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BlueCHiP for Medicare Core (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCHiP for Medicare Core (HMO). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueCHiP for Medicare Core (HMO) in 2026, please refer to our full plan details page.
BlueCHiP for Medicare Core (HMO) is a HMO plan offered by Blue Cross & Blue Shield of Rhode Island available for enrollment in 2025 to people living in State of Rhode Island. This plan received an overall rating of 4 out of 5 stars in 2026.
It's important to know that BlueCHiP for Medicare Core (HMO) is a Medicare Advantage (MA) Plan without drug coverage. That means that this plan covers medical services but doesn't cover prescription drugs. If you are looking for a plan with prescription drug coverage, please search for other MA and PDP plans offered in your area.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueCHiP for Medicare Core (HMO).
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 BlueCHiP for Medicare Core (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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.
Drugs are not covered by this plan, so a prescription drug deductible is not applicable.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $5000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
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 BlueCHiP for Medicare Core (HMO)
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Drug Coverage
Prescription drugs are not covered by BlueCHiP for Medicare Core (HMO).
Additional Benefits
The BlueCHiP for Medicare Core (HMO) plan offers comprehensive healthcare coverage with no copays for primary care doctor visits, telehealth services, preventive care, and home health services. For inpatient hospital stays, members pay a $275 daily copay for days one through six and no copay for subsequent days, while outpatient hospital services range from no copay to a $250 copay. Emergency room visits require a $130 copay, which is waived upon admission, and urgent care services are available for a $50 copay. Specialist visits, physical therapy, and routine vision and hearing exams feature low copays of up to $30, while dental care is covered up to a $1,500 annual limit with no copay. Durable medical equipment, dialysis services, and specific Part B drugs generally carry a 20% coinsurance, whereas diagnostic radiology and home infusions require no copay. Members also benefit from a $50 quarterly over-the-counter allowance and skilled nursing facility care with no copay for the first 20 days.
Inpatient Hospital See details
BlueCHiP for Medicare Core (HMO) partially covers inpatient hospital services with no coinsurance, requiring a $275 daily copay for days 1 through 6 and no copay for days 7 and beyond for acute and psychiatric stays. While unlimited additional days are covered at no copay, upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueCHiP for Medicare Core (HMO) covers outpatient hospital services with a copay ranging from no copay to $250 and observation services with a $250 copay per stay, both with no coinsurance. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions feature a copay of no copay to $30 and no coinsurance.
Partial Hospitalization See details
BlueCHiP for Medicare Core (HMO) covers partial hospitalization services with a $100.00 copay and no coinsurance.
Ambulance and Transportation Services See details
BlueCHiP for Medicare Core (HMO) covers ground and air ambulance services with a $200 copay and no coinsurance, though prior authorization is required. Transportation services to plan-approved or health-related locations are not covered.
Emergency Services See details
BlueCHiP for Medicare Core (HMO) covers emergency services with a $130 copay, which is waived if admitted to the hospital within one day, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $200 respectively.
Primary Care See details
BlueCHiP for Medicare Core (HMO) features primary care physician visits and telehealth benefits with no copay and no coinsurance, while chiropractic services are not covered. Other services like specialist visits, physical therapy, psychiatric care, and podiatry are covered with copays ranging from $0 to $30 and no coinsurance.
Preventive Services See details
Preventive services are covered by BlueCHiP for Medicare Core (HMO) with no copay and no coinsurance, which includes annual physical exams, kidney disease education, and other screenings. Additional preventive services are partially covered with no copay and no coinsurance, excluding PERS, re-admission prevention, chemotherapy wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, home and bathroom safety devices, and counseling.
Hearing Services See details
BlueCHiP for Medicare Core (HMO) partially covers hearing services, which include routine hearing exams for a $30 copay and no coinsurance, and prescription hearing aids with a $300 to $1,775 copay and no coinsurance. OTC hearing aids and inner ear, outer ear, and over the ear prescription hearing aids are not covered.
Vision Services See details
BlueCHiP for Medicare Core (HMO) partially covers vision services, with no coverage for other eye exam services and eyewear upgrades. Routine eye exams are covered once per year with a $30 copay, no coinsurance, and no deductible, while eyewear is covered with no copay, no coinsurance, no deductible, and a $150 annual maximum limit.
Dental Services See details
Dental services are partially covered by BlueCHiP for Medicare Core (HMO), with Medicare-covered dental requiring no copay and 20% coinsurance, and other covered services requiring no copay and no coinsurance up to a $1,500 yearly maximum. Sub-services that are not covered under this plan include other diagnostic dental, other preventive dental, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
BlueCHiP for Medicare Core (HMO) covers home infusion bundled services with no copay, while covered Medicare Part B insulin drugs require a $35 copay and no coinsurance. Other covered Medicare Part B drugs, including chemotherapy and radiation, have a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered under BlueCHiP for Medicare Core (HMO) with no copay and a 20% coinsurance.
Medical Equipment See details
Medical equipment is covered by BlueCHiP for Medicare Core (HMO) with no copay and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. This benefit is partially covered because diabetic supplies are not covered, and prior authorization is required for durable medical equipment.
Diagnostic and Radiological Services See details
BlueCHiP for Medicare Core (HMO) partially covers diagnostic services with no coinsurance and a $50 copay for procedures, though lab services are not covered. Covered radiological services require prior authorization and include diagnostic radiology with no copay, therapeutic radiology with a 20% minimum coinsurance, and outpatient X-rays with a $25 copay.
Home Health Services See details
Home Health Services are covered under the BlueCHiP for Medicare Core (HMO) plan with no copay and no coinsurance, although prior authorization is required.
Cardiac Rehabilitation Services See details
BlueCHiP for Medicare Core (HMO) covers Cardiac Rehabilitation Services with no coinsurance, but in practice only some services are covered because cardiac rehabilitation (which carries a $30 copay), intensive cardiac rehabilitation (with a $30 copay), pulmonary rehabilitation, and SET for PAD services (with a $20 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) care is covered by BlueCHiP for Medicare Core (HMO) with no coinsurance and no prior three-day hospital stay required, though prior authorization is necessary. There is no copay for days 1 through 20 and days 46 through 100, while days 21 through 45 require a $218 daily copay.
Other Services See details
Other services are partially covered by BlueCHiP for Medicare Core (HMO), which offers over-the-counter (OTC) items with no copay and no coinsurance up to a $50 maximum benefit every three months. Acupuncture, meal benefits, and naloxone are not covered under this benefit.
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