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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 Southeast 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 $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 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 with this plan. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $5 copay at preferred pharmacies. After your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BlueAdvantage Ruby (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and emergency care. Primary care visits have no copay, and there are also copays for specialist visits, mental health, and various therapies. The plan also covers preventive services, vision, hearing, and dental services with a set of copays, coinsurance, and annual maximums depending on the service. Additional benefits include home health services with no copay, and coverage for ambulance, dialysis, and medical equipment with copays or coinsurance. The plan also covers home infusion bundled services, and diagnostic and radiological services. However, some services like cardiac rehabilitation, certain dental and vision procedures, and other services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered with prior authorization. For days 1-4, there is a $205 copay, but for days 5-90, there is no copay. Additional Days for Inpatient Hospital-Acute are covered, while Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered. Non-Medicare-covered Stay and Additional Days for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services for 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 a $30 copay for individual sessions and a $20 copay for group sessions, and outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueAdvantage Ruby (PPO) plan. There is a $40 copay for this benefit, and prior authorization is required.
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, and air ambulance services have a 20% coinsurance, while transportation services to a 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 Services have a $85 copay for Worldwide Emergency Coverage and Worldwide Urgent Coverage, and a $175 copay with 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The BlueAdvantage Ruby (PPO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a $25 copay, and mental health specialty services with a copay between $20-$30 depending on the service. The plan also covers physical therapy and speech-language pathology services with a $15 copay, in addition to telehealth and opioid treatment program services with a copay between $20-$30. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services, including annual physical exams, additional preventive services, and kidney disease education 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, 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
The BlueAdvantage Ruby (PPO) plan covers hearing exams with a $10 copay, routine hearing exams once per year, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $199 and $699, while prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, along with OTC hearing aids.
Vision Services See details
Vision services include 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 are also covered, with a maximum plan benefit of $2750 per year. The plan covers oral exams (2 per year), dental x-rays, other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), other preventive dental services, restorative services (1 per year), endodontics (1 per tooth per 60 months), periodontics (1 every three years), prosthodontics, removable (1 per 60 months), implant services (1 per 60 months), prosthodontics, fixed (1 per 60 months), and oral and maxillofacial surgery. 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, with a $35 copay for Medicare Part B Insulin Drugs, and a coinsurance between 0% and 20% for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs. Prior authorization is required for this benefit.
Dialysis Services See details
Dialysis Services are covered under the BlueAdvantage Ruby (PPO) plan. You will pay 20% coinsurance for this benefit.
Medical Equipment See details
The BlueAdvantage Ruby (PPO) plan covers durable medical equipment with a 20% coinsurance, and medical supplies with a 20% coinsurance. Diabetic supplies have a 0-20% coinsurance, and 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 all diagnostic services and radiological services. 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, 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, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered under the BlueAdvantage Ruby (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation 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. Additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
Other Services includes coverage for Over-the-Counter (OTC) Items and Meal Benefits, with a $60 maximum benefit every three months for OTC items. 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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