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BlueAdvantage Total Heart and Diabetes (PPO C-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueAdvantage Total Heart and Diabetes (PPO C-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueAdvantage Total Heart and Diabetes (PPO C-SNP) in 2026, please refer to our full plan details page.
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) is a PPO C-SNP plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2026 to people living in East TN + North GA. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BlueAdvantage Total Heart and Diabetes (PPO C-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
BlueAdvantage Total Heart and Diabetes (PPO C-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueAdvantage Total Heart and Diabetes (PPO C-SNP).
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 Total Heart and Diabetes (PPO C-SNP), 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 $10100.00 (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 $10100.00 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:
Sign up for BlueAdvantage Total Heart and Diabetes (PPO C-SNP)
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Drug Coverage
The BlueAdvantage Total Heart and Diabetes (PPO C-SNP) prescription drug plan features an annual drug deductible of $250. For generic medications, members benefit from no copay on Tier 1 preferred generic and Tier 2 generic drugs when using a preferred pharmacy or preferred mail order service. If you choose standard pharmacies or standard mail order, copays start at $6 for Tier 1 and $15 for Tier 2 medications. For brand-name and specialty prescriptions, costs vary based on the drug tier and pharmacy selected. Tier 3 preferred brand drugs carry copays starting at $42 for a one-month supply at preferred pharmacies, while Tier 4 non-preferred drugs require a 50% coinsurance. Tier 5 specialty drugs require a 30% coinsurance for a one-month supply across all pharmacy and mail order options.
Additional Benefits
The BlueAdvantage Total Heart and Diabetes (PPO C-SNP) plan offers comprehensive coverage for essential medical care, featuring no copay and no coinsurance for primary care doctor visits and telehealth. For inpatient hospital stays, members pay a $350 daily copay for days 1 through 6 and no copay for days 7 through 90, while outpatient hospital visits require a $350 copay. Specialist visits require a low $15 copay, and emergency room services carry a $130 copay, both with no coinsurance. In addition to medical care, this plan provides valuable routine benefits, including dental, vision, and hearing exams with no copay or coinsurance. Members receive a $250 allowance every two years for eyewear, up to 24 one-way trips per year to plan-approved locations with no copay, and up to $95 per month for over-the-counter items with no copay. Key preventive services, such as annual physicals and diabetes self-management, are also covered with no copay and no coinsurance.
Inpatient Hospital See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers inpatient hospital services with no coinsurance and prior authorization required, charging a $350 daily copay for days 1 to 6 and no copay for days 7 to 90. The benefit is partially covered because upgrades and non-Medicare-covered stays are excluded for acute care, while psychiatric care excludes additional days and non-Medicare-covered stays.
Outpatient Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers outpatient services with no coinsurance, including outpatient hospital services for a $350 copay and ambulatory surgical center or observation services for a $300 copay. Outpatient substance abuse sessions have a $15 to $25 copay with no coinsurance, while outpatient blood services are fully covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required to access this covered benefit.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP), with ground ambulance services requiring a $295.00 copay and air ambulance services requiring a 20% coinsurance. Transportation services are partially covered with no copay and no coinsurance for up to 24 one-way trips per year to plan-approved locations, but transportation to any health-related location is not covered.
Emergency Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers emergency services with a $130 copay and no coinsurance, and urgently needed services with a $50 copay and no coinsurance, with both copays waived if you are admitted to the hospital within 24 hours. Worldwide emergency and urgent care are also covered, with worldwide emergency transportation requiring a $295 copay and 20% coinsurance.
Primary Care See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) offers primary care doctor visits, telehealth, and opioid treatment with no copay and no coinsurance. Specialist visits, therapy services, and podiatry require a $15 copay and no coinsurance, while mental health and psychiatric services have a $15 to $25 copay and no coinsurance; chiropractic care is not covered.
Preventive Services See details
Preventive services are covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP) with no copay and no coinsurance for annual physical exams, kidney disease education, and diabetes self-management. Additional preventive services are partially covered with no copay and no coinsurance, though excluded services include health education, in-home safety assessments, personal emergency response systems (PERS), medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional benefits, palliative care, in-home support, caregiver support, additional smoking cessation, telemonitoring, home safety devices, and counseling.
Hearing Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) offers partially covered hearing services, including one annual routine exam and unlimited fittings with no copay and no coinsurance. Up to two prescription hearing aids are covered annually with no coinsurance and a copay ranging from $399 to $899, though OTC hearing aids and inner-ear, outer-ear, or over-the-ear prescription models are not covered.
Vision Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) features partially covered vision services with no copay, no coinsurance, and no deductible. Covered benefits include one routine eye exam per year and a $250 allowance every two years for a pair of eyeglasses or contact lenses, while other eye exams, upgrades, and separate lenses or frames are not covered.
Dental Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) offers partially covered dental services, with no coverage for adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics. Covered preventive and diagnostic services have no copay and no coinsurance up to a $1,000 yearly limit, while covered comprehensive and Medicare-covered services feature no copay and coinsurance ranging from no coinsurance to 50%.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP) with no copay, though prior authorization is required. Associated Medicare Part B chemotherapy, radiation, and other drugs require no copay and 0% to 20% coinsurance, while Medicare Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis services are covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP) with no copay and a 20% coinsurance, subject to prior authorization.
Medical Equipment See details
Medical Equipment is partially covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP) with no copay, though prior authorization is required. Durable medical equipment and prosthetics carry a 20% coinsurance, diabetic supplies carry no coinsurance to 50% coinsurance, and diabetic therapeutic shoes or inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP), as diagnostic lab services are not covered. Prior authorization is required for covered services, which include diagnostic procedures with no coinsurance and a $0 to $100 copay, outpatient X-rays with no copay and applicable coinsurance, diagnostic radiology with a minimum $225 copay and no coinsurance, and therapeutic radiology with a minimum 20% coinsurance and an applicable copay.
Home Health Services See details
Home health services are covered under the BlueAdvantage Total Heart and Diabetes (PPO C-SNP) plan with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are partially covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP) with a $15 copay and no coinsurance, though prior authorization is required. Standard cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP) with no coinsurance, requiring prior authorization but no prior three-day hospital stay. There is no copay for days 1 through 20 and a $218 daily copay for days 21 through 100, though additional days beyond the Medicare-covered limit are not covered.
Other Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) partially covers other services, offering a chronic illness meal benefit and over-the-counter (OTC) items up to $95 per month with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered under these benefits.
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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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