for days 5-90. Additional days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay for Inpatient Hospital-Acute, Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services with the BlueAdvantage Ruby (PPO) plan include coverage for Outpatient Hospital Services with a $225 copay, Observation Services with a $200 copay, Ambulatory Surgical Center (ASC) Services with a $210 copay, and Outpatient Substance Abuse Services with a $30 copay for individual sessions and a $20 copay for group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueAdvantage Ruby (PPO) plan, but requires prior authorization. The plan has a $40 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueAdvantage Ruby (PPO) plan, with prior authorization required for all ambulance services. Ground ambulance services have a $175 copay, and air ambulance services have a 20% coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered under the BlueAdvantage Ruby (PPO) plan. Emergency Services have a $140 copay, while Urgently Needed Services have a $25 copay. Worldwide Emergency Transportation has a 20% coinsurance and a $175 copay, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have an $85 copay.
Primary Care See details
The BlueAdvantage Ruby (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 and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, while occupational therapy services have a $15 copay. Physician specialist services have a $25 copay, and individual mental health and psychiatric sessions have a $30 copay (group sessions have a $20 copay). Physical therapy and speech-language pathology services have a $15 copay, and opioid treatment program services have a minimum copay of $20 and a maximum copay of $30. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services, annual physical exams, and additional services, are covered by the BlueAdvantage Ruby (PPO) plan. Additional services that are not covered include In-Home Safety Assessments, Personal Emergency Response Systems, Medical Nutrition Therapy, and others.
Hearing Services See details
The BlueAdvantage Ruby (PPO) plan covers hearing exams with a $10 copay, as well as fitting/evaluation for hearing aids. The plan also covers Prescription Hearing Aids (all types) with a copay between $199 and $699 per year; however, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision Services include coverage for routine eye exams, with one exam covered every year, 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, with one pair covered every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueAdvantage Ruby (PPO) plan covers Medicare dental services with a $25 copay. Other dental services include oral exams (2 visits per year), dental x-rays (1 preventative x-ray per 12 months, 1 diagnostic x-ray per 36 months), other diagnostic services (unlimited), cleaning (2 visits per year), fluoride treatment (1 visit per year, requires prior authorization), and other preventive services (unlimited). Orthodontic services are covered, with a maximum benefit of $2000 per year. Restorative services, endodontics, periodontics, removable prosthodontics, implant services, fixed prosthodontics, and oral and maxillofacial surgery are covered, but require prior authorization. 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 Ruby (PPO) plan, and prior authorization is required. The plan covers Medicare Part B Insulin Drugs with a $35 copay and a coinsurance between 0% and 20%, and also covers Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueAdvantage Ruby (PPO) plan. You will pay a 20% coinsurance for these services.
Medical Equipment See details
The BlueAdvantage Ruby (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires prior authorization. Prosthetic Devices and Medical Supplies are covered with 20% coinsurance, and Diabetic Supplies are covered with 0-20% coinsurance while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The BlueAdvantage Ruby (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab services, diagnostic radiological services, therapeutic radiological services, and outpatient X-ray services. Diagnostic procedures/tests have a copay between $0 and $100. Lab services have no copay and a coinsurance of at most 20%. Diagnostic radiological services have a copay of at most $200, therapeutic radiological services have a copay of at most $40, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the BlueAdvantage Ruby (PPO) plan with no copay and no coinsurance, though 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 Ruby (PPO) plan. Prior authorization is required for the services, but none of the listed services are covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueAdvantage Ruby (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 and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BlueAdvantage Ruby (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. Over-the-Counter (OTC) Items are covered with a maximum benefit of $55 every three months, and the plan offers a meal benefit for chronic illnesses.
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