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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 2025, 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 North Georgia. This plan received an overall rating of 4.5 out of 5 stars in 2025.
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 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 Sapphire (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you'll pay a copay for generic drugs, and coinsurance for brand-name and non-preferred drugs. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase where you pay nothing for Part D covered drugs. The plan's premium may be reduced if you qualify for the low-income subsidy.
Additional Benefits
The BlueAdvantage Sapphire (PPO) plan offers a range of benefits, including coverage for inpatient hospital stays with a $285 copay for days 1-5, and no copay for days 6-90. Outpatient services such as hospital services, observation, and substance abuse have varying copays. The plan also covers ambulance services, emergency services, and primary care services. This plan provides coverage for preventive services, hearing exams with a $10 copay, and vision services with no copay for routine eye exams. Dental services are covered, including oral exams with a $30 copay. Additionally, this plan covers home infusion services, dialysis services, medical equipment, diagnostic and radiological services, home health services with no copay, and skilled nursing facility stays with no copay for days 1-20.
Inpatient Hospital See details
The BlueAdvantage Sapphire (PPO) plan covers inpatient hospital stays, including acute and psychiatric care. For days 1-5 of an inpatient hospital stay, there is a $285 copay, and for days 6-90, there is no copay. Additional days for Inpatient Hospital-Acute are covered. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, as are additional days and non-Medicare covered stays for Inpatient Hospital Psychiatric.
Outpatient Services See details
Outpatient Services include coverage for Outpatient Hospital Services with a $225 copay, Observation Services with a $200 copay, Ambulatory Surgical Center (ASC) Services with a $275 copay, and Outpatient Substance Abuse Services with a $30 copay for individual sessions and a $20 copay for group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueAdvantage Sapphire (PPO) plan, 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 Sapphire (PPO) plan, with prior authorization required for all ambulance services. Ground Ambulance Services have a $295 copay, while Air Ambulance Services have a 20% coinsurance; other transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BlueAdvantage Sapphire (PPO) plan. Emergency Services have a $125 copay, and Urgently Needed Services have a $25 copay. Worldwide Emergency Coverage and Worldwide Urgent Coverage both have a $90 copay, while Worldwide Emergency Transportation has a $295 copay and 20% coinsurance.
Primary Care See details
Primary Care services include coverage for primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, occupational therapy services have a $30 copay, physician specialist services have a $30 copay, individual mental health sessions have a $30 copay, and group mental health sessions have a $20 copay. Other health care professional services have a copay between $20 and $30, individual psychiatric sessions have a $30 copay, group psychiatric sessions have a $20 copay, physical therapy and speech-language pathology services have a $30 copay, and opioid treatment program services have a copay between $20 and $30. Podiatry services are not covered.
Preventive Services See details
The BlueAdvantage Sapphire (PPO) plan covers a range of preventive services, including health education, nutritional/dietary benefits, fitness benefits, enhanced disease management, telemonitoring services, glaucoma screenings, and diabetes self-management training. However, the plan does not cover 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 and tobacco cessation counseling, home and bathroom safety devices and modifications, or counseling services.
Hearing Services See details
Hearing services are covered, including hearing exams with a $10 copay for routine exams, and fitting/evaluation for hearing aids. Prescription hearing aids are covered with a copay between $399 and $899 for all types. However, prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The BlueAdvantage Sapphire (PPO) plan covers vision services, including routine eye exams with no copay, and eyewear with a combined maximum of $250 per year. Contact lenses and eyeglasses (lenses and frames) are also covered. Eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueAdvantage Sapphire (PPO) plan covers dental services including oral exams with a $30 copay, dental x-rays, and other diagnostic services. Other covered services include prophylaxis (cleaning) and fluoride treatments, with a yearly maximum of $2750. Orthodontic services are covered under the Diagnostic and Preventive Dental, with a maximum plan benefit coverage.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueAdvantage Sapphire (PPO) plan, with prior authorization required. For Medicare Part B Insulin Drugs, there is a $35 copay and a coinsurance between 0% and 20%. For Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs, there is a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueAdvantage Sapphire (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, Prosthetic Devices with 20% coinsurance, and Medical Supplies with 20% coinsurance. Diabetic Supplies have no coinsurance, and Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services, including Diagnostic Procedures/Tests, are covered with a copay between $0 and $100, and Lab Services are covered with 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 Sapphire (PPO) plan with no copay and no coinsurance, but authorization is required. Additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueAdvantage Sapphire (PPO) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, and Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueAdvantage Sapphire (PPO) plan, but require prior authorization. For days 1-20, there is no copay, and for days 21-100, the copay is $214 per day; additional days beyond Medicare-covered SNF stays and non-Medicare-covered stays are not covered.
Other Services See details
The BlueAdvantage Sapphire (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. Over-the-counter items are covered with a maximum benefit of $60 every three months. The plan also covers meal benefits.
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