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BlueAdvantage Sapphire (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueAdvantage Sapphire (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueAdvantage Sapphire (PPO) in 2025, please refer to our full plan details page.
BlueAdvantage Sapphire (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 Sapphire (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 Sapphire (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 Sapphire (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $9550.00 (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 $9550.00 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 Sapphire (PPO) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay for generic drugs, and coinsurance for brand-name and non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered Part D drugs. The plan offers different costs depending on the drug tier and the pharmacy you use.
Additional Benefits
The BlueAdvantage Sapphire (PPO) plan offers a variety of benefits with varying costs. Hospital stays have a copay of $285 for the first five days, while outpatient services have copays that range from $20 to $275. The plan also covers emergency services with a $125 copay and primary care services with copays from $15 to $30. Preventive services and routine vision exams are available with no copay, and dental services have a $30 copay for oral exams and cleanings. Hearing exams have a $10 copay, and hearing aids are covered with a copay between $399 and $899. Other benefits include home infusion, medical equipment, and skilled nursing facility services, each with specific cost-sharing details.
Inpatient Hospital See details
Inpatient Hospital coverage includes acute and psychiatric services. For Inpatient Hospital-Acute, you pay a $285 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you pay a $285 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, while non-Medicare covered stays and upgrades for Inpatient Hospital-Acute are not covered. Additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
The BlueAdvantage Sapphire (PPO) plan covers outpatient services, including outpatient hospital services with a $225 copay, observation services with a $200 copay, ambulatory surgical center services with a $275 copay, and outpatient substance abuse services. Individual and group sessions for outpatient substance abuse have a copay between $20-$30. Outpatient blood services are also covered, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueAdvantage Sapphire (PPO) plan, but requires prior authorization. The plan has a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueAdvantage Sapphire (PPO) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services are covered by the BlueAdvantage Sapphire (PPO) plan, with a $125 copay, and no coinsurance. Urgently Needed Services have a $25 copay, and no coinsurance. Worldwide Emergency Services are also covered, with varying copays and coinsurance depending on the service.
Primary Care See details
The BlueAdvantage Sapphire (PPO) plan covers Primary Care Physician Services, Chiropractic Services, Occupational Therapy Services, Physician Specialist Services, Mental Health Specialty Services, Other Health Care Professional, Psychiatric Services, Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic services have a $20 copay, while Physician Specialist Services have a $30 copay. Individual and group mental health and psychiatric sessions have copays ranging from $20 to $30, and physical therapy and speech-language pathology services have a $15 copay.
Preventive Services See details
The BlueAdvantage Sapphire (PPO) plan covers various preventive services, including Medicare-covered services, annual physical exams, health education, nutritional/dietary benefits, 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 with no copay or coinsurance. 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 and bathroom safety devices and modifications, counseling services, additional sessions of smoking and tobacco cessation counseling, home-based palliative care, in-home support services, and support for caregivers of enrollees are not covered.
Hearing Services See details
Hearing Services for the BlueAdvantage Sapphire (PPO) plan include routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids. Prescription hearing aids (all types) are covered with a copay between $399 and $899. However, Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
The BlueAdvantage Sapphire (PPO) plan covers vision services, including routine eye exams once per year with no copay or coinsurance, and eyewear with a combined maximum benefit of $250 per year. Contact lenses and eyeglasses (lenses and frames) are covered once per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueAdvantage Sapphire (PPO) plan covers dental services including oral exams for a $30 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning) for a $30 copay, fluoride treatment, other preventive dental services, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), oral and maxillofacial surgery, and implant services. Orthodontic services are covered under diagnostic and preventive dental, and the plan has a $3,000 maximum benefit per year for both in-network and out-of-network services. 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 Sapphire (PPO) plan. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%; for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueAdvantage Sapphire (PPO) plan with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical equipment, including durable medical equipment, prosthetics, medical supplies, and diabetic equipment, is covered under the BlueAdvantage Sapphire (PPO) plan. Durable Medical Equipment has a 20% coinsurance, while the plan has a 20% coinsurance for Medicare-covered prosthetic devices and medical supplies; Diabetic Therapeutic Shoes/Inserts have a $10 copay, and Diabetic Supplies have no coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueAdvantage Sapphire (PPO) plan, with the following costs: Diagnostic Procedures/Tests have a copay between $0 and $100, Lab Services have no copay and a 20% coinsurance, Diagnostic Radiological Services have a copay of at most $225, Therapeutic Radiological Services have a copay of at most $60, and Outpatient X-Ray Services have no copay. All services require prior authorization.
Home Health Services See details
Home Health Services are covered by the BlueAdvantage Sapphire (PPO) plan with no copay and no coinsurance, but authorization is required. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required for this benefit.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueAdvantage Sapphire (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, there is a $214 copay. Additional days beyond Medicare-covered for SNF and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BlueAdvantage Sapphire (PPO) plan does not cover 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. This plan covers Over-the-Counter (OTC) Items with a maximum benefit of $55.00 every three months, and also covers a meal benefit for a chronic illness.
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