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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 Northeast 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 $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 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 a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for your prescriptions, which varies depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $5 copay at a preferred pharmacy. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered Part D drugs. If you qualify for the low-income subsidy, you may have a reduced premium.
Additional Benefits
The BlueAdvantage Ruby (PPO) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $195 copay for days 1-4, and no copay for days 5-90. Outpatient services, including mental health and substance abuse services, have copays ranging from $20 to $225. This plan also covers emergency services, ambulance services, and home health services with specific copays and coinsurance amounts. Additionally, the plan includes coverage for hearing, vision, and dental services with copays and annual maximums. Other benefits include medical equipment, diagnostic services, and skilled nursing facility stays, each with its own cost structure.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric; however, Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, and Additional Days for Inpatient Hospital Psychiatric, and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered. For Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, you will pay a $195 copay for days 1-4, and no copay for days 5-90.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the BlueAdvantage Ruby (PPO) plan. Outpatient Hospital Services have a $225 copay, and Observation Services have a $200 copay. Ambulatory Surgical Center (ASC) Services have a $210 copay, and Outpatient Substance Abuse Services have a copay of $30 for individual sessions and $20 for group sessions.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueAdvantage Ruby (PPO) plan, and requires prior authorization. The copay for this benefit is $40.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueAdvantage Ruby (PPO) plan, with all ambulance services requiring prior authorization. Ground ambulance services have a $175 copay, while air ambulance services have a 20% coinsurance. Transportation services to health-related locations 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, and Urgently Needed Services have a $25 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage have an $85 copay, while 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 (with a $15 copay), physician specialist services (with a $25 copay), mental health specialty services (with a $30 copay for individual sessions and a $20 copay for group sessions), physical therapy and speech-language pathology services (with a $15 copay), additional telehealth benefits, psychiatric services (with a $30 copay for individual sessions and a $20 copay for group sessions), and opioid treatment program services (with a minimum $20 copay and maximum $30 copay). Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services, annual physical exams, 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 Welcome Visits. However, In-Home Safety Assessments, Personal Emergency Response Systems (PERS), Medical Nutrition Therapy (MNT), 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, as well as fitting and evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $199 and $699, but inner ear, outer ear, and over the ear hearing aids are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include coverage for routine eye exams, with one exam allowed per year. Eyewear is covered up to a combined maximum of $250 per year for both in-network and out-of-network services, including contact lenses (one pair per year) and eyeglasses (one pair per year). Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueAdvantage Ruby (PPO) plan covers dental services, including oral exams with a $25 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning) with a $25 copay, fluoride treatment, other preventive dental services, and restorative services. This plan has a $4,000 annual maximum for dental services. Orthodontics and the following services are not covered: Adjunctive General Services, Maxillofacial Prosthetics, and Orthodontics.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered under the BlueAdvantage Ruby (PPO) plan, with prior authorization required. The plan includes a $35 copay for Medicare Part B Insulin Drugs, with a coinsurance between 0% and 20% depending on the specific drug; other Medicare Part B drugs have a coinsurance between 0% and 20% and Medicare Part B Chemotherapy/Radiation Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueAdvantage Ruby (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the BlueAdvantage Ruby (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance, while Durable Medical Equipment for use outside the home is not covered. Prosthetics/Medical Supplies have no copay and a coinsurance for Medicare-covered Prosthetic Devices and Medical Supplies. Diabetic Supplies have a 0-20% coinsurance and no copay, while Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueAdvantage Ruby (PPO) plan, which includes coverage for 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. Prior authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueAdvantage Ruby (PPO) plan. The plan also does not cover Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or 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, but for days 21-100, the copay is $214. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
Other Services includes coverage for over-the-counter items with a maximum benefit of $65.00 every three months, and a meal benefit for chronic illness, but does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, or the additional services listed.
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