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BlueAdvantage Extra (PPO)

Health Insurance Company: BlueCross BlueShield of Tennessee

Medicare Advantage Plan Details

$26 /mo

monthly premium

BlueAdvantage Extra (PPO)

Additional Coverage

Overall Star Rating (2025)

Rx
Dental
Vision
Hearing

4.5

out of 5 stars

General Plan Details

Medical Deductible

Out-of-Pocket Maximum

$4200

Rx Drug Coverage

Yes

Rx Deductible

$590

Primary Doctor Office Visit

$0 copay

Specialist Office Visit

$25 copay per visit

Additional Benefits

Dental Coverage

Yes

Vision Coverage

Yes

Mental Health Coverage

Yes

Transportation for non-emergency

Yes

Fitness Benefits

Yes

Worldwide emergency

Yes

Telehealth

Yes

Part B Give Back

Doctor & Hospital Coverage

Primary Doctor Office Visit

In-network: $0 copay
Out-of-network: $10 copay per visit

Specialist Office Visit

In-network: $25 copay per visit
Out-of-network: $30 copay per visit

Periodic Exam Coverage

In-network: $0 copay
Out-of-network: 50% coinsurance

Emergency Room

$125 copay per visit (always covered)

Ambulance Coverage

In-network: $295 copay
Out-of-network: $295 copay

Lab, X-Ray, Radiology Coverage

Outpatient diag procs/tests/lab services:
Medicare-covered diagnostic procedures/tests: In-network: $0-100 copay
Out-of-network: 50% coinsurance
Medicare-covered lab services: In-network: $0-40 copay or 20% coinsurance
Out-of-network: 50% coinsurance
Outpatient diag/therapeutic rad services:
Medicare-covered diagnostic radiological services (e.g., CT, MRI, etc): In-network: $175 copay
Out-of-network: 50% coinsurance
Medicare-covered x-ray services: In-network: $0-50 copay
Out-of-network: 50% coinsurance

Outpatient Surgery Coverage

Outpatient hospital:
Medicare-covered outpatient hospital services: In-network: $175 copay per visit
Out-of-network: $225 copay per visit

Hospitalization Coverage

Inpatient hospital-acute:
In-network: $195 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $295 per day for days 1 through 5
$0 per day for days 6 through 90
Inpatient hospital psychiatric:
In-network: $195 per day for days 1 through 5
$0 per day for days 6 through 90
Out-of-network: $295 per day for days 1 through 5
$0 per day for days 6 through 90

Rehabilitation Coverage

Occupational therapy services:
In-network: $25 copay
Out-of-network: 50% coinsurance
Physical therapy and speech and language therapy services:
In-network: $25 copay
Out-of-network: 50% coinsurance

Urgent Care Coverage

$25 copay per visit (always covered)

Skilled Nursing Facility (SNF)

In-network: $0 per day for days 1 through 20
$214 per day for days 21 through 100
Out-of-network: 50% per stay

Mental Health Coverage

Medicare-covered individual sessions: In-network: $25 copay
Out-of-network: 50% coinsurance
Medicare-covered group sessions: In-network: $15 copay
Out-of-network: 50% coinsurance

Dental, Vision, Hearing Benefits

Dental Services

Oral exams:
In-network: $0 copay
Out-of-network: 50% coinsurance
Prophylaxis (cleaning):
In-network: $0 copay
Out-of-network: 50% coinsurance
Dental x-rays:
In-network: $0 copay
Out-of-network: 50% coinsurance

Vision Benefits

Eye exams:
Routine eye exams: In-network: $0 copay
Out-of-network: $0 copay
Eyewear:
Contact Lenses: In-network: $0 copay
Out-of-network: $0 copay
Eyeglasses: In-network: $0 copay
Out-of-network: $0 copay

Hearing Benefits

Hearing exams:
Routine hearing exams: In-network: $10 copay
Out-of-network: $10 copay
Hearing aids:
Hearing aids (all types): In-network: $199-699 copay
Out-of-network: $199-699 copay

More Additional Benefits

Annual physical exams

Yes

Chiropractic Coverage

Acupuncture

Massage Therapy

Health Education

Yes

Counseling Services

Support for Caregivers of Enrollees

Personal Emergency Response System (PERS)

In-home support services

Home and bathroom safety devices

Meals for short duration

Yes

Plan Links

Plan Link

Doctor Lookup

Drug Link

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(888) 311-4264

TTY 711

Mon-Fri: 8am-9pm, Sat: 8am-8pm ET

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Where This Plan is Available

State:

Tennessee

Counties:

Anderson, Bedford, Benton, Bledsoe, Blount, Bradley, Campbell, Cannon, Carroll, Carter, Cheatham, Chester, Claiborne, Clay, Cocke, Coffee, Crockett, Cumberland, Davidson, Decatur, Dekalb, Dickson, Dyer, Fayette, Fentress, Franklin, Gibson, Giles, Grainger, Greene, Grundy, Hamblen, Hamilton, Hancock, Hardeman, Hardin, Hawkins, Haywood, Henderson, Henry, Hickman, Houston, Humphreys, Jackson, Jefferson, Johnson, Knox, Lake, Lauderdale, Lawrence, Lewis, Lincoln, Loudon, Macon, Madison, Marion, Marshall, Maury, Mcminn, Mcnairy, Meigs, Monroe, Montgomery, Moore, Morgan, Obion, Overton, Perry, Pickett, Polk, Putnam, Rhea, Roane, Robertson, Rutherford, Scott, Sequatchie, Sevier, Shelby, Smith, Stewart, Sullivan, Sumner, Tipton, Trousdale, Unicoi, Union, Van Buren, Warren, Washington, Wayne, Weakley, White, Williamson, Wilson

View all plans in your Tennessee County

Additional Plan Info

Plan Year:

2025

Insurance Company Website:

BlueCross BlueShield of Tennessee

BlueAdvantage Extra (PPO)

Medicare Advantage Plan Details

General Plan Details

Additional Benefits

Doctor & Hospital Coverage

Emergency Room

Ambulance Coverage

Lab, X-Ray, Radiology Coverage

Outpatient Surgery Coverage

Hospitalization Coverage

Rehabilitation Coverage

Urgent Care Coverage

Skilled Nursing Facility (SNF)

Mental Health Coverage

Dental, Vision, Hearing Benefits

Dental Services

Vision Benefits

Hearing Benefits

More Additional Benefits

Plan Links

Where This Plan is Available

Additional Plan Info

Health Insurance Companies Offering Plans