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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 Middle 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 $107.00. 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 an enhanced alternative drug benefit. There is no 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 a preferred pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase and pay nothing for covered drugs.
Additional Benefits
The BlueAdvantage Ruby (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, and outpatient services have copays depending on the service. Emergency, primary care, hearing, vision, and dental services are covered with copays. The plan also covers preventive services, home infusion, dialysis, medical equipment, and diagnostic services, with varying copays and coinsurance. Additional benefits include home health services with no copay, and an over-the-counter (OTC) allowance. However, some services like cardiac rehabilitation and certain dental services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered under the BlueAdvantage Ruby (PPO) plan. For days 1-4, there is a $205 copay, and for days 5-90, there is no copay.
Outpatient Services See details
Outpatient Services with the BlueAdvantage Ruby (PPO) plan covers outpatient hospital services with a $225 copay, observation services with a $200 copay, and ambulatory surgical center services with a $210 copay. Outpatient substance abuse services are covered, with individual sessions costing $30 and group sessions costing $20, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueAdvantage Ruby (PPO) plan and requires prior authorization. You will have a $40 copay for this service.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueAdvantage Ruby (PPO) plan. 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, Urgently Needed Services, and Worldwide Emergency Services are covered by the BlueAdvantage Ruby (PPO) plan. Emergency Services have a $140 copay, and Urgently Needed Services have a $25 copay, with no coinsurance for either. Worldwide Emergency Coverage has an $85 copay, Worldwide Urgent Coverage has an $85 copay, and Worldwide Emergency Transportation has a $175 copay and 20% coinsurance.
Primary Care See details
The BlueAdvantage Ruby (PPO) plan covers Primary Care Physician Services, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $15 copay, Physician Specialist Services with a $25 copay, Mental Health Specialty Services with a copay of $30 for individual sessions and $20 for group sessions, Physical Therapy and Speech-Language Pathology Services with a $15 copay, Additional Telehealth Benefits, and Opioid Treatment Program Services with a copay between $20 and $30. Routine Chiropractic Care and Podiatry Services are not covered.
Preventive Services See details
Preventive services, including Medicare-covered zero dollar preventive services, an annual physical exam, and other preventive services, are covered by the BlueAdvantage Ruby (PPO) plan. The plan also covers health education, nutritional/dietary benefits, in-home support services, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, kidney disease education services, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a 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 related to chemotherapy, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, support for caregivers of enrollees, additional sessions of smoking and tobacco cessation counseling, home and bathroom safety devices and modifications, and counseling services are not covered.
Hearing Services See details
Hearing services include routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered, with a copay between $199 and $699 for all types, but inner ear, outer ear, and over the ear prescription hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams with one exam covered every year, and eyewear with a combined maximum of $250 per year for both in-network and out-of-network services, and includes contact lenses and eyeglasses (lenses and frames). Eyeglass lenses, eyeglass frames and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a $25 copay for Medicare Dental Services. Other Dental Services are covered up to a maximum of $2250 per year, including Oral Exams (2 visits per year), Dental X-Rays (limited), Other Diagnostic Dental Services, Prophylaxis (Cleaning) (2 visits per year), Fluoride Treatment (1 visit per year, requires prior authorization), Other Preventive Dental Services, and Orthodontic Services. Restorative Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Implant Services, and Oral and Maxillofacial Surgery are covered, but require prior authorization and have visit limitations. Adjunctive General Services, Maxillofacial Prosthetics, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the BlueAdvantage Ruby (PPO) plan. 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 Ruby (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
The BlueAdvantage Ruby (PPO) plan covers Durable Medical Equipment (DME) with 20% coinsurance and requires authorization, but does not cover Durable Medical Equipment for use outside the home. Prosthetic Devices and Medical Supplies are covered with a 20% coinsurance, and Diabetic Equipment is covered with varying coinsurance and copayments, and has a $10 copay for Diabetic Therapeutic Shoes/Inserts.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueAdvantage Ruby (PPO) plan. 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 $200 and Therapeutic Radiological Services have a copay of at most $40. 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 or coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueAdvantage Ruby (PPO) plan. The plan does not cover any of the sub-services, including Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services.
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 per day; additional days beyond Medicare coverage and non-Medicare-covered stays are not covered.
Other Services See details
Other Services with the BlueAdvantage Ruby (PPO) plan includes coverage for over-the-counter (OTC) items with a maximum benefit of $55.00 every three months, and a meal benefit for chronic illnesses. 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 are not covered.
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