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BlueAdvantage Extra (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueAdvantage Extra (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueAdvantage Extra (PPO) in 2025, please refer to our full plan details page.
BlueAdvantage Extra (PPO) is a PPO plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2025 to people living in Statewide TN + Northwest GA. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BlueAdvantage Extra (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 Extra (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 Extra (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $26.00. 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 $590.00 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 Extra (PPO) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for your drugs based on their tier until your total drug costs reach $2,000. Once your yearly out-of-pocket drug costs reach $2,000, you will enter the catastrophic coverage phase, where you will pay nothing for your Part D covered drugs. If you qualify for the low-income subsidy, you'll pay $26.00.
Additional Benefits
The BlueAdvantage Extra (PPO) plan offers comprehensive coverage, including inpatient hospital stays with a copay of $195 for days 1-5 and no copay for days 6-90. Outpatient services have varying copays, such as $175 for hospital services and $125 for ambulatory surgical centers. The plan also includes coverage for primary care visits with a $20 copay, hearing exams for a $10 copay, and routine eye exams, along with dental services. This plan provides additional benefits like ambulance services with a copay, emergency services with a $125 copay, and diagnostic services with copays from $0 to $100. You'll also find coverage for home health services with no copay, and skilled nursing facility stays with no copay for the first 20 days. The plan also offers an OTC benefit with a maximum of $125 every three months.
Inpatient Hospital See details
Inpatient Hospital services, including acute and psychiatric, are covered. For days 1-5, there is a $195 copay; for days 6-90, there is no copay.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, are covered by the BlueAdvantage Extra (PPO) plan. Outpatient Hospital Services and Observation Services have a $175 copay, Ambulatory Surgical Center (ASC) Services have a $125 copay, and Outpatient Substance Abuse Services have copays that range from $15 to $25 depending on the service. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueAdvantage Extra (PPO) plan, with a $45 copay. Prior authorization is required.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueAdvantage Extra (PPO) plan. Ground ambulance services have a $295 copay, while air ambulance services have a 20% coinsurance. Transportation Services to a plan-approved health-related location are covered for up to 24 one-way trips per year, but transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services are covered by the BlueAdvantage Extra (PPO) plan with a $125 copay, while Urgently Needed Services have a $25 copay. Worldwide Emergency Coverage has a $120 copay, Worldwide Urgent Coverage has a $90 copay, and Worldwide Emergency Transportation has a 20% coinsurance and a $295 copay.
Primary Care See details
The BlueAdvantage Extra (PPO) plan covers primary care physician services, chiropractic services with a $20 copay, occupational therapy services with a $25 copay, physician specialist services with a $25 copay, mental health specialty services with a $15-$25 copay, other health care professional services with a $20-$35 copay, psychiatric services with a $15-$25 copay, physical therapy and speech-language pathology services with a $25 copay, additional telehealth benefits, and opioid treatment program services. Routine chiropractic care and podiatry services are not covered.
Preventive Services See details
The BlueAdvantage Extra (PPO) plan covers 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, weight management programs, alternative therapies, therapeutic massage, adult day health services, home-based palliative care, in-home support services, support for caregivers, additional smoking cessation counseling, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
Hearing Services includes coverage for routine hearing exams with a $10 copay, and prescription hearing aids with a copay between $199 and $699, depending on the type of hearing aid. Fitting/Evaluation for Hearing Aids is covered. Some services, like prescription hearing aids for the inner, outer, and over the ear, and OTC hearing aids, are not covered.
Vision Services See details
Vision Services includes coverage for routine eye exams with one visit per year. Eyewear is covered up to a combined maximum of $250 every year, and includes one pair of contact lenses or eyeglasses (lenses and frames) per year; however, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
The BlueAdvantage Extra (PPO) plan covers dental services, including oral exams with a $25 copay, dental x-rays, other diagnostic dental services, prophylaxis (cleaning), fluoride treatment, and other preventive dental services. The plan also covers restorative services, endodontics, periodontics, prosthodontics (removable), implant services, prosthodontics (fixed), and oral and maxillofacial surgery with 20% coinsurance. Adjunctive general services, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered and require prior authorization. Medicare Part B Insulin Drugs have a $35 copay with coinsurance between 0% and 20%, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueAdvantage Extra (PPO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits are covered by the BlueAdvantage Extra (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, Medical Supplies have a 20% coinsurance, and Diabetic Supplies have between 0% and 20% coinsurance. Diabetic Therapeutic Shoes/Inserts have a $10 copay.
Diagnostic and Radiological Services See details
The BlueAdvantage Extra (PPO) plan covers diagnostic and radiological services, including diagnostic procedures and tests with a copay between $0 and $100. Lab services have no copay and a coinsurance of up to 20%, and diagnostic radiological services have a copay of at least $175, 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 Extra (PPO) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered. Authorization is required for this benefit.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are not covered by the BlueAdvantage Extra (PPO) plan. 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.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueAdvantage Extra (PPO) plan. There is no copay for days 1-20, and a $214 copay for days 21-100. Additional days beyond Medicare-covered and non-Medicare-covered SNF stays are not covered.
Other Services See details
The BlueAdvantage Extra (PPO) plan's "Other Services" benefit includes coverage for over-the-counter (OTC) items, with a maximum benefit coverage amount of $125 every three months, and meal benefits for chronic illnesses. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and several 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.
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