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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 2026, 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 out of 5 stars in 2026.
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 $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 Ruby (PPO) plan features a $250 annual drug deductible and offers structured copayments and coinsurance across five drug tiers. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service, while standard options start at a $6 copay. Tier 2 generic drugs cost $5 at preferred pharmacies and preferred mail order, compared to a $10 copay for a one-month supply at standard pharmacies. Tier 3 preferred brand drugs require a $28 copay for a one-month supply at preferred pharmacies and preferred mail order, which increases to $33 at standard locations. For higher-tier medications, you will pay coinsurance instead of a flat copay, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance for a one-month supply across all pharmacy types.
Additional Benefits
The BlueAdvantage Ruby (PPO) plan offers comprehensive medical coverage with predictable out-of-pocket costs, featuring no copays or coinsurance for primary care, telehealth, and preventive services. Specialist visits require a $25 copay, while inpatient hospital stays carry a $210 daily copay for the first five days and no copay for days six through 90. Emergency room visits are covered with a $150 copay, which is waived if you are admitted to the hospital within 24 hours. Members also benefit from dental coverage with an annual maximum of $2,250, alongside a $300 vision allowance every two years with no copays or deductibles. Routine hearing exams require a $10 copay, and the plan provides a $55 quarterly allowance for over-the-counter items with no copay. Furthermore, home health services are covered with no copay, and skilled nursing facility stays feature no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital services are covered by BlueAdvantage Ruby (PPO) with no coinsurance, requiring a daily copay of $210 for days 1 through 5 and no copay for days 6 through 90 for both acute and psychiatric stays. While unlimited additional acute hospital days are covered, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueAdvantage Ruby (PPO) covers outpatient services with no coinsurance, featuring a $260 copay for outpatient hospital services, a $210 copay for ambulatory surgical center services, and a $200 copay per stay for observation services. Outpatient substance abuse sessions require a $20 to $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by BlueAdvantage Ruby (PPO) with a $40.00 copay and no coinsurance, though prior authorization is required.
Ambulance and Transportation Services See details
BlueAdvantage Ruby (PPO) covers ground ambulance services with a $175 copay and applicable coinsurance, and air ambulance services with a 20% coinsurance and an applicable copay, with prior authorization required for both. While some transportation services are covered, transportation to plan-approved health-related locations and any health-related locations is not covered.
Emergency Services See details
BlueAdvantage Ruby (PPO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent care are covered with an $85 copay and no coinsurance, while worldwide emergency transportation requires a $175 copay and 20% coinsurance.
Primary Care See details
BlueAdvantage Ruby (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Physical, occupational, speech, mental health, and psychiatric therapies are also covered with copays ranging from $10 to $30 and no coinsurance, but podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are covered by BlueAdvantage Ruby (PPO) with no copay and no coinsurance, including annual physical exams, kidney disease education, and diabetes self-management training. Additional preventive services are partially covered with no copay and no coinsurance, but do not cover health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
BlueAdvantage Ruby (PPO) covers hearing services, featuring routine hearing exams with a $10 copay and no coinsurance. Prescription hearing aids are partially covered with copays ranging from $199 to $699 and no coinsurance, though inner ear, outer ear, over-the-ear, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
BlueAdvantage Ruby (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible. The plan covers one routine eye exam per year and up to $300 every two years for contact lenses or eyeglasses (lenses and frames), but other eye exams, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
BlueAdvantage Ruby (PPO) offers partially covered dental services with an annual maximum benefit of $2,250, featuring a $25 copay and no coinsurance for Medicare-covered dental, and no copay with 0% to 20% coinsurance for other covered services. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueAdvantage Ruby (PPO) covers Home Infusion bundled Services with no copay, subject to prior authorization. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs have no coinsurance to 20% coinsurance, while Part B insulin drugs require a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
BlueAdvantage Ruby (PPO) covers Dialysis Services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
BlueAdvantage Ruby (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies require a copay and 0% to 50% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered by BlueAdvantage Ruby (PPO) with prior authorization, featuring a $0 to $100 copay plus coinsurance for diagnostic tests, and no copay with a 20% minimum coinsurance for lab services. Radiological services require no coinsurance, with no copay for outpatient X-rays, a $40 minimum copay for therapeutic services, and a $200 minimum copay for diagnostic radiology.
Home Health Services See details
Home health services are covered under the BlueAdvantage Ruby (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueAdvantage Ruby (PPO) with no coinsurance, though prior authorization is required. While some services are covered, specific programs including standard cardiac rehabilitation ($20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for peripheral artery disease ($10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
BlueAdvantage Ruby (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, featuring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the 100-day Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by BlueAdvantage Ruby (PPO), featuring a chronic illness meal benefit and over-the-counter (OTC) items up to $55 every three months with no copay and no coinsurance. Acupuncture is not covered under this benefit.
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