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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 West 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) Medicare plan features an annual drug deductible of $250 and offers significant savings on generic medications. For Tier 1 preferred generics, you will pay no copay when using a preferred pharmacy or preferred mail-order service, while standard locations charge a $6 copay for a one-month supply. Tier 2 generic drugs are also highly affordable, costing a flat $10 copay at preferred pharmacies and mail-order compared to $15 at standard locations. Brand-name and specialty medications under this plan have higher cost-sharing requirements. Tier 3 preferred brand-name drugs carry a $42 copay at preferred pharmacies and a $47 copay at standard pharmacies for a one-month supply. For more complex prescriptions, Tier 4 non-preferred drugs require a 50% coinsurance, while Tier 5 specialty drugs require a 30% coinsurance across all pharmacy options.
Additional Benefits
The BlueAdvantage Garnet (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, annual physical exams, and home health services. For inpatient hospital stays, members pay a $295 daily copay for days 1 through 5 and no copay for days 6 through 90, while outpatient hospital services require a $310 copay. Emergency care is available with a $130 copay, and specialist office visits require a $30 copay, both featuring no coinsurance. This plan also includes valuable supplemental benefits, such as dental coverage up to a $2,000 annual limit with no copay or coinsurance for preventive care. Routine eye exams and eyewear are covered with no copay up to a $300 limit every two years, while routine hearing exams require a $10 copay. Additionally, durable medical equipment and prosthetics are covered with no copay and a 20% coinsurance.
Inpatient Hospital See details
BlueAdvantage Garnet (PPO) offers partially covered inpatient hospital services with no coinsurance, requiring a $295 copay for days 1 through 5 and no copay for days 6 through 90 for acute and psychiatric stays. Unlimited additional acute days are covered, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueAdvantage Garnet (PPO) covers outpatient services with no coinsurance, featuring a $310 copay for outpatient hospital services, a $200 copay per stay for observation services, and a $260 copay for ambulatory surgical center services. Outpatient substance abuse sessions require a $20 to $30 copay with no coinsurance, while outpatient blood services are covered with no copay, coinsurance, or deductible.
Partial Hospitalization See details
BlueAdvantage Garnet (PPO) covers partial hospitalization services with a $45.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
BlueAdvantage Garnet (PPO) covers ambulance services with prior authorization, requiring a $295 copay for ground ambulance services and a 20% coinsurance for air ambulance services. Transportation services to health-related locations are not covered under this plan.
Emergency Services See details
BlueAdvantage Garnet (PPO) covers emergency services with a $130 copay and urgently needed services with a $25 copay, both featuring no coinsurance and 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) covers primary care physician visits and telehealth services with no copay and no coinsurance. Specialist visits require a $30 copay, and physical, occupational, and speech therapies require a $15 copay, all with no coinsurance. Mental health, psychiatric, and opioid treatment services feature copays ranging from $20 to $30 with no coinsurance, while podiatry and chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by BlueAdvantage Garnet (PPO) with no copay and no coinsurance for covered options like annual physical exams and kidney disease education. However, the plan does not cover sub-services such as health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs for hair loss, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by BlueAdvantage Garnet (PPO), which offers one routine hearing exam annually for a $10 copay and no coinsurance, and up to two prescription hearing aids per year with a copay ranging from $399 to $899 and no coinsurance. OTC hearing aids, along with 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 Garnet (PPO), offering one routine eye exam per year and eyewear (one pair of contacts or eyeglasses every two years up to a $300 limit) with no copay and no coinsurance. Other eye exam services, individual eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by BlueAdvantage Garnet (PPO) up to a $2,000 annual maximum, featuring no copay and no coinsurance for preventive care, and a $30 copay with no coinsurance for Medicare-covered dental. Covered comprehensive services require no copay and either no coinsurance or a 20% coinsurance, but 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 and no coinsurance, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs have no copay and coinsurance ranging from no coinsurance to 20%, while Part B insulin drugs require a $35 copay and coinsurance ranging from no coinsurance to 20%.
Dialysis Services See details
BlueAdvantage Garnet (PPO) covers dialysis services with no copay and a 20% coinsurance, though prior authorization is required.
Medical Equipment See details
BlueAdvantage Garnet (PPO) covers durable medical equipment, prosthetics, and medical supplies with no copay and 20% coinsurance. Diabetic supplies are covered with no copay and coinsurance ranging from no coinsurance to 50%, while diabetic therapeutic shoes or 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 outpatient X-rays with no copay or coinsurance. Lab services require a 20% coinsurance with no copay, diagnostic tests have a $0 to $100 copay, and diagnostic and therapeutic radiological services require no coinsurance with copays starting at $225 and $60, respectively.
Home Health Services See details
BlueAdvantage Garnet (PPO) covers Home Health Services with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
BlueAdvantage Garnet (PPO) covers some Cardiac Rehabilitation Services with no coinsurance, although prior authorization is required. However, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
BlueAdvantage Garnet (PPO) partially covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BlueAdvantage Garnet (PPO) provides partial coverage for other services, offering over-the-counter (OTC) items and meals for chronic illness with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered under these benefits.
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