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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 East 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 $6300.00 (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 $6300.00 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 and offers significant savings on generic medications. Tier 1 preferred generic drugs have no copay when filled through a preferred pharmacy or preferred mail order, while standard locations charge a $6 copay for a one-month supply. For Tier 2 generics, you will pay a low $10 copay for a one-month supply at preferred pharmacies, compared to a $15 copay at standard pharmacies. For brand-name and specialty medications, Tier 3 preferred brands require a $42 copay for a one-month supply at preferred pharmacies, which increases to $47 at standard locations. Higher-tier prescriptions are subject to coinsurance, with Tier 4 non-preferred drugs requiring 50% coinsurance and Tier 5 specialty drugs requiring 30% coinsurance for a one-month supply at both preferred and standard pharmacies.
Additional Benefits
The BlueAdvantage Sapphire (PPO) plan offers comprehensive medical coverage with no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay no coinsurance and a $295 daily copay for the first five days, followed by no copay for days six through 90. Specialist visits require a $30 copay, while emergency services are covered with a $150 copay that is waived if admitted within 24 hours. This plan also provides valuable supplemental benefits, including routine eye exams and eyewear up to a $300 limit with no copay and no coinsurance. Preventive dental care features no copay and no coinsurance, while restorative dental services require a 20% coinsurance up to a $2,250 annual maximum. Additionally, members can access an over-the-counter benefit of up to $55 every three months with no copay and no coinsurance.
Inpatient Hospital See details
BlueAdvantage Sapphire (PPO) covers inpatient acute and psychiatric hospital services with no coinsurance, requiring a $295 daily copay for days 1 through 5 and no copay for days 6 through 90. Prior authorization is required, and the benefit is partially covered as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueAdvantage Sapphire (PPO) covers outpatient services with no coinsurance, including outpatient hospital services for a $300 copay, observation services for a $200 copay per stay, and ambulatory surgical center services for a $250 copay. Outpatient substance abuse sessions have a $20 to $30 copay with no coinsurance, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by BlueAdvantage Sapphire (PPO) with a $45.00 copay and no coinsurance, although prior authorization is required.
Ambulance and Transportation Services See details
BlueAdvantage Sapphire (PPO) covers emergency ambulance services with prior authorization, requiring a $295.00 copay (and no coinsurance) for ground ambulance services and a 20% coinsurance (and no copay) for air ambulance services, neither of which is waived if you are admitted to the hospital. Routine transportation services to health-related locations are not covered under this plan.
Emergency Services See details
BlueAdvantage Sapphire (PPO) covers emergency services with a $150 copay and no coinsurance, and urgently needed services with a $25 copay and no coinsurance, with both copays waived if admitted to the hospital within 24 hours. Worldwide emergency and urgent services 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 Sapphire (PPO) provides primary care and telehealth services with no copay and no coinsurance, while specialist visits require a $30 copay and no coinsurance. Covered therapy, mental health, and psychiatric services feature no coinsurance and copays ranging from $15 to $30, while chiropractic and podiatry services are not covered.
Preventive Services See details
Preventive services are covered by BlueAdvantage Sapphire (PPO) with no copay and no coinsurance for annual physical exams, kidney disease education, and various screenings. Additional preventive benefits are partially covered, including memory fitness, enhanced disease management, and remote access technologies, while services like health education, personal emergency response systems, and in-home safety assessments are not covered.
Hearing Services See details
BlueAdvantage Sapphire (PPO) provides partially covered hearing services, featuring a $10 copay and no coinsurance for one routine hearing exam per year and unlimited fitting evaluations. Prescription hearing aids are covered for up to two devices annually with copays ranging from $399 to $899 and no coinsurance, though over-the-counter (OTC) hearing aids as well as inner ear, outer ear, and over the ear prescription models are not covered.
Vision Services See details
BlueAdvantage Sapphire (PPO) offers partially covered vision services with no copay, no coinsurance, and no deductible for routine eye exams (one per year) and eyewear (one pair of eyeglasses or contact lenses every two years up to a $300 limit). Other eye exam services, individual eyeglass lenses, individual eyeglass frames, and upgrades are not covered.
Dental Services See details
BlueAdvantage Sapphire (PPO) partially covers dental services up to a $2,250 annual maximum, though adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered. Medicare-covered dental services require a $30 copay and no coinsurance, preventive and diagnostic care have no copay and no coinsurance, and restorative or surgical services require no copay and 20% coinsurance.
Home Infusion bundled Services See details
BlueAdvantage Sapphire (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Covered Medicare Part B chemotherapy, radiation, and other drugs require no copay and no coinsurance to 20% coinsurance, while Part B insulin is covered with a $35 copay and no coinsurance to 20% coinsurance.
Dialysis Services See details
BlueAdvantage Sapphire (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 Sapphire (PPO) covers durable medical equipment (DME) 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.
Diagnostic and Radiological Services See details
BlueAdvantage Sapphire (PPO) covers diagnostic and radiological services with prior authorization required. Diagnostic tests and procedures have a copay ranging from no copay up to $100, while lab services require no copay and a 20% coinsurance. Radiological services feature no coinsurance, with no copay for outpatient X-rays, a copay starting at $60 for therapeutic services, and a copay starting at $225 for diagnostic radiological services.
Home Health Services See details
Home Health Services are covered by the BlueAdvantage Sapphire (PPO) plan with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
BlueAdvantage Sapphire (PPO) covers some cardiac rehabilitation services with no coinsurance, though prior authorization is required. However, standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for symptomatic peripheral artery disease (PAD) services are not covered.
Skilled Nursing Facility (SNF) See details
BlueAdvantage Sapphire (PPO) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. Patients pay no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the standard Medicare benefit are not covered.
Other Services See details
Other services covered by BlueAdvantage Sapphire (PPO) include over-the-counter (OTC) items and a chronic illness meal benefit, both of which feature no copay and no coinsurance. Under this benefit, OTC items are covered up to $55 every three months, while acupuncture and other additional services are not covered.
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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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