A non-government entity
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 2025, 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 4.5 out of 5 stars in 2025.
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 $4000.00 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)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
Prescription drugs are not covered by BlueCHiP for Medicare Core (HMO).
Additional Benefits
The BlueCHiP for Medicare Core (HMO) plan offers comprehensive coverage with varying costs depending on the service. Inpatient hospital stays have a $225 copay for the first few days, while outpatient services have copays ranging from $0 to $200. Emergency services have a $125 copay, and ambulance services have a $175 copay. This plan includes coverage for primary care with no copay, specialist visits for a $25 copay, and other services like hearing, vision, and dental. Hearing exams have a $25 copay, and vision exams have a $25 copay, while dental services have a 20% coinsurance, up to a $1500 maximum benefit. The plan also offers an OTC benefit of $75 every three months.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the BlueCHiP for Medicare Core (HMO) plan, including acute and psychiatric care. For inpatient hospital acute care, you will pay a $225 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For inpatient hospital psychiatric care, you will pay a $225 copay for days 1-5, and no copay for days 6-60; additional days are covered with no copay.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered by the BlueCHiP for Medicare Core (HMO) plan. Outpatient hospital services have a copay between $0 and $200, while observation services have a $200 copay. Ambulatory Surgical Center (ASC) Services have no copay, and Outpatient Substance Abuse Services have a $25 copay for both individual and group sessions. Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered with a $50 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered under the BlueCHiP for Medicare Core (HMO) plan. Ground and Air Ambulance Services have a $175 copay, and there is no coinsurance. Transportation Services to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BlueCHiP for Medicare Core (HMO) plan. Emergency Services has a $125 copay with no coinsurance, Urgently Needed Services has a $50 copay with no coinsurance, and Worldwide Emergency Services has a copay of $125 for Worldwide Emergency Coverage, $50 for Worldwide Urgent Coverage, and $175 for Worldwide Emergency Transportation, with no coinsurance.
Primary Care See details
The BlueCHiP for Medicare Core (HMO) plan covers primary care physician services with no copay, chiropractic services with a $20 copay, occupational therapy services with a $15 copay, physician specialist services with a $25 copay, mental health specialty services with a $25 copay for individual and group sessions, podiatry services with a $25 copay, other health care professional services with a copay between $15 and $25, psychiatric services with a $25 copay for individual and group sessions, physical therapy and speech-language pathology services with a $15 copay, additional telehealth benefits, and opioid treatment program services with a $25 copay. Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services, including Medicare-covered services and annual physical exams, are covered. Additional preventive services are covered, with a copay for Remote Access Technologies (including Web/Phone-based technologies and Nursing Hotline).
Hearing Services See details
Hearing services include routine hearing exams with a $25 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids (all types) are covered with a copay between $200 and $1675, but Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, and Prescription Hearing Aids - Over the Ear are not covered. OTC hearing aids are not covered.
Vision Services See details
Vision services include eye exams with a $25 copay, as well as coverage for eyewear including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames; the plan offers a combined maximum of $200 per year for eyewear. Upgrades are not covered.
Dental Services See details
Dental services are covered, with a 20% coinsurance for Medicare Dental Services. Other dental services have a maximum benefit of $1500 per year.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueCHiP for Medicare Core (HMO) plan, with a coinsurance between 20% and 20%.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME), Prosthetics/Medical Supplies, and Diabetic Equipment. DME has a 20% coinsurance and requires authorization, while Prosthetic Devices and Medical Supplies have a 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the BlueCHiP for Medicare Core (HMO) plan, though some services are not covered. Diagnostic services do not have a copay, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $150, while Therapeutic Radiological Services have a coinsurance of at most 20%. Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the BlueCHiP for Medicare Core (HMO) plan with no copay and no coinsurance. Additional Hours of Care and Personal Care Services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered under the BlueCHiP for Medicare Core (HMO) plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCHiP for Medicare Core (HMO) plan, but require prior authorization. For days 1-20 and 46-100, there is no copay, and for days 21-45, the copay is $214. Additional days beyond Medicare-covered for SNF and Non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BlueCHiP for Medicare Core (HMO) plan's Other Services benefit covers over-the-counter (OTC) items with a maximum benefit of $75 every three months, and a meal benefit for chronic illnesses, but does not cover acupuncture, Dual Eligible SNPs with Highly Integrated Services, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), Institution for Mental Disease Services for Individuals 65 or Older, Services in an Intermediate Care Facility for Individuals with Intellectual Disabilities, Case Management, Tobacco Cessation Counseling for Pregnant Women, Freestanding Birth Center Services, Respiratory Care Services, Family Planning Services, Nursing Home Services, Home and Community Based Services, Personal Care Services, or Self-Directed Personal Assistance Services. Nicotine Replacement Therapy (NRT) is offered as a Part C OTC benefit.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved