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BlueCHiP for Medicare Preferred (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCHiP for Medicare Preferred (HMO-POS). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueCHiP for Medicare Preferred (HMO-POS) in 2025, please refer to our full plan details page.
BlueCHiP for Medicare Preferred (HMO-POS) is a HMO-POS 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 Preferred (HMO-POS) 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 Preferred (HMO-POS).
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 Preferred (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $227.00. 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 $5000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5000.00 for in-network covered services, the plan will pay 100% of in-network covered costs for the rest of the year.
This plan has a Maximum Out-Of-Pocket cost of $3000.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $5000.00 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:
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Drug Coverage
The BlueCHiP for Medicare Preferred (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you may pay a copay or coinsurance depending on the drug tier and pharmacy. For example, you may pay a $6 copay for preferred generic drugs at a standard pharmacy, or 33% coinsurance for non-preferred drugs. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. If you qualify for the low-income subsidy (LIS), your monthly premium may be reduced.
Additional Benefits
The BlueCHiP for Medicare Preferred (HMO-POS) plan offers a range of benefits, including coverage for inpatient hospital stays with a $225 copay for the first five days, and no copay for days 6-90. The plan also covers outpatient services, primary care, preventive services, hearing, vision, dental, home infusion, dialysis, and medical equipment. Copays and coinsurance vary depending on the service. This plan provides coverage for emergency services, with copays between $50 and $175 depending on the service, and no copay for home health services. Other covered services include skilled nursing facilities with varying copays, and over-the-counter items with a quarterly maximum of $100. However, some services like acupuncture, private duty nursing, and certain rehabilitation services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits are covered under the BlueCHiP for Medicare Preferred (HMO-POS) plan, with a copay of $225 for days 1-5, and no copay for days 6-90 for Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. Additional days for Inpatient Hospital-Acute and Psychiatric services are covered with no copay, while Non-Medicare covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services are covered, including all outpatient hospital services, ambulatory surgical center services, outpatient substance abuse services, and outpatient blood services. For outpatient hospital services, the copay is between $0 and $200, and for observation services, the copay is $200. Ambulatory Surgical Center (ASC) Services have no copay, while individual and group sessions for outpatient substance abuse have a $25 copay.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueCHiP for Medicare Preferred (HMO-POS) plan with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueCHiP for Medicare Preferred (HMO-POS) plan. Ground and air ambulance services have a $175 copay, with no coinsurance, while transportation services to any health-related location are not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, Worldwide Emergency Coverage, and Worldwide Urgent Coverage have a copay of $125, $50, $125, and $50, respectively, with no coinsurance, while Worldwide Emergency Transportation has a $175 copay and no coinsurance. The copay for Emergency Services is waived if admitted to the hospital within 1 day.
Primary Care See details
The BlueCHiP for Medicare Preferred (HMO-POS) plan covers primary care physician services, chiropractic services, occupational therapy services, physician specialist services, mental health specialty services, podiatry services, other health care professional services, psychiatric services, physical therapy and speech-language pathology services, additional telehealth benefits, and opioid treatment program services. Chiropractic services have a $20 copay, occupational therapy services have a $15 copay, physician specialist services have a $25 copay, individual and group sessions for mental health specialty services have a $25 copay, podiatry services and routine foot care have a $25 copay, other health care professional services have a copay between $15 and $25, individual and group sessions for psychiatric services have a $25 copay, physical therapy and speech-language pathology services have a $15 copay, and opioid treatment program services have a $25 copay.
Preventive Services See details
The BlueCHiP for Medicare Preferred (HMO-POS) plan covers several preventive services with no copay, including Medicare-covered services, annual physical exams, and additional preventive services. The plan's additional preventive services include Health Education, Medical Nutrition Therapy, Post discharge In-Home Medication Reconciliation, Wigs for Hair Loss Related to Chemotherapy, Nutritional/Dietary Benefit, Additional Sessions of Smoking and Tobacco Cessation Counseling, Fitness Benefit, Enhanced Disease Management, Telemonitoring Services, and Remote Access Technologies, with a copay of $0-$25.
Hearing Services See details
Hearing services are covered by BlueCHiP for Medicare Preferred (HMO-POS), including routine hearing exams with a $25 copay. Prescription hearing aids are covered with a copay between $0 and $1475, but fitting/evaluation for hearing aids is covered with no copay.
Vision Services See details
Vision services include coverage for eye exams with a $25 copay, and eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. Eyewear has a combined maximum benefit of $200 every year, and upgrades are not covered.
Dental Services See details
The BlueCHiP for Medicare Preferred (HMO-POS) plan covers dental services with a 20% coinsurance for Medicare dental services, and a $1,500 annual maximum for other dental services. Oral exams, dental x-rays, prophylaxis (cleaning), and fluoride treatments are covered, with limitations on the number of visits or x-rays per year. Orthodontic services are covered under Diagnostic and Preventive Dental, while maxillofacial prosthetics, implant services, and orthodontics are not covered.
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 are also covered, with coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueCHiP for Medicare Preferred (HMO-POS) plan. You will pay 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and Prosthetic Devices with 20% coinsurance, while Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered. Medical Supplies and Diabetic Therapeutic Shoes/Inserts also have 20% coinsurance.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by BlueCHiP for Medicare Preferred (HMO-POS), but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a maximum copay of $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 Preferred (HMO-POS) plan with no copay and no coinsurance, but additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are technically covered, but 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 Preferred (HMO-POS) plan, but require prior authorization. For days 1-20, there is no copay, days 21-45 have a $214 copay, and days 46-100 have no copay.
Other Services See details
The BlueCHiP for Medicare Preferred (HMO-POS) plan 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. The plan covers Over-the-Counter (OTC) items with a maximum benefit of $100 every three months, including Nicotine Replacement Therapy (NRT), and a Meal Benefit for chronic illnesses.
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