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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 Southeast 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 $92.00. 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 an annual drug deductible of $250. For Tier 1 preferred generic drugs, you will pay no copay when using preferred pharmacies or preferred mail order services. Tier 2 generic drugs offer a low $5 copay at preferred pharmacies, while standard pharmacies charge up to $25 depending on the supply duration. Tier 3 preferred brand drugs require a $28 copay for a one-month supply at preferred pharmacies, compared to a $33 copay at standard pharmacies. Higher-tier medications require coinsurance rather than flat copays, with Tier 4 non-preferred drugs carrying a 50% coinsurance. Finally, Tier 5 specialty drugs require a 30% coinsurance for a one-month supply across all pharmacy and mail order options.
Additional Benefits
The BlueAdvantage Ruby (PPO) plan offers robust medical coverage with no copay or coinsurance for primary care, telehealth, and preventive services. Specialist visits require a $25 copay, while inpatient hospital stays cost a $215 daily copay for the first five days and no copay for days six through ninety. Outpatient hospital services carry a $260 copay, and emergency room visits have a $150 copay which is waived if you are admitted within 24 hours. For dental, vision, and hearing needs, the plan provides no copay for preventive dental up to a $2,250 annual limit, no copay for annual routine vision exams, and a $10 copay for routine hearing exams. Additionally, members benefit from a quarterly $61 over-the-counter item allowance with no copay, as well as home health services and the first twenty days of skilled nursing facility stays at no cost.
Inpatient Hospital See details
BlueAdvantage Ruby (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $215 daily copay for days 1 through 5 and no copay for days 6 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 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 a $20 copay for group sessions or a $30 copay for individual sessions, while outpatient blood services are provided with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by BlueAdvantage Ruby (PPO) with a $40.00 copay and no coinsurance. Prior authorization is required to access this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are partially covered by BlueAdvantage Ruby (PPO), as transportation services to plan-approved or health-related locations are not covered. Medicare-covered ground ambulance services require a $175 copay and no coinsurance, while air ambulance services require a 20% coinsurance and no copay, with prior authorization required for all ambulance transfers.
Emergency Services See details
BlueAdvantage Ruby (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if admitted within 24 hours, and urgently needed services with a $25 copay and no coinsurance. 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) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $25 copay and no coinsurance. Therapy services feature a $10 copay and no coinsurance, mental health and psychiatric services range from a $20 to $30 copay with no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
BlueAdvantage Ruby (PPO) covers preventive services with no copay and no coinsurance, including annual physical exams, kidney disease education, and select fitness benefits. This benefit is partially covered, as sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, home/bathroom safety, and counseling are not covered.
Hearing Services See details
BlueAdvantage Ruby (PPO) hearing services are partially covered and feature no deductible, offering routine exams for a $10 copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $199 to $699, though OTC hearing aids and inner ear, outer ear, or over the ear prescription models are not covered.
Vision Services See details
BlueAdvantage Ruby (PPO) provides partially covered vision services with no copay, no coinsurance, and no deductible, including one routine eye exam annually and up to $300 every two years for contacts or eyeglasses. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
BlueAdvantage Ruby (PPO) dental services are partially covered up to a combined $2,250 annual limit, offering preventive care, endodontics, and periodontics with no copay and no coinsurance, and Medicare-covered dental for a $25 copay and no coinsurance. Covered restorative services, prosthodontics, and oral surgery carry no copay and 20% coinsurance, while 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, though prior authorization is required. Associated Medicare Part B chemotherapy and other drugs require 0% to 20% coinsurance with no copay, while Part B insulin is covered with a $35 copay and 0% 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 medical equipment, including durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and coinsurance.
Diagnostic and Radiological Services See details
BlueAdvantage Ruby (PPO) covers diagnostic procedures and tests with a copay ranging from no copay to $100 plus coinsurance, while lab services require no copay and a minimum 20% coinsurance. Radiological services feature no coinsurance, with copays starting at $200 for diagnostic radiology, $40 for therapeutic radiology, and no copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered by BlueAdvantage Ruby (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueAdvantage Ruby (PPO) requires prior authorization and charges no coinsurance for cardiac rehabilitation, meaning some services are covered. However, cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered in practice, carrying copays ranging from $10.00 to $15.00.
Skilled Nursing Facility (SNF) See details
BlueAdvantage Ruby (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but allowing admission without a prior three-day hospital stay. There is no copay for days 1 through 20, while days 21 through 100 require a $218 daily copay, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by BlueAdvantage Ruby (PPO), providing a chronic illness meal benefit and over-the-counter (OTC) items up to $61 every three months with no copay and no coinsurance. Acupuncture and certain other supplemental services are not covered under this plan.
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