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BlueCHiP for Medicare Plus (HMO)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCHiP for Medicare Plus (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 Plus (HMO) in 2025, please refer to our full plan details page.
BlueCHiP for Medicare Plus (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 Plus (HMO) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueCHiP for Medicare Plus (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 Plus (HMO), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $120.00. 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.
This plan has no drug deductible. Your prescription medication coverage will start immediately.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $3500.00 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 Plus (HMO)
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Drug Coverage
The BlueCHiP for Medicare Plus (HMO) plan has an enhanced alternative drug benefit. The plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay a copay for your prescriptions. For example, a standard pharmacy will have a $6.00 copay for preferred generic drugs, a $47.00 copay for standard generic drugs, and a $100.00 copay for preferred brand drugs. Non-preferred drugs have a 33% coinsurance. After your yearly out-of-pocket drug costs reach $2000.00, you pay nothing for covered drugs.
Additional Benefits
The BlueCHiP for Medicare Plus (HMO) plan offers a range of benefits with varying cost-sharing. Hospital stays have a copay, while outpatient services may have copays or no cost depending on the service. This plan also includes coverage for primary care, vision, hearing, and dental services, with copays or coinsurance applying to specific services. Additionally, it provides benefits for ambulance services, emergency care, and offers additional services like OTC items and a meal benefit for chronic illness, with specific cost-sharing structures for each.
Inpatient Hospital See details
Inpatient Hospital services are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric. For Inpatient Hospital-Acute, the copay is $225 for days 1-5 and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, the copay is $225 for days 1-5 and no copay for days 6-60; additional days are covered with no copay. Non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered by the BlueCHiP for Medicare Plus (HMO) plan. Outpatient Hospital Services have a copay of $0-$200, Observation Services have a copay of $200, and Ambulatory Surgical Center (ASC) Services have no copay. Outpatient Substance Abuse Services have a copay of $25 for both Individual and Group Sessions, and Outpatient Blood Services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueCHiP for Medicare Plus (HMO) plan, with a $40 copay.
Ambulance and Transportation Services See details
The BlueCHiP for Medicare Plus (HMO) plan covers ambulance services, including both ground and air ambulance services, each with a $175 copay and no coinsurance. Transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BlueCHiP for Medicare Plus (HMO) plan. Emergency Services have a $125 copay, while Urgently Needed Services have a $50 copay, and Worldwide Emergency Services have a copay of $125 for Worldwide Emergency Coverage, $50 for Worldwide Urgent Coverage, and $175 for Worldwide Emergency Transportation.
Primary Care See details
The BlueCHiP for Medicare Plus (HMO) plan covers primary care physician services, 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 for Medicare-covered and routine foot care), 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 copay between $25 and $25). Routine chiropractic care is not covered.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam, additional services, Health Education, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Wigs for Hair Loss Related to Chemotherapy with a $350 maximum benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Telemonitoring Services, and Remote Access Technologies with a copay between $0 and $25. In-Home Safety Assessment, Personal Emergency Response System (PERS), Re-admission Prevention, Weight Management Programs, Alternative Therapies, Therapeutic Massage, Adult Day Health Services, Home-Based Palliative Care, In-Home Support Services, Support for Caregivers of Enrollees, Home and Bathroom Safety Devices and Modifications, and Counseling Services are not covered.
Hearing Services See details
Hearing Services for the BlueCHiP for Medicare Plus (HMO) plan include hearing exams with a $25 copay, routine hearing exams (1 per year), and fitting/evaluation for hearing aids (1 per year). Prescription Hearing Aids (all types) are covered with a copay between $0 and $1475, but prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are not covered.
Vision Services See details
The BlueCHiP for Medicare Plus (HMO) plan covers vision services, including routine eye exams with a $25 copay, and eyewear with a combined maximum benefit of $200 every year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are also covered, while upgrades are not covered.
Dental Services See details
The BlueCHiP for Medicare Plus (HMO) plan covers Medicare dental services with a 20% coinsurance. Other dental services are covered up to a maximum of $1500 per year. The plan covers oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments, but each of these services is limited to a specific number of visits per year. Orthodontic services are covered under Diagnostic and Preventive Dental. Prosthodontics, restorative services, endodontics, periodontics, adjunctive general services, prosthodontics (removable), oral and maxillofacial surgery, and prosthodontics (fixed) are covered. Maxillofacial prosthetics, implant services and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs are covered. For Medicare Part B Insulin Drugs, there is a $35 copay; for Medicare Part B Chemotherapy/Radiation Drugs, the coinsurance is between 0-20%; and for Other Medicare Part B Drugs, the coinsurance is between 0-20%.
Dialysis Services See details
Dialysis Services are covered by the BlueCHiP for Medicare Plus (HMO) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance, Prosthetics/Medical Supplies - Non-Medicare benefit with coinsurance for Medicare-covered items, and Diabetic Equipment with coinsurance for Medicare-covered supplies, as well as Diabetic Therapeutic Shoes/Inserts with 20% coinsurance. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
The BlueCHiP for Medicare Plus (HMO) plan covers diagnostic and radiological services, but diagnostic procedures/tests, lab services, and outpatient X-ray services are not covered. Diagnostic Radiological Services have a copay of at most $175, and Therapeutic Radiological Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the BlueCHiP for Medicare Plus (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 not covered by the BlueCHiP for Medicare Plus (HMO) plan. The plan does not cover Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCHiP for Medicare Plus (HMO) plan, but require prior authorization. For days 1-20, there is no copay; for days 21-45, the copay is $214, and for days 46-100, there is no copay. Additional days beyond Medicare-covered and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The "Other Services" benefit in the BlueCHiP for Medicare Plus (HMO) plan covers Over-the-Counter (OTC) Items, with a maximum benefit of $100 every three months, and a meal benefit for a chronic illness. Acupuncture, Dual Eligible SNPs with Highly Integrated Services, and other services such as Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services and Home and Community Based Services are not covered.
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