2022 BlueAdvantage Ruby (PPO)


BlueAdvantage Ruby (PPO) H7917-012 is a 2022 Medicare Advantage Plan or Part-C by BlueCross BlueShield of Tennessee available to residents in Tennessee. This plan includes additional prescription drug (Part-D) coverage. The BlueAdvantage Ruby (PPO) has a monthly premium of $97.00 and has an in-network maximum out-of-pocket limit of $4,800 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,800 out-of-pocket. This can be a extremely nice safety net.

BlueAdvantage Ruby (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

BlueCross BlueShield of Tennessee works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for BlueAdvantage Ruby (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from BlueCross BlueShield of Tennessee and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from BlueCross BlueShield of Tennessee except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.




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2022 BlueCross BlueShield of Tennessee Medicare Advantage Plan Costs

Name:
BlueAdvantage Ruby (PPO)
Plan ID:
H7917-012
Provider:BlueCross BlueShield of Tennessee
Year:2022
Type: Local PPO
Monthly Premium C+D: $97.00
Part C Premium:$75.10
MOOP: $4,800
Part D (Drug) Premium:$21.90
Part D Supplemental Premium$0.00
Total Part D Premium:$21.90
Drug Deductible:$0.00
Tiers with No Deductible:0
Gap Coverage:Yes
Benchmark:not below the regional benchmark
Type of Medicare Health:Enhanced Alternative
Drug Benefit Type:Enhanced
Similar Plan: H7917-013
New Plan: 2023 H7917-013




BlueAdvantage Ruby (PPO) Part-C Premium

BlueCross BlueShield of Tennessee charges a $75.10 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.



H7917-012 Part-D Deductible and Premium

BlueAdvantage Ruby (PPO) has a monthly drug premium of $21.90 and a $0.00 drug deductible. This BlueCross BlueShield of Tennessee plan offers a $21.90 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by BlueCross BlueShield of Tennessee above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $21.90 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.



BlueCross BlueShield of Tennessee Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This BlueCross BlueShield of Tennessee plan does offer additional coverage through the gap.



Premium Assistance

The Low Income Subsidy (LIS) helps people with Medicare pay for prescription drugs, and lowers the costs of Medicare prescription drug coverage. Depending on your income level you may be eligible for full 75%, 50%, 25% premium assistance. The BlueAdvantage Ruby (PPO) medicare insurance offers a $0.00 premium obligation if you receive a full low-income subsidy (LIS) assistance. And the payment is $5.50 for 75% low income subsidy $10.90 for 50% and $16.40 for 25%.



Full LIS Premium:$0.00
75% LIS Premium:$5.50
50% LIS Premium:$10.90
25% LIS Premium:$16.40


H7917-012 Formulary or Drug Coverage

BlueAdvantage Ruby (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 BlueAdvantage Ruby (PPO) H7917-012 Formulary here.

Drug Tier Copay
Preferred
Pharmacy
Copay
Nonpreferred
Pharmacy
Tier 1 $1 $6
Tier 2 $5 $10
Tier 3 $28 $33
Tier 4 $65 $70
Tier 5 33% 33%
*Initial Coverage Phase and 30 day supply





2021 BlueAdvantage Ruby (PPO) Summary of Benefits

*This will be updated with 2022 data when available.



Additional Benefits


No



Comprehensive Dental


Diagnostic services $0 copay
Diagnostic services 50% coinsurance (Out-of-Network)
Endodontics 50% coinsurance (Out-of-Network)
Endodontics $0 copay
Extractions $0 copay
Extractions 50% coinsurance (Out-of-Network)
Non-routine services 50% coinsurance (Out-of-Network)
Non-routine services $0 copay
Periodontics 50% coinsurance (Out-of-Network)
Periodontics $0 copay
Prosthodontics, other oral/maxillofacial surgery, other services 50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services $0 copay
Restorative services $0 copay
Restorative services 50% coinsurance (Out-of-Network)



Deductible


$0



Diagnostic Tests and Procedures


Diagnostic radiology services (e.g., MRI) $200 copay
Diagnostic radiology services (e.g., MRI) 50% coinsurance (Out-of-Network)
Diagnostic tests and procedures $10-100 copay
Diagnostic tests and procedures 50% coinsurance (Out-of-Network)
Lab services 50% coinsurance (Out-of-Network)
Lab services $0-40 copay or 20% coinsurance
Outpatient x-rays 50% coinsurance (Out-of-Network)
Outpatient x-rays $10-50 copay



Doctor Visits


Primary $10 copay per visit
Primary 50% coinsurance per visit (Out-of-Network)
Specialist 50% coinsurance per visit (Out-of-Network)
Specialist $25 copay per visit



Emergency care/Urgent Care


Emergency $85 copay per visit (always covered)
Urgent care $55 copay per visit (always covered)



Foot Care (podiatry services)


Foot exams and treatment 50% coinsurance (Out-of-Network)
Foot exams and treatment $25 copay
Routine foot care Not covered



Ground Ambulance


$150 copay
$150 copay (Out-of-Network)



Hearing


Fitting/evaluation $0 copay (Out-of-Network)
Fitting/evaluation $0 copay
Hearing aids $399-699 copay (Out-of-Network)
Hearing aids $399-699 copay
Hearing exam $10 copay
Hearing exam $10 copay (Out-of-Network)



Inpatient Hospital Coverage


$260 per day for days 1 through 4
$0 per day for days 5 through 90
$0 per day for days 91 and beyond
50% per stay (Out-of-Network)



Medical Equipment/Supplies


Diabetes supplies $0 copay
Diabetes supplies 50% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 50% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs) 50% coinsurance per item (Out-of-Network)



Medicare Part B Drugs


Chemotherapy 20% coinsurance
Chemotherapy 50% coinsurance (Out-of-Network)
Other Part B drugs 50% coinsurance (Out-of-Network)
Other Part B drugs 20% coinsurance



Mental Health Services


Inpatient hospital - psychiatric $260 per day for days 1 through 4
$0 per day for days 5 through 90
Inpatient hospital - psychiatric 50% per stay (Out-of-Network)
Outpatient group therapy visit $20 copay
Outpatient group therapy visit 50% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist 50% coinsurance (Out-of-Network)
Outpatient group therapy visit with a psychiatrist $20 copay
Outpatient individual therapy visit 50% coinsurance (Out-of-Network)
Outpatient individual therapy visit $30 copay
Outpatient individual therapy visit with a psychiatrist 50% coinsurance (Out-of-Network)
Outpatient individual therapy visit with a psychiatrist $30 copay



MOOP


$10,000 In and Out-of-network
$4,800 In-network



Option


No



Optional supplemental benefits


No



Outpatient Hospital Coverage


50% coinsurance per visit (Out-of-Network)
$260 copay per visit



Preventive Care


50% coinsurance (Out-of-Network)
$0 copay



Preventive Dental


Cleaning $0 copay
Cleaning 50% coinsurance (Out-of-Network)
Dental x-ray(s) $0 copay
Dental x-ray(s) 50% coinsurance (Out-of-Network)
Fluoride treatment Not covered
Oral exam $0 copay
Oral exam 50% coinsurance (Out-of-Network)



Rehabilitation Services


Occupational therapy visit 50% coinsurance (Out-of-Network)
Occupational therapy visit $15 copay
Physical therapy and speech and language therapy visit $15 copay
Physical therapy and speech and language therapy visit 50% coinsurance (Out-of-Network)



Skilled Nursing Facility


$0 per day for days 1 through 20
$172 per day for days 21 through 100
50% per stay (Out-of-Network)



Transportation


Not covered



Vision


Contact lenses $0 copay (Out-of-Network)
Contact lenses $0 copay
Eyeglass frames Not covered
Eyeglass lenses Not covered
Eyeglasses (frames and lenses) $0 copay (Out-of-Network)
Eyeglasses (frames and lenses) $0 copay
Other Not covered
Routine eye exam $25 copay
Routine eye exam $25 copay (Out-of-Network)
Upgrades Not covered



Wellness Programs (e.g. fitness nursing hotline)


Covered




CMS Star Ratings for BlueAdvantage Ruby (PPO) H7917



2021 Overall Rating
Part C Summary Rating
Part-D Summary Rating
Staying Healthy: Screenings, Tests, Vaccines
Managing Chronic (Long Term) Conditions
Member Experience with Health Plan
Complaints and Changes in Plans Performance
Health Plan Customer Service
Drug Plan Customer Service
Complaints and Changes in the Drug Plan
Member Experience with the Drug Plan
Drug Safety and Accuracy of Drug Pricing


Staying Healthy, Screening, Testing, & Vaccines

Total Preventative Rating
Breast Cancer Screening
Colorectal Cancer Screening
Annual Flu Vaccine
Monitoring Physical Activity


Managing Chronic And Long Term Care for Older Adults

Total Rating
SNP Care Management
Medication Review
Functional Status Assessment
Osteoporosis Management
Diabetes Care - Eye Exam
Diabetes Care - Kidney Disease
Diabetes Care - Blood Sugar
Rheumatoid Arthritis
Reducing Risk of Falling
Improving Bladder Control
Medication Reconciliation
Statin Therapy


Member Experience with Health Plan

Total Experience Rating
Getting Needed Care
Getting Appointments
Customer Service
Health Care Quality
Rating of Health Plan
Care Coordination


Member Complaints and Changes in BlueAdvantage Ruby (PPO) Plans Performance

Total Rating
Complaints about Health Plan
Members Leaving the Plan
Health Plan Quality Improvement


Health Plan Customer Service Rating for BlueAdvantage Ruby (PPO)

Total Customer Service Rating
Timely Decisions About Appeals
Reviewing Appeals Decisions
Call Center, TTY, Foreign Language


BlueAdvantage Ruby (PPO) Drug Plan Customer Service Ratings

Total Rating
Call Center, TTY, Foreign Language


Ratings For Member Complaints and Changes in the Drug Plans Performance

Total Rating
Complaints about the Drug Plan
Members Choosing to Leave the Plan
Drug Plan Quality Improvement


Member Experience with the Drug Plan

Total Rating
Rating of Drug Plan
Getting Needed Prescription Drugs


Drug Safety and Accuracy of Drug Pricing

Total Rating
MPF Price Accuracy
Drug Adherence for Diabetes Medications
Drug Adherence for Hypertension (RAS antagonists)
Drug Adherence for Cholesterol (Statins)
MTM Program Completion Rate for CMR
Statin with Diabetes



Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST




Coverage Area for BlueAdvantage Ruby (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.

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