A non-government entity
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 West and Middle TN. 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BlueAdvantage Total Heart and Diabetes (PPO C-SNP) prescription drug plan features an annual drug deductible of $250. For Tier 1 preferred generic and Tier 2 generic medications, you will enjoy no copay when filling your prescriptions at a preferred pharmacy or through preferred mail order. If you use standard pharmacies or standard mail-order services, Tier 1 copays start at $6 and Tier 2 copays start at $15 for a one-month supply. For Tier 3 preferred brand drugs, a one-month supply costs a $42 copay at preferred pharmacies and a $47 copay at standard pharmacies. Higher-tier prescriptions transition to coinsurance, with Tier 4 non-preferred drugs requiring a 50% coinsurance and Tier 5 specialty drugs requiring a 30% coinsurance. Choosing preferred pharmacies and mail-order options can help you maximize your savings under this plan.
Additional Benefits
The BlueAdvantage Total Heart and Diabetes (PPO C-SNP) plan offers comprehensive medical coverage with no copay for primary care visits, telehealth services, and routine preventive care. For specialist visits and physical therapy, members pay a low $15 copay with no coinsurance. Inpatient hospital stays require a $390 daily copay for the first six days and no copay thereafter, while outpatient hospital services carry a $395 copay. This plan also features valuable supplemental benefits, including routine vision and hearing exams with no copay, alongside a $250 eyewear allowance every two years and hearing aid coverage with copays between $399 and $899. Preventive dental care is covered with no copay up to a $1,000 annual maximum, and members receive up to 24 one-way transportation trips per year with no copay. Additionally, the plan provides a $60 monthly allowance for over-the-counter items and home health services with no copay.
Inpatient Hospital See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $390 daily copay for days 1 to 6 and no copay for days 7 to 90. This benefit is partially covered, as upgrades, non-Medicare-covered stays, and additional psychiatric days are not covered.
Outpatient Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers outpatient hospital and observation services with a $395 copay and no coinsurance, and ambulatory surgical center services with a $345 copay and no coinsurance. Outpatient substance abuse services feature no coinsurance and a copay of $25 for individual sessions or $15 for group sessions, while outpatient blood services are covered with no copay and no coinsurance.
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 benefit.
Ambulance and Transportation Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers ground ambulance services with a $295 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered, offering up to 24 one-way trips per year to plan-approved locations with no copay or coinsurance, though 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, including worldwide emergency transportation which requires a $295 copay and 20% coinsurance.
Primary Care See details
Primary care benefits under BlueAdvantage Total Heart and Diabetes (PPO C-SNP) feature no copay and no coinsurance for primary care provider visits, telehealth, and opioid treatment. Specialist visits, physical therapy, and podiatry require a $15 copay and no coinsurance, while mental health services have a $15 to $25 copay with no coinsurance, and chiropractic services are not covered.
Preventive Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are partially covered with no copay and no coinsurance for memory fitness and remote access technologies, while sub-services like health education, weight management, and in-home safety assessments are not covered.
Hearing Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) partially covers hearing services, providing routine exams and fitting evaluations with no copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay between $399.00 and $899.00, though OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) partially covers vision services with no copay and no coinsurance, offering one routine eye exam annually and a $250 combined allowance for eyeglasses or contact lenses every two years. Other eye exam services, separate eyeglass lenses, separate eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP), featuring a $1,000 annual maximum for preventive and diagnostic care with no copay and no coinsurance. Covered comprehensive and Medicare dental services have no copay and coinsurance ranging from no coinsurance up to 50%, while adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers Home Infusion bundled services with no copay, though prior authorization and step therapy are required. Under this benefit, Medicare Part B chemotherapy, insulin, and other drugs incur a coinsurance ranging from no coinsurance up to 20%, with insulin also requiring a $35 copay.
Dialysis Services See details
Dialysis services are covered by BlueAdvantage Total Heart and Diabetes (PPO C-SNP) with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers durable medical equipment and prosthetics with no copay and 20% coinsurance. Diabetic equipment is partially covered with no copay and between no coinsurance and 50% coinsurance for supplies, though diabetic therapeutic shoes and 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 lab services are not covered. Covered diagnostic procedures require no coinsurance and a $0 to $100 copay, while radiological services require prior authorization and feature a minimum $225 copay for diagnostic radiology, a minimum 20% coinsurance for therapeutic radiology, and no copay for outpatient X-rays.
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, although 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 rehabilitation, intensive cardiac rehabilitation, pulmonary rehabilitation, and SET for PAD services are not covered.
Skilled Nursing Facility (SNF) See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20, followed by a $218 daily copay for days 21 through 100, with no coverage provided for additional days.
Other Services See details
BlueAdvantage Total Heart and Diabetes (PPO C-SNP) partially covers other services, offering a chronic illness meal benefit and up to $60 per month for over-the-counter (OTC) items with no copay and no coinsurance. Acupuncture is not covered under this plan benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
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.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
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.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved