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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 Middle 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 $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 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) Medicare plan features a $250 drug deductible and offers affordable copays on lower-tier prescription medications. Members pay no copay for Tier 1 preferred generic drugs when using preferred pharmacies or preferred mail-order services, compared to a $6 copay at standard pharmacies. Tier 2 generic drugs are also highly accessible, costing only a $5 copay at preferred locations and starting at a $10 copay at standard locations. For Tier 3 preferred brand drugs, copays start at $28 at preferred pharmacies and rise to $33 at standard locations for a one-month supply. Higher-tier prescriptions require coinsurance, with Tier 4 non-preferred drugs carrying a 50% coinsurance and Tier 5 specialty tier drugs requiring a 30% coinsurance. Utilizing preferred mail-order and retail pharmacies is the most cost-effective way to fill prescriptions under this plan.
Additional Benefits
The BlueAdvantage Ruby (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, home health services, and routine preventive care. For specialist visits, members pay a $25 copay, while inpatient hospital stays require a $205 daily copay for the first five days and no copay for days 6 through 90. Outpatient hospital services and emergency room visits are covered with flat copays of $260 and $150 respectively, with no coinsurance required for either service. This plan also provides valuable supplemental benefits, including a $2,250 annual limit for dental care with no copays for preventive services and a $300 eyewear allowance every two years. Members pay no copay for the first 20 days of a skilled nursing facility stay and receive a $56 quarterly allowance for over-the-counter items. Routine hearing exams carry a low $10 copay, while prescription hearing aids are covered with copayments ranging from $199 to $699.
Inpatient Hospital See details
BlueAdvantage Ruby (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $205 daily copay for days 1 to 5 and no copay for days 6 to 90. While unlimited additional days are covered for acute care, psychiatric additional 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 $200 copay per stay for observation services, and a $210 copay for ambulatory surgical center services. Outpatient substance abuse services require no coinsurance with copays ranging from $20 to $30, while outpatient blood services are provided with no copay and no coinsurance.
Partial Hospitalization See details
BlueAdvantage Ruby (PPO) covers partial hospitalization services with a $40 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
BlueAdvantage Ruby (PPO) covers ambulance services with prior authorization, requiring a $175 copay for ground transport and a 20% coinsurance for air transport. Additional transportation services to health-related locations are not covered.
Emergency Services See details
BlueAdvantage Ruby (PPO) covers emergency services with a $150 copay and urgently needed services with a $25 copay, both with no coinsurance and 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. Other covered benefits, including physical, occupational, speech, mental health, psychiatric, and opioid treatment services, feature no coinsurance and copays ranging from $15 to $30. Chiropractic and podiatry 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. Additional preventive services are partially covered with no copay and no coinsurance, but exclude 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 counseling, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
BlueAdvantage Ruby (PPO) hearing services are partially covered, featuring routine hearing exams with a $10.00 copay and no coinsurance, but OTC hearing aids are not covered. Prescription hearing aids are also partially covered with a copay ranging from $199.00 to $699.00 and no coinsurance, though inner ear, outer ear, and over the ear models are not covered.
Vision Services See details
BlueAdvantage Ruby (PPO) offers partially covered vision services with no copay and no coinsurance, including one routine eye exam annually and a $300 combined eyewear allowance every two years. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by BlueAdvantage Ruby (PPO) up to a combined annual limit of $2,250, offering preventive care, endodontics, and periodontics with no copay and no coinsurance. Medicare-covered dental services require a $25 copay and no coinsurance, while restorative care, prosthodontics, and oral surgery require no copay and 20% coinsurance. Adjunctive general services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueAdvantage Ruby (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this plan, Medicare Part B chemotherapy, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the BlueAdvantage Ruby (PPO) plan 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 a 20% coinsurance. Diabetic supplies feature no coinsurance to 50% coinsurance, while diabetic therapeutic shoes or inserts require a $10 copay, with prior authorization required for these services.
Diagnostic and Radiological Services See details
BlueAdvantage Ruby (PPO) covers diagnostic services with a 20% coinsurance and no copay for labs, and a $0 to $100 copay plus coinsurance for diagnostic tests. Radiological services require no coinsurance, featuring no copay for X-rays, a minimum $40 copay for therapeutic radiology, and a minimum $200 copay for diagnostic radiology.
Home Health Services See details
BlueAdvantage Ruby (PPO) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueAdvantage Ruby (PPO) covers Cardiac Rehabilitation Services with no coinsurance and prior authorization, although only some services are covered. Standard cardiac rehabilitation (with a $20 copay), intensive cardiac rehabilitation ($20 copay), pulmonary rehabilitation ($15 copay), and supervised exercise therapy for PAD ($10 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueAdvantage Ruby (PPO) 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, a prior three-day inpatient hospital stay is not required, and additional days beyond the standard 100 days are not covered.
Other Services See details
Other services are partially covered by BlueAdvantage Ruby (PPO), as acupuncture, nicotine replacement therapy, and naloxone are not covered. Covered benefits include meals for chronic illness and over-the-counter (OTC) items up to $56 every three months, both offered with no copay and no coinsurance.
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