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BlueAdvantage Garnet (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueAdvantage Garnet (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueAdvantage Garnet (PPO) in 2026, please refer to our full plan details page.
BlueAdvantage Garnet (PPO) is a PPO plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2025 to people living in Middle Tennessee. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BlueAdvantage Garnet (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 Garnet (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 Garnet (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 $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 Garnet (PPO) plan features a $250 annual drug deductible. Under this plan, you will pay no copay for Tier 1 preferred generic drugs when using a preferred pharmacy or preferred mail order service. Tier 2 generic drugs are also highly affordable, costing just a $10 copay for a 1-month supply at preferred locations compared to a $15 copay at standard pharmacies. For Tier 3 preferred brand drugs, copays start at $42 for a 1-month supply through preferred pharmacies and mail order. Higher-tier prescription drugs require a coinsurance payment, specifically 50% coinsurance for Tier 4 non-preferred drugs and 30% coinsurance for Tier 5 specialty drugs. Choosing preferred pharmacies and mail-order options is the most cost-effective way to manage your prescription drug costs with this PPO plan.
Additional Benefits
The BlueAdvantage Garnet (PPO) plan offers robust coverage for everyday healthcare needs, featuring no copays or coinsurance for primary care visits, home health services, and cardiac rehabilitation. Specialist visits require a $30 copay, while emergency room visits carry a $130 copay, which is waived if you are admitted. For hospital stays, members pay a $325 daily copay for the first six days of inpatient care and no copay for days seven through ninety. This plan also provides valuable supplemental benefits to lower your out-of-pocket costs, including routine vision exams and dental preventive care with no copays. Members receive a $300 eyewear allowance every two years, up to $2,000 in annual dental coverage, and a quarterly $60 allowance for over-the-counter items with no copay. Routine hearing exams are available for a $10 copay, with hearing aid coverage requiring copays ranging from $399 to $899 per device.
Inpatient Hospital See details
BlueAdvantage Garnet (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $325 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
Outpatient services are covered by BlueAdvantage Garnet (PPO) with no coinsurance, featuring a $300 copay for outpatient hospital services, a $200 copay per stay for observation services, and a $250 copay for ambulatory surgical center services. Individual and group substance abuse sessions require copays of $30 and $20 respectively, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
BlueAdvantage Garnet (PPO) covers partial hospitalization services with a $45.00 copay and no coinsurance. Prior authorization is required for this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered under BlueAdvantage Garnet (PPO), with prior-authorized ground ambulance services requiring a $295.00 copay and coinsurance, and air ambulance services requiring a 20% coinsurance and a copay. Although some transportation services are covered, transportation to plan-approved health-related locations and any other health-related locations is not covered.
Emergency Services See details
Emergency services under BlueAdvantage Garnet (PPO) are covered with a $130 copay and no coinsurance, while urgently needed services require 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 a $90 copay and no coinsurance, while worldwide emergency transportation requires a $295 copay and 20% coinsurance.
Primary Care See details
BlueAdvantage Garnet (PPO) offers primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Physical, occupational, and speech therapies feature a $15 copay and no coinsurance, but chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services under BlueAdvantage Garnet (PPO) are partially covered with no copay and no coinsurance for covered services like annual physicals and kidney disease education. However, several supplemental services are not covered, including health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional tobacco cessation, telemonitoring, home/bathroom safety devices, and counseling.
Hearing Services See details
BlueAdvantage Garnet (PPO) covers routine hearing exams and fitting evaluations with a $10.00 copay, no coinsurance, and no deductible. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $399.00 to $899.00 for up to two devices per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision services are partially covered by BlueAdvantage Garnet (PPO) with no copay, no coinsurance, and no deductible, offering one routine eye exam per year and a $300 eyewear allowance every two years for contact lenses or eyeglasses. Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
BlueAdvantage Garnet (PPO) offers partially covered dental services up to a $2,000 annual limit, featuring no copay and no coinsurance for preventive care, endodontics, and periodontics. Medicare-covered dental services require a $30 copay and no coinsurance, while restorative, prosthodontic, and oral surgery services have no copay and 20% coinsurance. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueAdvantage Garnet (PPO) covers home infusion bundled services with no copay, requiring prior authorization. Covered Medicare Part B chemotherapy, radiation, and other drugs have no copay and a 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
BlueAdvantage Garnet (PPO) covers dialysis services with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
BlueAdvantage Garnet (PPO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance. Diabetic supplies are covered with no copay and 0% to 50% coinsurance, while diabetic therapeutic shoes and inserts require a $10 copay and no coinsurance.
Diagnostic and Radiological Services See details
BlueAdvantage Garnet (PPO) covers diagnostic and radiological services with prior authorization, offering diagnostic tests for a $0 to $100 copay plus coinsurance and lab services with no copay and a minimum 20% coinsurance. Radiological services require no coinsurance, with copays ranging from no copay for outpatient X-rays to a minimum of $60 for therapeutic and $225 for diagnostic radiology.
Home Health Services See details
Home Health Services are covered by BlueAdvantage Garnet (PPO) with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueAdvantage Garnet (PPO) with no copay and no coinsurance, though prior authorization is required. Some services are covered, but standard cardiac rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
BlueAdvantage Garnet (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BlueAdvantage Garnet (PPO) provides partially covered Other Services, which include a chronic illness meal benefit and over-the-counter (OTC) items with no copay and no coinsurance. While the OTC benefit provides up to $60 of coverage every three months, acupuncture and dual-eligible SNP services are not covered.
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