BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP)
H7917-046 • 2026 • Roane County, TN
BlueAdvantage Total Heart and Diabetes Plus (PPO C-SNP) H7917-046 • 2026 • Roane County, TN
CMS Plan ID H7917-046 identifies the Medicare Chronic or Disabling Condition plan BlueAdvantage Total Heart and Diabetes Plus, offered by BlueCross BlueShield of Tennessee for the 2026 plan year. This Special Needs Plan (SNP) is designed for individuals who meet specific eligibility requirements.
BlueAdvantage Total Heart and Diabetes Plus Overview
Plan Overview for H7917-046-0 | |
|---|---|
| CMS Plan ID: | H7917-046-0 |
| Plan Type: | PPO C-SNP |
| Plan Year: | 2026 |
| Monthly Premium: | $27.70 Plus your Medicare Part B premium. |
| Medical Deductible: | $0.00 |
| Maximum Out-of-Pocket: | $6700.00 (In-Network) |
| Part B Give Back: | Not offered |
| Prescription Drug Coverage: | Basic, $615.00 deductible |
| Additional Benefits: | Dental, Vision, Hearing |
| Service Area: | Roane County, TN |
| Enrollment (Nationwide) | 327 beneficiaries |
| Enrollment (CMS – Local) | 0 beneficiaries in Roane County |
| Provided By: | BlueCross BlueShield of Tennessee |
Plan Overview and Eligibility
- BlueAdvantage Total Heart and Diabetes Plus is a Medicare C-SNP plan for individuals with specific chronic or disabling conditions.
- To enroll, you must have Medicare Part A and Part B and live in the plan’s service area (Roane County).
- This plan uses a PPO provider network and includes Medicare Part D prescription drug coverage. The annual Part D deductible is $615.00.
- BlueAdvantage Total Heart and Diabetes Plus provides the same core benefits as Original Medicare, with additional benefits for eligible members.
- Out-of-pocket costs differ from Original Medicare and may vary by service. See the cost and coverage tables below.
BlueAdvantage Total Heart and Diabetes Plus uses a Preferred Provider Organization (PPO) network for delivery of care. As a PPO member, you can receive services from both in-network and out-of-network providers, typically at a lower cost when using the plan’s network. Referrals are not usually required to see specialists. Emergency care and out-of-area dialysis are covered.
Covered Services and Cost Structure
This section outlines in-network costs for primary care and specialist office visits, along with related preventive services.
| Covered Service | In-Network Cost |
|---|---|
| Primary: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Specialist: | In-network: $15 copay | Out-of-network: 50% coinsurance |
This section outlines in-network costs for preventive and wellness services included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Annual wellness exam: | In-network: $0 copay |
| Telehealth benefit: | In-network: $0 copay |
| Routine chiropractic: | Not covered |
| Fitness benefits: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Health education: | Not covered |
| Counseling services: | Not covered |
| Over-the-counter drug benefits: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Health transportation (non-emergency): | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
This section outlines in-network costs for diagnostic services, lab tests, x-rays, and other imaging services.
| Covered Service | In-Network Cost |
|---|---|
| Diagnostic radiology services: | In-network: $225 copay | Out-of-network: 50% coinsurance |
| Lab services: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Outpatient x-rays: | In-network: $25 copay | Out-of-network: 50% coinsurance |
| Diagnostic tests and procedures: | In-network: $0-$100 copay | Out-of-network: 50% coinsurance |
This section outlines in-network costs for emergency services, urgent care, ambulance transportation, inpatient hospital stays, and skilled nursing facility care.
| Covered Service | In-Network Cost |
|---|---|
| Emergency room care: | $130 copay |
| Worldwide emergency care: | $0 copay |
| Urgent care: | $50 copay |
| Inpatient hospital care: | In-network: | Tier 1 | $385 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | 50% per stay |
| Skilled Nursing Facility: | In-network: | Tier 1 | $0 per day for days 1-20 | $218 per day for days 21-100 | Out-of-network: | 50% per stay |
| Ground ambulance: | In-network: $315 copay | Out-of-network: $315 copay |
This section outlines in-network costs for mental health services, including outpatient therapy and inpatient psychiatric care.
| Covered Service | In-Network Cost |
|---|---|
| Outpatient individual therapy: | In-network: $25 copay | Out-of-network: 50% coinsurance |
| Outpatient group therapy: | In-network: $15 copay | Out-of-network: 50% coinsurance |
| Inpatient psychiatric hospital care: | In-network: | Tier 1 | $385 per day for days 1-6 | $0 per day for days 7-90 | $0 per stay | Out-of-network: | 50% per stay |
This section outlines in-network costs for rehabilitation services, including physical therapy, speech and language therapy, and occupational therapy.
| Covered Service | In-Network Cost |
|---|---|
| Physical therapy and speech and language therapy: | In-network: $15 copay | Out-of-network: 50% coinsurance |
| Occupational therapy: | In-network: $15 copay | Out-of-network: 50% coinsurance |
This section outlines in-network costs for medical equipment and supplies, including diabetes supplies, durable medical equipment, and prosthetics.
| Covered Service | In-Network Cost |
|---|---|
| Diabetes supplies: | In-network: 0%-50% coinsurance | Out-of-network: 50% coinsurance |
| Durable medical equipment: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
| Prosthetics: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
This section outlines in-network cost sharing for chemotherapy and other Medicare Part B-covered drugs.
| Covered Service | In-Network Cost |
|---|---|
| Chemotherapy: | In-network: 0%-20% coinsurance | Out-of-network: 50% coinsurance |
| Other Part B drugs (Medicare-covered): | In-network: 0%-20% coinsurance | Out-of-network: 50% coinsurance |
This section outlines in-network cost sharing for dental services, including preventive care, exams, x-rays, cleanings, and comprehensive dental procedures.
| Covered Service | In-Network Cost |
|---|---|
| Oral exam: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Dental x-rays: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Cleaning: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Periodontics: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Endodontics: | In-network: $0 copay | Out-of-network: 50% coinsurance |
| Restorative services: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
| Implant services: | Not covered |
| Orthodontics: | Not covered |
| Oral/Maxillofacial surgery: | In-network: 20% coinsurance | Out-of-network: 50% coinsurance |
This section outlines in-network cost sharing for vision services, including eye exams, eyeglasses, and contact lenses.
| Covered Service | In-Network Cost |
|---|---|
| Routine eye exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Contact lenses: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Eyeglass frames only: | Not covered |
| Eyeglass lenses only: | Not covered |
| Eyeglasses (frames & lenses): | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Upgrades: | Not covered |
This section outlines in-network cost sharing for hearing-related services, including exams, fittings, and hearing aids.
| Covered Service | In-Network Cost |
|---|---|
| Hearing exam: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Fitting/evaluation: | In-network: $0 copay | Out-of-network: $0 copay, 0% coinsurance |
| Prescription hearing aids: | In-network: $399-$899 copay | Out-of-network: $399-$899 copay |
| OTC hearing aids: | Not covered |
This section outlines in-network cost sharing for additional and special needs services that may be included in the plan.
| Covered Service | In-Network Cost |
|---|---|
| Adult day health services: | Not covered |
| Home-based palliative care: | Not covered |
| Personal emergency response system: | Not covered |
| Weight management programs: | Not covered |
| Wigs for chemotherapy-related hair loss: | Not covered |
| Alternative therapies: | Not covered |
| Massage therapy: | Not covered |
| Home/bathroom safety devices: | Not covered |
Prescription Drug Plan Costs & Benefits
Prescription Drug Plan Premium
The following table outlines the prescription drug plan premium details of this plan.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $27.70 |
| Supplemental Part D Premium: | $0.00 |
| Total Part D Premium: | $27.70 |
| Low Income Premium Subsidy: | $27.74 |
| Low Income Premium Subsidy CMS Pays: | $27.70 |
| Low Income Subsidy Premium: | $0.00 |
For more information about the Low Income Subsidy, refer to the Social Security Extra Help page.
Drug Plan Deductible
The prescription drug annual deductible with this plan is $615.00. This is the amount you must pay at the pharmacy before BlueCross BlueShield of Tennessee begins paying its share.
Drug Plan Out-of-Pocket Costs
In addition to the plan's monthly premium and drug plan deductible, BlueAdvantage Total Heart and Diabetes Plus has costs that you must pay out-of-pocket when you pick up your prescriptions. The following table details those costs by formulary tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Brand-name drugs | 25% coinsurance | Coming soon |
| Generic drugs | 25% coinsurance | Coming soon |
| *Deductible does not apply. | ||
Plan Star Ratings
Medicare evaluates plan quality using a star rating system developed by the Centers for Medicare & Medicaid Services (CMS). Ratings are based on measures such as health outcomes, member experience, and customer service, and are reported on a 1 to 5 star scale, with higher ratings indicating stronger overall performance.
CMS Star Ratings for Plan H7917-046-0 – 2026
| CMS Measure | Star Rating (out of 5) |
|---|---|
| 2026 Overall 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 |
Contact Information for BlueCross BlueShield of Tennessee
| Contact Type | Details |
|---|---|
| Website: | BlueCross BlueShield of Tennessee Plan Page |
| New Members: | 1-800-292-5146 |
| Existing Members: | 1-800-831-2583 |
| Plan Address: | 1 Cameron Hill Circle | Chattanooga, TN 37402 |
Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at medicare.gov.
- CMS.gov, Landscape Source Files — Last accessed May 2, 2026
- CMS.gov, Medicare Part C & D Performance — Last accessed May 2, 2026
- CMS.gov, Plan Benefits Package — Last accessed May 2, 2026
- CMS.gov, Monthly Enrollment by Contract/Plan/State/County — Last accessed May 2, 2026
Data sources and methodology documentation.
- BlueCross BlueShield of Tennessee (official source), http://bluecareplus.bcbst.com — Last accessed April 30, 2026
- CMS.gov, "Chronic Condition Special Needs Plans (C-SNPs)" — Last accessed April 28, 2026
- Medicare.gov, "Compare types of Medicare Advantage Plans" — Last accessed April 28, 2026
- NCOA.org, "5 Steps to Choosing the Right Medicare Plan for You" — Last accessed April 28, 2026
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