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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 2025, 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 4.5 out of 5 stars in 2025.
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 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 Garnet (PPO) plan has an "Enhanced Alternative" drug benefit type with a $0 deductible. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy type. For example, preferred generic drugs have a $10 copay at preferred pharmacies. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. This plan's premium may be reduced if you qualify for the low-income subsidy (LIS).
Additional Benefits
The BlueAdvantage Garnet (PPO) plan offers a wide range of benefits with varying costs. Inpatient hospital stays have a copay, while outpatient services such as primary care and vision exams often have low or no copays. Emergency services, ambulance, and transportation services are covered, but may have copays or coinsurance. Additional benefits include coverage for hearing, dental, and home health services, with specific copays and limitations. Diagnostic and radiological services, dialysis, and medical equipment are also covered with copays or coinsurance. This plan provides a comprehensive set of services with a focus on both preventative and acute care, but it's important to review the details of each benefit to understand the specific costs and limitations.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For Inpatient Hospital-Acute, you will pay a $270 copay for days 1-5, and no copay for days 6-90; for Inpatient Hospital Psychiatric, you will pay a $270 copay for days 1-5, and no copay for days 6-90. Additional days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute are not covered, and Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $325 copay, Observation Services with a $200 copay, Ambulatory Surgical Center (ASC) Services with a $275 copay, and Outpatient Substance Abuse Services. Individual and group sessions for outpatient substance abuse have copays of $30 and $20, respectively. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered, but requires prior authorization. You will have a $45 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueAdvantage Garnet (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 under the BlueAdvantage Garnet (PPO) plan, with a $125 copay and no coinsurance. Urgently Needed Services have a $25 copay with no coinsurance, and Worldwide Emergency Services have varying costs, including a $90 copay for Worldwide Emergency and Urgent Coverage, a $295 copay and 20% coinsurance for Worldwide Emergency Transportation.
Primary Care See details
The BlueAdvantage Garnet (PPO) plan covers primary care physician 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 are covered with a $20 copay, and individual and group sessions for mental health and psychiatric services have copays ranging from $20 to $30. Podiatry services are not covered.
Preventive Services See details
The BlueAdvantage Garnet (PPO) plan covers a variety of 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 following a Welcome Visit. 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-based palliative care, in-home support services, support for caregivers, additional sessions of smoking cessation counseling, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services are covered, including routine hearing exams with a $10 copay, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $399 and $899, but prescription hearing aids - inner ear, outer ear, and over the ear, as well as OTC hearing aids, are not covered.
Vision Services See details
Vision Services includes coverage for eye exams, with no copay, and eyewear, with a combined maximum benefit of $250 every year for both in-network and out-of-network services. Contact lenses and eyeglasses (lenses and frames) are covered, with one pair allowed every year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, with a $30 copay for Medicare dental services. Other dental services have a maximum plan benefit of $2,500 per year. Oral exams are limited to 2 per year, dental x-rays are limited, and cleanings are limited to 2 per year. Fluoride treatment, restorative services, endodontics, periodontics, prosthodontics (removable and fixed), implant services, and oral and maxillofacial surgery are covered, with limitations on the number of visits or services covered. 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 Garnet (PPO) plan, and require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0-20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the BlueAdvantage Garnet (PPO) plan, with a coinsurance of 20%.
Medical Equipment See details
The BlueAdvantage Garnet (PPO) plan covers Durable Medical Equipment (DME) with a 20% coinsurance and Prosthetic Devices with a 20% coinsurance. Diabetic Supplies have a 0-20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The BlueAdvantage Garnet (PPO) plan covers diagnostic and radiological services, including diagnostic procedures/tests, lab 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 $225, therapeutic radiological services have a copay of at most $60, and outpatient X-ray services have no copay.
Home Health Services See details
Home Health Services are covered by the BlueAdvantage Garnet (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. This benefit requires authorization.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not the specific services of Cardiac Rehabilitation, Intensive Cardiac Rehabilitation, Pulmonary Rehabilitation, and SET for PAD. Prior authorization is required, and there may be a copay, but more information is needed.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueAdvantage Garnet (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214.
Other Services See details
The BlueAdvantage Garnet (PPO) plan covers Over-the-Counter (OTC) items with a maximum benefit of $60 every three months. 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 are not covered.
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