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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 2026, 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 out of 5 stars in 2026.
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 $27.60. 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 $615.00 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) Medicare plan features an annual prescription drug deductible of $615. This deductible represents the amount you must pay out-of-pocket for your covered medications before the plan begins to pay its share. Knowing this yearly deductible amount is a crucial first step in estimating your overall annual healthcare expenses with this PPO plan. Specific drug tier details, copayments, and coinsurance rates for this plan are currently unavailable. To fully understand your potential medication costs, you should verify if your specific prescriptions are covered on the plan's formulary. Consulting the official plan documents will help you determine how different drug tiers might affect your out-of-pocket costs after meeting the deductible.
Additional Benefits
The BlueAdvantage Extra (PPO) plan offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, telehealth, and routine preventive services. Specialist visits require a $25 copay with no coinsurance, while inpatient hospital stays have a $235 daily copay for the first five days and no copay for subsequent days. Emergency room visits feature a $130 copay and urgent care has a $45 copay, with no coinsurance required for either service. This plan also includes valuable extra benefits, such as dental coverage up to a $2,500 annual limit with no copay for preventive care, and routine vision exams with a $250 allowance for eyewear every two years. Members also benefit from up to 24 one-way transportation trips to approved locations per year with no copay, as well as an over-the-counter item allowance of up to $111 every three months with no copay and no coinsurance. Prescription hearing aids are covered with copays ranging from $199 to $699 per aid.
Inpatient Hospital See details
BlueAdvantage Extra (PPO) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring prior authorization and a $235 daily copay for days 1 through 5, followed by no copay for days 6 through 90. Unlimited additional days are covered for acute care, but additional psychiatric days, upgrades, and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueAdvantage Extra (PPO) covers outpatient hospital and observation services with a $175 copay and no coinsurance, and ambulatory surgical center services with a $125 copay and no coinsurance. Outpatient substance abuse services require no coinsurance and a $25 copay for individual sessions or $15 copay for group sessions, while outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
BlueAdvantage Extra (PPO) covers partial hospitalization benefits with a $45.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
BlueAdvantage Extra (PPO) covers ambulance services with a $295 copay and coinsurance for ground transport, and a 20% coinsurance and copay for air transport. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay and no coinsurance, though transportation to any health-related location is not covered.
Emergency Services See details
BlueAdvantage Extra (PPO) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $45 copay and no coinsurance, with copays waived if admitted to the hospital within 24 hours. Worldwide emergency services are also covered, featuring a $120 copay for emergency care, a $90 copay for urgent care (both with no coinsurance), and a $295 copay plus 20% coinsurance for emergency transportation.
Primary Care See details
BlueAdvantage Extra (PPO) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance, while specialist visits, therapy services, and individual psychiatric or mental health sessions require a $25 copay and no coinsurance. Other professional services have a $20 to $25 copay and no coinsurance, group therapy sessions cost a $15 copay and no coinsurance, and chiropractic and podiatry services are not covered.
Preventive Services See details
BlueAdvantage Extra (PPO) provides preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. This benefit is partially covered, as several additional services like health education, in-home safety assessments, and weight management programs are not covered.
Hearing Services See details
BlueAdvantage Extra (PPO) covers routine hearing exams with a $10 copay and no coinsurance, alongside fitting evaluations. Prescription hearing aids are partially covered with no coinsurance and copays ranging from $199.00 to $699.00 for up to two aids per year, though OTC hearing aids and inner, outer, or over-the-ear prescription models are not covered.
Vision Services See details
BlueAdvantage Extra (PPO) offers partially covered vision services with no copay and no coinsurance, which includes one routine eye exam per year and a $250 combined maximum benefit every two years for contact lenses or eyeglasses. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
BlueAdvantage Extra (PPO) offers partially covered dental services with a $2,500 annual limit, featuring no copay and no coinsurance for preventive care, endodontics, and periodontics. Medicare-covered dental requires a $25 copay and no coinsurance, while restorative care, prosthodontics, and oral surgery require no copay and 20% coinsurance. Adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueAdvantage Extra (PPO) covers home infusion bundled services with no copay and no coinsurance, though prior authorization is required. Associated Medicare Part B drugs—including chemotherapy, radiation, and insulin—carry a coinsurance of 0% to 20%, with insulin drugs also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered under the BlueAdvantage Extra (PPO) plan with no copay and a 20% coinsurance. Prior authorization is required to receive these covered services.
Medical Equipment See details
BlueAdvantage Extra (PPO) covers durable medical equipment and prosthetics with no copay and a 20% coinsurance, requiring prior authorization. Diabetic therapeutic shoes and inserts require a $10 copay, while diabetic supplies from specified manufacturers carry no coinsurance to 50% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under BlueAdvantage Extra (PPO) subject to prior authorization, featuring no copay and a 20% minimum coinsurance for lab services, alongside a $0 to $100 copay and coinsurance for diagnostic tests. Radiological services require no coinsurance, charging a $175 minimum copay for diagnostic services, a $60 minimum copay for therapeutic services, and no copay for outpatient X-rays.
Home Health Services See details
Home Health Services are covered under the BlueAdvantage Extra (PPO) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueAdvantage Extra (PPO) technically offers Cardiac Rehabilitation Services with no coinsurance, but in practice, none of the sub-services are covered. Specifically, cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered by the plan.
Skilled Nursing Facility (SNF) See details
BlueAdvantage Extra (PPO) covers skilled nursing facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20, a $218 daily copay for days 21 through 100, and additional days beyond the Medicare-covered limit are not covered.
Other Services See details
Other services covered under the BlueAdvantage Extra (PPO) include meal benefits for chronic illnesses and over-the-counter (OTC) items, both offered with no copay and no coinsurance. Acupuncture is not covered, and the OTC benefit is limited to a maximum of $111 every three months for select items.
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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.
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