2027 Medicare Advantage plan
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP): 2027 benefits and costs
BlueCross BlueShield of Tennessee PPO C-SNP Special Needs Plan
CMS plan ID: H7917-046-0 · Plan year: 2027
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) is a 2027 Medicare Advantage plan offered by BlueCross BlueShield of Tennessee. It is listed in Tennessee.
2027 plan costs at a glance
- Organization
- BlueCross BlueShield of Tennessee
- Plan organization
- BLUECROSS BLUESHIELD OF TENNESSEE, INC.
- Parent company
- BlueCross BlueShield of Tennessee
- Plan type
- PPO C-SNP
- Part C premium
- $0.00
- Part D premium
- $13.70
- Prescription drug coverage
- Yes
- Special Needs Plan type
- Chronic or Disabling Condition
- 2027 CMS Star Rating
- Standard monthly Medicare Part B premium
- $209.50 (estimated)
You must continue to pay your Medicare Part B premium.
- Annual medical deductible
- None
- In-network medical maximum
- $9,850.00
- Combined in/out-of-network medical maximum
- $14,800.00
- Out-of-network medical maximum
- Not applicable
Who can join this Special Needs Plan?
This plan is for people with qualifying chronic or disabling conditions. The plan must confirm that your condition meets its eligibility rules.
- Plan eligibility type
- Chronic or Disabling Condition
- Qualifying conditions
- Diabetes Mellitus, Chronic Heart Failure, and Cardiovascular Disorders
2027 benefit summary
Doctor visits and medical care
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Primary care doctor | $0
| 50% coinsurance
| |
| Specialist visit | $30.00 copay
| 50% coinsurance
|
|
| Telehealth | $0
| Not summarized. Check coverage with the plan. |
|
| Emergency care | $115.00 copay | Not summarized. Check coverage with the plan. | |
| Urgent care | $40.00 copay | Not summarized. Check coverage with the plan. | |
| Home health | $0
| 50% coinsurance
|
|
| Dialysis | 20% coinsurance
| 20% coinsurance
|
|
| Part B chemotherapy and radiation drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Other Part B drugs | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Kidney disease education services | $0
| 50% coinsurance
|
|
| Medicare-covered chiropractic | $15.00 copay
| 50% coinsurance
|
|
| Medicare-covered foot care | $30.00 copay
| 50% coinsurance
|
|
| Other health professionals | $15.00 to $30.00 copay
| 50% coinsurance
|
|
Hospital, outpatient surgery and observation care
Inpatient stays and skilled nursing care
| Care | Your share of the cost | What to know |
|---|---|---|
| Inpatient hospital stay | $0.00 copay per stay Days 1–6: $405.00 copay per day Days 7–90: $0.00 copay per day |
|
| Inpatient mental health care | $0.00 copay per stay Days 1–6: $345.00 copay per day Days 7–90: $0.00 copay per day |
|
| Skilled nursing facility | Days 1–20: $0.00 copay per day Days 21–100: $221.00 copay per day |
|
See plan documents for out-of-network hospital and skilled nursing costs.
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Outpatient hospital care | $445.00 copay
| 50% coinsurance
| |
| Hospital observation services | $395.00 copay
| 50% coinsurance
| |
| Ambulatory surgical center | $345.00 copay
| 50% coinsurance
|
|
| Outpatient blood | $0
| $0
|
|
Tests, imaging and laboratory services
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Diagnostic procedures and tests | $0.00 to $100.00 copay
| 50% coinsurance
|
|
| Laboratory services | $0
| 50% coinsurance
|
|
| Diagnostic radiology (CT, MRI) | $225.00 copay
| 50% coinsurance
|
|
| Therapeutic radiology | 20% coinsurance
| 50% coinsurance
|
|
| X-rays | $25.00 to $30.00 copay
| 50% coinsurance
|
|
Mental health and substance use treatment
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Partial hospitalization | $105.00 copay
| 50% coinsurance
|
|
| Intensive outpatient program | $105.00 copay
| 50% coinsurance
|
|
| Substance use treatment, individual sessions | $25.00 copay
| 50% coinsurance
|
|
| Substance use treatment, group sessions | $15.00 copay
| 50% coinsurance
|
|
| Opioid treatment program | $0
| 50% coinsurance
|
|
| Mental health, individual sessions | $25.00 copay
| 50% coinsurance
|
|
| Mental health, group sessions | $15.00 copay
| 50% coinsurance
|
|
| Psychiatry, individual sessions | $25.00 copay
| 50% coinsurance
|
|
| Psychiatry, group sessions | $15.00 copay
| 50% coinsurance
|
|
Therapy and rehabilitation
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Occupational therapy | $25.00 copay
| 50% coinsurance
|
|
| Physical and speech therapy | $25.00 copay
| 50% coinsurance
|
|
| Cardiac rehabilitation | $0
| 50% coinsurance
|
|
| Intensive cardiac rehabilitation | $0
| 50% coinsurance
|
|
| Pulmonary rehabilitation | $15.00 copay
| 50% coinsurance
|
|
| Supervised exercise for peripheral artery disease | $15.00 copay
| 50% coinsurance
|
|
Ambulance, medical equipment and supplies
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Ground ambulance | $315.00 copay
| $315.00 copay
|
|
| Air ambulance | 20% coinsurance
| 20% coinsurance
|
|
| Durable medical equipment | 20% coinsurance
| 50% coinsurance
|
|
| Prosthetic devices | 20% coinsurance
| 50% coinsurance
|
|
| Medical supplies | 20% coinsurance
| 50% coinsurance
|
|
| Diabetic supplies | 0% to 20% coinsurance
| 50% coinsurance
|
|
| Diabetic shoes and inserts | $0
| 50% coinsurance
|
|
| Diabetic monitors | 0% to 20% coinsurance
| 50% coinsurance
|
|
Dental benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered dental | 20% coinsurance | 50% coinsurance
| |
| Oral examsAdditional plan benefit | $0 | 50% coinsurance
| |
| Dental X-raysAdditional plan benefit | $0 | 50% coinsurance
| |
| Dental cleaningAdditional plan benefit | $0 | 50% coinsurance
| |
| Restorative dental careAdditional plan benefit | 20% coinsurance | 50% coinsurance
| |
| Root canal treatment (endodontics)Additional plan benefit | $0 | 50% coinsurance
| |
| Gum treatment (periodontics)Additional plan benefit | $0 | 50% coinsurance
| |
| Removable dentures (prosthodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Fixed dental restorations (prosthodontics)Additional plan benefit | 50% coinsurance | 50% coinsurance
| |
| Oral surgeryAdditional plan benefit | 20% coinsurance | 50% coinsurance
| |
| Other dental servicesAdditional plan benefit | 20% coinsurance | 50% coinsurance
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Diagnostic and preventive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Comprehensive dental (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Vision benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered eye exams | $0
| $0
|
|
| Routine eye examsAdditional plan benefit | $0 | $0
|
|
| Medicare-covered eyewear | $0
| $0
|
|
| Contact lensesAdditional plan benefit | $0 | $0
|
|
| Eyeglasses, lenses and framesAdditional plan benefit | $0 | $0
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Eye exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Eyewear (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Hearing benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Medicare-covered hearing exams | $0
| $0
|
|
| Routine hearing examsAdditional plan benefit | $0 | 90% coinsurance
|
|
| Hearing aid fitting and evaluationAdditional plan benefit | $0 | 90% coinsurance
|
|
| Prescription hearing aids (all types)Additional plan benefit | $399.00 to $899.00 copay
| 90% coinsurance
|
|
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Hearing exams (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
| Prescription hearing aids (category)Additional plan benefit | Out-of-network | Confirm with the plan (copay); Confirm with the plan (coinsurance) |
|
Extra benefits
| Service | In-network | Out-of-network | What to know |
|---|---|---|---|
| Over-the-counter health itemsAdditional plan benefit | $0
| 80% coinsurance
| |
| Limited-duration mealsAdditional plan benefit | $0
| 80% coinsurance
|
|
| Annual physical examAdditional plan benefit | $0
| 50% coinsurance
|
|
| Fitness benefitAdditional plan benefit | $0
| 80% coinsurance
|
|
Additional services and network costs
Additional network details
These costs apply to the listed service categories and networks.
| Service | Network | Your share of the cost | What to know |
|---|---|---|---|
| Podiatry Services - Routine Foot CareAdditional plan benefit | Out-of-network | 50% coinsurance
|
|
| Transportation to plan-approved health locationsAdditional plan benefit | Out-of-network | 90% coinsurance
|
|
| Medicare-covered preventive servicesMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Enhanced Disease ManagementAdditional plan benefit | Out-of-network | $0
|
|
| Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline)Additional plan benefit | Out-of-network | $0
|
|
| Glaucoma ScreeningMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Diabetes Self-Management TrainingMedicare-covered care | Out-of-network | 20% coinsurance
| |
| Digital Rectal ExamsMedicare-covered care | Out-of-network | 50% coinsurance
| |
| EKG after a Welcome to Medicare visitMedicare-covered care | Out-of-network | 50% coinsurance
| |
| Medicare Part B insulinMedicare-covered care | Out-of-network | $35.00 copay; 20% coinsurance
|
Allowances and optional benefits
Benefits for qualifying members
OTC + Health Food
The plan must confirm eligibility, including any qualifying condition.
- Qualifying conditions
- Cardiovascular disorders; Chronic heart failure; Diabetes mellitus
- Included services
- Food and produce
- Applies to out-of-network or point-of-service care
- Yes
- Some package benefits are exempt from the deductible
- No
- Package limit
- $0.00
- How often this limit applies
- Every month
- How benefits are provided
- Debit Card
- Services sharing the package limit
- Food and produce
Prescription drug coverage
Costs shown are for initial coverage.
This plan uses a non-tiered standard drug benefit; individual drug prices are not listed here.
| Pharmacy | Supply |
|---|---|
| Standard retail | 30 days |
| Standard retail | 60 days |
| Standard retail | 100 days |
| Standard mail order | 30 days |
| Standard mail order | 60 days |
| Standard mail order | 100 days |
| Out-of-network pharmacy | 30 days |
| Long-term care pharmacy | 31 days |
Where this plan is offered
CMS lists this plan in 1 state or territory. Availability can vary by county and ZIP code.
View all locations 95 county listings across 1 state or territory
Tennessee
- Anderson, Tennessee
- Bedford, Tennessee
- Benton, Tennessee
- Bledsoe, Tennessee
- Blount, Tennessee
- Bradley, Tennessee
- Campbell, Tennessee
- Cannon, Tennessee
- Carroll, Tennessee
- Carter, Tennessee
- Cheatham, Tennessee
- Chester, Tennessee
- Claiborne, Tennessee
- Clay, Tennessee
- Cocke, Tennessee
- Coffee, Tennessee
- Crockett, Tennessee
- Cumberland, Tennessee
- Davidson, Tennessee
- Decatur, Tennessee
- DeKalb, Tennessee
- Dickson, Tennessee
- Dyer, Tennessee
- Fayette, Tennessee
- Fentress, Tennessee
- Franklin, Tennessee
- Gibson, Tennessee
- Giles, Tennessee
- Grainger, Tennessee
- Greene, Tennessee
- Grundy, Tennessee
- Hamblen, Tennessee
- Hamilton, Tennessee
- Hancock, Tennessee
- Hardeman, Tennessee
- Hardin, Tennessee
- Hawkins, Tennessee
- Haywood, Tennessee
- Henderson, Tennessee
- Henry, Tennessee
- Hickman, Tennessee
- Houston, Tennessee
- Humphreys, Tennessee
- Jackson, Tennessee
- Jefferson, Tennessee
- Johnson, Tennessee
- Knox, Tennessee
- Lake, Tennessee
- Lauderdale, Tennessee
- Lawrence, Tennessee
- Lewis, Tennessee
- Lincoln, Tennessee
- Loudon, Tennessee
- Macon, Tennessee
- Madison, Tennessee
- Marion, Tennessee
- Marshall, Tennessee
- Maury, Tennessee
- McMinn, Tennessee
- McNairy, Tennessee
- Meigs, Tennessee
- Monroe, Tennessee
- Montgomery, Tennessee
- Moore, Tennessee
- Morgan, Tennessee
- Obion, Tennessee
- Overton, Tennessee
- Perry, Tennessee
- Pickett, Tennessee
- Polk, Tennessee
- Putnam, Tennessee
- Rhea, Tennessee
- Roane, Tennessee
- Robertson, Tennessee
- Rutherford, Tennessee
- Scott, Tennessee
- Sequatchie, Tennessee
- Sevier, Tennessee
- Shelby, Tennessee
- Smith, Tennessee
- Stewart, Tennessee
- Sullivan, Tennessee
- Sumner, Tennessee
- Tipton, Tennessee
- Trousdale, Tennessee
- Unicoi, Tennessee
- Union, Tennessee
- Van Buren, Tennessee
- Warren, Tennessee
- Washington, Tennessee
- Wayne, Tennessee
- Weakley, Tennessee
- White, Tennessee
- Williamson, Tennessee
- Wilson, Tennessee