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BlueAdvantage Prime (PPO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueAdvantage Prime (PPO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueAdvantage Prime (PPO) in 2025, please refer to our full plan details page.
BlueAdvantage Prime (PPO) is a PPO plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2025 to people living in Southeast + East TN. This plan received an overall rating of 4.5 out of 5 stars in 2025.
It's important to know that BlueAdvantage Prime (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 Prime (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 Prime (PPO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $206.00. 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
We don't have information on the Maximum Out-Of-Pocket cost for this plan. You can call our licensed insurance specialists by clicking "Call to Enroll" below 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 Prime (PPO) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay or coinsurance depending on the drug tier and pharmacy. For example, preferred generic drugs have a $10 copay at a preferred pharmacy, while preferred brand drugs have 50% coinsurance. Once your total drug costs reach $2,000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your Part D premium is $14.50.
Additional Benefits
The BlueAdvantage Prime (PPO) plan offers a variety of health benefits with no copay for many services. This includes emergency services, primary care, preventive services, ambulance services, home health services, and durable medical equipment. The plan covers outpatient services, hearing exams, vision exams, and dental services, but coverage details and costs vary for each of these.
Inpatient Hospital See details
Inpatient Hospital benefits, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, are covered. Additional Days for Inpatient Hospital-Acute are covered, but Non-Medicare-covered Stay and Upgrades for Inpatient Hospital-Acute, as well as Additional Days and Non-Medicare-covered Stay for Inpatient Hospital Psychiatric, are not covered.
Outpatient Services See details
Outpatient Services are covered by the BlueAdvantage Prime (PPO) plan, including outpatient hospital services, observation services, ambulatory surgical center (ASC) services, and outpatient blood services, with prior authorization required for some services, and individual and group sessions for outpatient substance abuse are not covered. The plan also offers an enhanced benefit where the three (3) pint deductible is waived for outpatient blood services.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueAdvantage Prime (PPO) plan, but requires prior authorization. There is no information about the cost of this benefit.
Ambulance and Transportation Services See details
The BlueAdvantage Prime (PPO) plan covers all ambulance services with no copay or coinsurance, but requires prior authorization. Ground ambulance services, air ambulance services, and transportation services are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are covered under the BlueAdvantage Prime (PPO) plan with no copay and no coinsurance.
Primary Care See details
Primary care physician services, occupational therapy services, physician specialist services, physical therapy, speech-language pathology services, and additional telehealth benefits are covered with no copay and no coinsurance, while chiropractic services, mental health specialty services, psychiatric services, and opioid treatment program services are covered, but require prior authorization. Routine chiropractic care, individual sessions for mental health specialty services, individual sessions for psychiatric services, and podiatry services are not covered.
Preventive Services See details
The BlueAdvantage Prime (PPO) plan covers preventive services, including annual physical exams, health education, nutritional/dietary benefits, fitness benefits, enhanced disease management, telemonitoring services, remote access technologies, glaucoma screening, 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, 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 and tobacco cessation counseling, home and bathroom safety devices, and counseling services are not covered.
Hearing Services See details
The BlueAdvantage Prime (PPO) plan covers hearing exams with no deductible, and routine hearing exams with one visit allowed every year. Fitting/Evaluation for Hearing Aids are covered, and Prescription Hearing Aids are covered, with a copay between $199 and $699, but Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered. OTC Hearing Aids are not covered.
Vision Services See details
Vision services include eye exams, but the plan does not cover contact lenses, eyeglasses (lenses and frames), eyeglass lenses, eyeglass frames, or upgrades. Routine eye exams are offered as an optional, supplemental benefit, and you may have to pay more for access to this benefit.
Dental Services See details
Dental Services are partially covered by the BlueAdvantage Prime (PPO) plan. Medicare Dental Services are covered, but Orthodontic Services, Restorative Services, Adjunctive General Services, Endodontics, Periodontics, Prosthodontics (removable and fixed), Maxillofacial Prosthetics, Implant Services, Oral and Maxillofacial Surgery, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, with prior authorization required. Insulin and Medicare Part B Insulin Drugs are covered. Medicare Part B Chemotherapy/Radiation Drugs are not covered.
Dialysis Services See details
Dialysis services are covered by the BlueAdvantage Prime (PPO) plan. There is no information about the cost of these services provided in the snippet.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) and Prosthetics/Medical Supplies, both with no copay and no coinsurance, but some sub-services like DME for use outside the home, Prosthetic Devices, Medical Supplies, Diabetic Supplies, and Diabetic Therapeutic Shoes/Inserts are not covered. Diabetic Equipment is also covered, but its sub-services are not.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueAdvantage Prime (PPO) plan, but Diagnostic Procedures/Tests, Lab Services, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services are not covered. There is no copay for any covered services.
Home Health Services See details
Home Health Services are covered by the BlueAdvantage Prime (PPO) plan with no copay and no coinsurance, but prior 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 Prime (PPO) plan, including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services. Prior authorization is required for these services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered, but additional days beyond Medicare coverage and non-Medicare stays are not covered. Prior authorization is required for this benefit.
Other Services See details
The BlueAdvantage Prime (PPO) plan does not cover acupuncture, over-the-counter items, meal benefits, 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, or Self-Directed Personal Assistance Services. No authorization or referral is required for the additional services.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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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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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.
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