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BlueAdvantage Total Heart and Diabetes Plus (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 Plus (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 Plus (PPO C-SNP) in 2026, please refer to our full plan details page.
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) is a PPO C-SNP plan offered by BlueCross BlueShield of Tennessee available for enrollment in 2026 to people living in Statewide 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 Plus (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 Plus (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 Plus (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 Plus (PPO C-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.70. 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 $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 Plus (PPO C-SNP)
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Drug Coverage
The BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) Medicare plan has an annual prescription drug deductible of $615. This deductible represents the amount you must pay out of pocket for your medications before your prescription coverage kicks in. Since specific drug tier details and copayments are currently unavailable for this plan, you will need to consult the plan's formulary to determine your exact costs. To get a complete picture of your potential drug expenses, it is highly recommended to check which tier your specific medications fall under. This will help you understand whether your prescriptions are subject to the $615 deductible or if they have different cost-sharing requirements. Knowing these details beforehand ensures you can accurately budget for your healthcare needs under this PPO C-SNP plan.
Additional Benefits
The BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) plan offers comprehensive healthcare coverage with no copay or coinsurance for primary care visits, telehealth, and routine preventive services. For specialized medical needs, specialist visits require a low $15 copay, while inpatient hospital stays have a $385 copay for days one through six and no copay for days seven through 90. Emergency care is available with a $130 copay, which is waived upon hospital admission, and urgent care visits require a $50 copay. In addition to medical care, the plan provides robust supplemental benefits including routine dental, vision, and hearing exams with no copay or coinsurance. Members benefit from a $2,000 annual maximum for comprehensive dental care, a $250 allowance every two years for eyewear, and a $100 monthly allowance for over-the-counter items. Home health services and up to 24 one-way trips to plan-approved locations are also covered with no copay or coinsurance.
Inpatient Hospital See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) covers inpatient acute and psychiatric hospital stays with no coinsurance, requiring a $385 copay for days 1 through 6 and no copay for days 7 through 90. This benefit is partially covered because upgrades, non-Medicare-covered stays, and additional psychiatric hospital days are not covered.
Outpatient Services See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) covers outpatient hospital and observation services with a $395 copay and ambulatory surgical center services with a $345 copay, both with no coinsurance. Outpatient substance abuse services have no coinsurance and a copay of $15 for group sessions or $25 for individual sessions, while outpatient blood services are covered with no copay or coinsurance.
Partial Hospitalization See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance. Prior authorization is required for these services.
Ambulance and Transportation Services See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) covers ground ambulance services with a $315 copay and no coinsurance, and air ambulance services with a 20% coinsurance and no copay. Transportation services are partially covered with no copay or 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 Plus (PPO C-SNP) covers emergency services with a $130 copay and no coinsurance, which is waived if you are admitted to the hospital within 24 hours. Urgently needed services are covered with a $50 copay and no coinsurance, while worldwide emergency transportation requires a $275 copay and 20% coinsurance.
Primary Care See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) covers primary care, telehealth, and opioid treatment with no copay and no coinsurance. Specialist, podiatry, and therapy services require a $15 copay and no coinsurance, while mental health individual sessions carry a $25 copay and no coinsurance. Chiropractic services are partially covered with a $15 copay and no coinsurance, excluding routine and other chiropractic care.
Preventive Services See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) covers preventive services, including annual physical exams and kidney disease education, with no copay and no coinsurance. Additional preventive benefits are only partially covered, as the plan excludes health education, in-home safety assessments, personal emergency response systems, medical nutrition therapy, post-discharge medication reconciliation, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, nutritional/dietary benefits, home-based palliative care, in-home support, caregiver support, smoking cessation, telemonitoring, home safety devices, and counseling.
Hearing Services See details
Hearing services are partially covered by BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP), featuring no copay and no coinsurance for routine hearing exams and fitting evaluations. Covered prescription hearing aids require no coinsurance and a $399 to $899 copay for up to two devices per year, but inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) provides partially covered vision services with no copay and no coinsurance, which includes one routine eye exam annually and a $250 combined limit every two years for contacts or eyeglasses (lenses and frames). Other eye exam services, eyeglass lenses, eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental services are partially covered by BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP), featuring a $2,000 annual maximum for non-Medicare dental care. Preventive and diagnostic services require no copay and no coinsurance, while covered comprehensive services have no copay and 20% to 50% coinsurance; however, adjunctive general services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueAdvantage Total Heart and Diabetes Plus (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, radiation, and other drugs have no copay and 0% to 20% coinsurance, while Part B insulin is covered with a $35 copay and 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered under the BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) plan with no copay and a 20% coinsurance. Prior authorization is required for these services.
Medical Equipment See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) partially covers medical equipment with no copays, featuring a 20% coinsurance for durable medical equipment, prosthetics, and medical supplies. Diabetic supplies are covered with no copay and range from no coinsurance up to 50% coinsurance, 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 Plus (PPO C-SNP), with lab services being excluded from coverage. Covered diagnostic tests require no coinsurance and copays ranging from no copay to $100, while radiological services involve a $25 copay plus coinsurance for X-rays, a 20% coinsurance plus copays for therapeutic services, and copays starting at $225 with no coinsurance for diagnostic imaging.
Home Health Services See details
Home Health Services are covered by BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) partially covers Cardiac Rehabilitation Services with a $15 copayment, no coinsurance, and prior authorization required for covered services. Standard cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered under this plan.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) with no coinsurance, offering no copay for days 1 to 20 and a $218 daily copay for days 21 to 100. Prior authorization is required, a three-day prior hospital stay is not required, and additional days beyond the standard 100-day Medicare benefit are not covered.
Other Services See details
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) provides partial coverage for other services, including meal benefits for chronic illness and over-the-counter items with no copay and no coinsurance. Acupuncture, nicotine replacement therapy, and naloxone are not covered under these benefits, and the over-the-counter benefit is capped at $100 per month.
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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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