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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 Northeast 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 $46.00. 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 and offers cost-saving pharmacy network options. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order, while standard pharmacies charge a $6 copay for a one-month supply. For Tier 2 generic drugs, copays are a low $5 at preferred pharmacies and preferred mail order, compared to $10 at standard pharmacies for a one-month supply. Tier 3 preferred brand drugs cost a $28 copay for a one-month supply at preferred locations and preferred mail order, or $33 at standard pharmacies. Higher-tier prescriptions require coinsurance, with a 50% coinsurance for Tier 4 non-preferred drugs and a 30% coinsurance for Tier 5 specialty drugs for a one-month supply. Utilizing the plan's preferred pharmacy and mail-order networks offers the greatest savings on your prescription medication costs.
Additional Benefits
The BlueAdvantage Ruby (PPO) plan offers robust medical coverage with no copay or coinsurance for primary care visits, telehealth services, and preventive care. For inpatient hospital stays, members pay a $195 daily copay for the first four days and no copay for days five through ninety, while specialist visits require a $25 copay. Outpatient hospital services feature a $225 copay with no coinsurance, and emergency room visits have a $150 copay that is waived if you are admitted. This plan also includes valuable supplemental benefits, such as dental care up to $2,750 annually and routine vision exams with eyewear coverage up to $300 every two years, both featuring no copays or coinsurance. Routine hearing exams are available for a $10 copay, and members receive up to $68 every three months for over-the-counter items with no copay. Additionally, skilled nursing facility stays have no copay for the first 20 days, and home health services are fully covered with no copay or coinsurance.
Inpatient Hospital See details
BlueAdvantage Ruby (PPO) inpatient hospital benefits are partially covered with no coinsurance and a copay of $195 per day for days 1 to 4, followed by no copay for days 5 to 90. Non-Medicare-covered stays, upgrades for acute care, and additional days for psychiatric stays are not covered.
Outpatient Services See details
BlueAdvantage Ruby (PPO) covers outpatient hospital services with no coinsurance and a $225 copay, observation services with a $200 copay per stay, and ambulatory surgical center services with no coinsurance and a $175 copay. Outpatient substance abuse services have no coinsurance and require a $30 copay for individual sessions or a $20 copay for group sessions, while outpatient blood services are covered with no copay, no coinsurance, and no deductible.
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. Transportation services are 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. Specialist visits require a $25 copay, therapy services require a $10 copay, and mental health, psychiatric, and opioid treatment services have copays ranging from $20 to $30, all with no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
BlueAdvantage Ruby (PPO) covers preventive services with no copay and no coinsurance, though the benefit is partially covered as it excludes health education, in-home safety assessments, PERS, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, palliative care, in-home support, caregiver support, tobacco cessation counseling, telemonitoring, home safety devices, and counseling.
Hearing Services See details
BlueAdvantage Ruby (PPO) provides partially covered hearing services with no deductible, featuring one routine hearing exam per year for a $10 copay and no coinsurance. Up to two prescription hearing aids are covered annually with a copay of $199.00 to $699.00 and no coinsurance, though OTC, inner ear, outer ear, and over-the-ear prescription hearing aids are not covered.
Vision Services See details
Vision Services are partially covered under the BlueAdvantage Ruby (PPO) plan, offering routine eye exams (one per year) and eyewear (up to a $300 combined limit every two years) with no copay, no coinsurance, and no deductible. However, other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered under the BlueAdvantage Ruby (PPO) plan up to an annual maximum of $2,750, 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, prosthodontic, and oral surgery services require no copay and a 20% coinsurance; 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. Medicare Part B chemotherapy, radiation, and other drugs feature no copay and coinsurance ranging from no coinsurance to 20%, while Medicare Part B insulin is covered with a $35 copay and coinsurance ranging from no coinsurance to 20%.
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 and prosthetics with no copay and 20% coinsurance. Diabetic supplies are covered with no coinsurance to 50% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay, with prior authorization required for these benefits.
Diagnostic and Radiological Services See details
BlueAdvantage Ruby (PPO) covers diagnostic and radiological services with prior authorization, featuring no coinsurance for radiological services and copays ranging from no copay for X-rays to minimum copays of $40 for therapeutic radiology and $200 for diagnostic radiology. Outpatient lab services have no copay with a minimum 20% coinsurance, while other diagnostic procedures and tests range from no copay up to a $100 copay with applicable coinsurance.
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) offers Cardiac Rehabilitation Services with no coinsurance and prior authorization, but some services are covered while cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered. Copayments for these non-covered services range from $10 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueAdvantage Ruby (PPO) with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services are partially covered by BlueAdvantage Ruby (PPO), which offers a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. While acupuncture is not covered, the plan provides up to $68 every three months for OTC items.
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