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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 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 Northeast 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 $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 Sapphire (PPO) plan features a $250 annual drug deductible. Tier 1 preferred generic drugs have no copay when filled at a preferred pharmacy or through preferred mail order, while standard pharmacies and mail order options charge a $6 copay for a one-month supply. For Tier 2 generic drugs, you will pay a $10 copay for a one-month supply at preferred locations, compared to a $15 copay at standard pharmacies. Tier 3 preferred brand drugs require a $42 copay at preferred pharmacies and a $47 copay at standard pharmacies for a one-month supply. Higher-tier medications require coinsurance instead of flat copays, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance for a one-month supply.
Additional Benefits
The BlueAdvantage Sapphire (PPO) plan offers comprehensive medical coverage with low out-of-pocket costs, featuring no copays or coinsurance for primary care visits, preventive services, and home health care. Specialist visits require a $30 copay, while inpatient hospital stays carry a $270 daily copay for the first five days and no copay for days six through 90. Outpatient hospital services feature a $250 copay, and emergency room visits require a $150 copay, which is waived if you are admitted. This plan also includes key supplemental benefits, such as dental coverage with no copay for preventive care and a 20% coinsurance for comprehensive services up to a $2,750 annual limit. Routine eye exams and up to $300 for eyewear every two years are covered with no copay or coinsurance, while routine hearing exams require a $10 copay. Additionally, members benefit from no copays on over-the-counter items up to $75 every three months and no copays for home infusion services.
Inpatient Hospital See details
BlueAdvantage Sapphire (PPO) covers inpatient hospital stays with no coinsurance, requiring a $270 daily copay for days 1 through 5 and no copay for days 6 through 90. While unlimited additional days are covered for acute care, additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueAdvantage Sapphire (PPO) covers outpatient services with no coinsurance, featuring a $250 copay for outpatient hospital services, a $200 copay for ambulatory surgical center and observation services, and a $20 to $30 copay for outpatient substance abuse sessions. Outpatient blood services are also covered with no copay, no coinsurance, and no deductible.
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
BlueAdvantage Sapphire (PPO) covers ground ambulance services with a $250 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay, both of which require prior authorization. Some transportation services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
BlueAdvantage Sapphire (PPO) covers emergency services with a $150 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services require a $25 copay and no coinsurance, while worldwide emergency and urgent care are covered with a $90 copay and no coinsurance, and worldwide emergency transportation has a $250 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 and no coinsurance. Chiropractic services are partially covered with a $20 copay and no coinsurance (routine and other chiropractic services are not covered), therapy services have a $15 copay and no coinsurance, and podiatry is not covered. Mental health, psychiatric, and opioid treatment services are covered with no coinsurance and copays ranging from $20 to $30.
Preventive Services See details
BlueAdvantage Sapphire (PPO) covers preventive services, including annual physical exams, kidney disease education, and various screenings, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay or coinsurance, offering memory fitness, enhanced disease management, and remote access technologies, while sub-services such as health education and personal emergency response systems are not covered.
Hearing Services See details
BlueAdvantage Sapphire (PPO) covers routine hearing exams with a $10 copay and no coinsurance, as well as prescription hearing aids with copays ranging from $399 to $899 and no coinsurance. OTC hearing aids and inner-ear, outer-ear, and over-the-ear prescription hearing aid types 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 covered services, which include one routine eye exam annually and up to $300 every two years for one pair of eyeglasses or contact lenses. 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 $2,750 annual maximum for both in- and out-of-network care, featuring no copay or coinsurance for preventive care like exams and cleanings. Medicare-covered dental services require a $30 copay and no coinsurance, while covered comprehensive services like restorative care and oral surgery carry a 20% coinsurance and no copay, though implants, orthodontics, maxillofacial prosthetics, and adjunctive general services are not covered.
Home Infusion bundled Services See details
Home infusion bundled services are covered by BlueAdvantage Sapphire (PPO) with no copay, although prior authorization and step therapy are required. Covered Medicare Part B chemotherapy, radiation, and other drugs carry a 0% to 20% coinsurance with no copay, while Part B insulin has a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered under the BlueAdvantage Sapphire (PPO) plan with no copay and a 20% coinsurance, although prior authorization is required.
Medical Equipment See details
Medical equipment is covered under the BlueAdvantage Sapphire (PPO) plan, with durable medical equipment and prosthetics requiring no copay and 20% coinsurance. Diabetic supplies feature coinsurance ranging from no coinsurance up to 50%, while diabetic therapeutic shoes or inserts have a $10 copay, with prior authorization required for these services.
Diagnostic and Radiological Services See details
BlueAdvantage Sapphire (PPO) covers diagnostic and radiological services with prior authorization. Diagnostic procedures and tests have a copay ranging from $0 to $100 plus coinsurance, while lab services have no copay and a minimum 20% coinsurance. Radiological services require no coinsurance, with copays starting at $225 for diagnostic radiology and $60 for therapeutic radiology, and no copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the BlueAdvantage Sapphire (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueAdvantage Sapphire (PPO) covers cardiac rehabilitation services with no copay and no coinsurance, though prior authorization is required. While some services are covered, specific sub-services including cardiac rehabilitation, intensive rehabilitation, pulmonary rehabilitation, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) are not covered.
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 inpatient 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
Other services are partially covered by BlueAdvantage Sapphire (PPO), featuring no copay and no coinsurance for over-the-counter (OTC) items up to $75 every three months and chronic illness meal benefits. Acupuncture is not covered under this plan.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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.
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