A non-government entity
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 West 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:
Sign up for BlueAdvantage Garnet (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 Garnet (PPO) plan has an enhanced alternative drug benefit. There is no deductible for prescription drugs. During the initial coverage phase, you will pay a copay for generic drugs, and coinsurance for brand name and non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs.
Additional Benefits
The BlueAdvantage Garnet (PPO) plan offers a range of benefits, including inpatient hospital stays with a copay, outpatient services, and partial hospitalization. Emergency, primary care, preventive, hearing, vision, and dental services are also covered, with varying copays and coinsurance amounts. The plan also provides coverage for home health, skilled nursing, and medical equipment, with specific cost-sharing structures. Additional benefits include coverage for ambulance and transportation services, home infusion, and dialysis services. Diagnostic and radiological services are covered with copays and coinsurance, while cardiac rehabilitation services are covered, but not in practice. The plan also offers an over-the-counter (OTC) benefit and a meal benefit for chronic illness.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. For days 1-5 of an inpatient stay, the copay is $295, and there is no copay for days 6-90; there is no coinsurance.
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, Outpatient Substance Abuse Services with a $30 copay for individual sessions and a $20 copay for group sessions, and Outpatient Blood Services. Prior authorization is required for some services.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueAdvantage Garnet (PPO) plan, and 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 BlueAdvantage Garnet (PPO). 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, Urgently Needed Services, and Worldwide Emergency Services are covered under the BlueAdvantage Garnet (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $25 copay. Worldwide Emergency Transportation has a $295 copay and 20% coinsurance, while Worldwide Emergency Coverage and Worldwide Urgent Coverage have a $90 copay.
Primary Care See details
The BlueAdvantage Garnet (PPO) plan covers primary care physician services, occupational therapy, physician specialist services, mental health specialty services, psychiatric services, physical therapy, speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, and routine chiropractic care is not covered. Occupational therapy services have a $15 copay. Physician specialist services have a $30 copay. Individual sessions for both mental health and psychiatric specialty services have a $30 copay, while group sessions have a $20 copay. Physical therapy and speech-language pathology services have a $15 copay. Opioid treatment program services have a copay between $20 and $30.
Preventive Services See details
The BlueAdvantage Garnet (PPO) plan covers preventive services, including Medicare-covered services, annual physical exams, health education, kidney disease education, glaucoma screenings, diabetes self-management training, barium enemas, digital rectal exams, and EKGs after a welcome visit. However, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge in-home medication reconciliation, readmission 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. The plan also offers a nutritional/dietary benefit and a fitness benefit.
Hearing Services See details
Hearing services through the BlueAdvantage Garnet (PPO) plan include hearing exams with a $10 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $399 and $899 for up to 2 hearing aids per year, but inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
Vision services include routine eye exams, contact lenses, and eyeglasses, with no deductible for any of these services. This plan covers one routine eye exam per year, one pair of contact lenses per year, and one pair of eyeglasses (lenses and frames) per year, with a combined maximum of $225 for all eyewear per year. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are covered, including a $30 copay for Medicare dental services. Other dental services have a $2,500 maximum benefit per year, covering oral exams (2 per year), dental X-Rays (1 preventative per 12 months, 1 diagnostic per 36 months), other diagnostic dental services, prophylaxis (cleaning) (2 per year), fluoride treatment (1 per year), other preventive dental services, restorative services (1 visit), endodontics (1 visit per tooth per 60 months), periodontics (1 visit every three years), prosthodontics, removable (1 per 60 months), implant services (1 per 60 months), prosthodontics, fixed (1 per 60 months), and oral and maxillofacial surgery. 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, but require prior authorization. For Medicare Part B Insulin Drugs, there is a $35 copay with a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, the coinsurance ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueAdvantage Garnet (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered under the BlueAdvantage Garnet (PPO) plan. Durable Medical Equipment (DME) has a 20% coinsurance and requires authorization, while Durable Medical Equipment for use outside the home is not covered. Prosthetic Devices have a 20% coinsurance, while Medical Supplies have a 20% coinsurance. Diabetic Supplies have between 0% and 20% coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueAdvantage Garnet (PPO) plan. Diagnostic Procedures/Tests have a copay between $0 and $100. Lab Services have no copay, but have a coinsurance of at most 20%. Diagnostic Radiological Services have a copay of at least $225, while Therapeutic Radiological Services have a copay of at least $60. 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. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered, but not in practice as the plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services. Prior authorization is required.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered under the BlueAdvantage Garnet (PPO) plan, but require prior authorization. There is no copay for days 1-20, but there is a $214 copay for days 21-100; additional days beyond Medicare-covered and non-Medicare-covered stays are not covered.
Other Services See details
The BlueAdvantage Garnet (PPO) plan does not cover 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. This plan covers Over-the-Counter (OTC) items with a maximum benefit of $55.00 every three months, and also offers a meal benefit for chronic illness.
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