A non-government entity
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 2026, 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 out of 5 stars in 2026.
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 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 $6300.00 (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 $6300.00 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:
Sign up for BlueAdvantage Sapphire (PPO)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BlueAdvantage Sapphire (PPO) Medicare plan features a $250 annual drug deductible. For Tier 1 preferred generic drugs, you will pay no copay when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs are also highly affordable, costing a flat $10 copay for a one-month supply at preferred locations. Tier 3 preferred brand drugs require a $42 copay for a one-month supply at preferred pharmacies, while standard pharmacies charge a slightly higher $47 copay. For higher-tier prescriptions, Tier 4 non-preferred drugs carry a 50% coinsurance and Tier 5 specialty drugs require a 30% coinsurance. Choosing preferred pharmacies and mail-order options across all tiers will help maximize your savings under this plan.
Additional Benefits
The BlueAdvantage Sapphire (PPO) plan offers coverage with no copay and no coinsurance for primary care, telehealth visits, and routine preventive services. For specialized medical care, members pay a $30 copay for specialist visits, while inpatient hospital stays require a $295 daily copay for the first five days and no copay for days six through 90. Emergency care carries a $150 copay, and urgent care is available for a $25 copay, with both fees waived if you are admitted to the hospital within 24 hours. This plan also features dental coverage up to a $2,250 annual maximum with no copay for preventive care, and vision coverage that includes one routine annual exam and a $300 eyewear allowance every two years. Routine hearing exams require a $10 copay, and prescription hearing aids are covered with copays ranging from $399 to $899. Additionally, members receive home health services with no copay and a skilled nursing facility benefit with no copay for the first 20 days.
Inpatient Hospital See details
Inpatient hospital benefits under BlueAdvantage Sapphire (PPO) are partially covered with no coinsurance, requiring a $295 daily copay for days 1 to 5 and no copay for days 6 to 90 per admission. Unlimited additional days are covered for acute stays, but psychiatric additional days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueAdvantage Sapphire (PPO) covers outpatient services with no coinsurance, including outpatient hospital services for a $285 copay, observation services for a $200 copay, and ambulatory surgical center services for a $235 copay. Outpatient substance abuse services require a $20 to $30 copay with no coinsurance, while outpatient blood services are covered with no copay and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by BlueAdvantage Sapphire (PPO) with a $45.00 copay and no coinsurance. Prior authorization is required for this benefit.
Ambulance and Transportation Services See details
Ambulance services are covered by BlueAdvantage Sapphire (PPO) with prior authorization, requiring a $295 copay and no coinsurance for ground transport, and a 20% coinsurance with no copay for air transport. These costs are not waived if you are admitted to the hospital, and transportation services to plan-approved or other health-related locations are not covered.
Emergency Services See details
BlueAdvantage Sapphire (PPO) covers emergency services with a $150 copay and no coinsurance, and urgent care with a $25 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services are covered with a $90 copay and no coinsurance, while worldwide emergency transportation requires a $295 copay and 20% coinsurance.
Primary Care See details
BlueAdvantage Sapphire (PPO) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $30 copay with no coinsurance. Physical, occupational, and speech therapy services are available for a $15 copay and no coinsurance, and mental health, psychiatric, and opioid treatment services have copays ranging from $20 to $30 with no coinsurance. Chiropractic and podiatry services are not covered.
Preventive Services See details
BlueAdvantage Sapphire (PPO) covers preventive services, including annual physical exams, kidney disease education, and diabetes self-management training, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance, excluding services such as health education, personal emergency response systems, and nutritional counseling.
Hearing Services See details
BlueAdvantage Sapphire (PPO) hearing services are partially covered, offering routine hearing exams for a $10 copay and no coinsurance, and prescription hearing aids with no coinsurance and copays ranging from $399 to $899. Over-the-counter (OTC) hearing aids, as well as inner ear, outer ear, and over-the-ear prescription hearing aids, are not covered.
Vision Services See details
Vision services are partially covered by BlueAdvantage Sapphire (PPO) with no copay, no coinsurance, and no deductible for one routine eye exam per year and eyewear up to a $300 limit every two years. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
BlueAdvantage Sapphire (PPO) dental services are partially covered up to a $2,250 annual maximum, with no copay and no coinsurance for preventive care, endodontics, and periodontics. Medicare-covered dental has a $30 copay and no coinsurance, while restorative, prosthodontic, and oral surgery services require no copay and 20% coinsurance. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueAdvantage Sapphire (PPO) covers home infusion bundled services with no copay, though prior authorization is required. Under this benefit, Medicare Part B chemotherapy, radiation, and other drugs require no copay and range from no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and range from no coinsurance to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the BlueAdvantage Sapphire (PPO) with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
BlueAdvantage Sapphire (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and a 20% coinsurance, subject to prior authorization. Covered diabetic supplies carry no copay and a 0% to 50% coinsurance, while diabetic therapeutic shoes or inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueAdvantage Sapphire (PPO) covers diagnostic procedures with a copay of $0 to $100 plus coinsurance, and lab services with no copay and a minimum 20% coinsurance. Radiological services feature no coinsurance, with copays ranging from no copay for outpatient X-rays, a minimum $60 copay for therapeutic services, and a minimum $225 copay for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered by BlueAdvantage Sapphire (PPO) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueAdvantage Sapphire (PPO) covers some Cardiac Rehabilitation Services with no copay and no coinsurance, though prior authorization is required. In practice, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered, and they carry copays ranging from $10 to $20.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueAdvantage Sapphire (PPO) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage for additional days.
Other Services See details
BlueAdvantage Sapphire (PPO) partially covers other services, offering a meal benefit for chronic illness and up to $55 every three months for over-the-counter items with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered under this plan's other services benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved