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BlueCHiP for Medicare Enhanced (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCHiP for Medicare Enhanced (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 Enhanced (HMO-POS) in 2025, please refer to our full plan details page.
BlueCHiP for Medicare Enhanced (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 Enhanced (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 Enhanced (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 Enhanced (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $38.00. 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 $7500.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7500.00 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 $4800.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $7500.00 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 Enhanced (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you'll pay a copay or coinsurance depending on the drug tier and pharmacy. For example, standard generic drugs have a $47 copay. Once your total drug costs reach $2000, you enter the catastrophic coverage phase where you pay nothing for covered drugs. However, you may still pay a share of the costs for excluded drugs covered under any enhanced benefit.
Additional Benefits
The BlueCHiP for Medicare Enhanced (HMO-POS) plan offers comprehensive coverage with varying cost-sharing. Inpatient hospital stays have a $325 copay for days 1-5, and no copay for days 6-90. Outpatient services have no copay for some services, and up to a $325 copay for others. The plan includes coverage for primary care with a $20 copay, and specialist services with a $30 copay. Preventive services have no copay, and there is coverage for hearing, vision, and dental services. The plan also covers ambulance, emergency, and home health services.
Inpatient Hospital See details
Inpatient Hospital benefits include coverage for acute and psychiatric care, with a copay of $325 for days 1-5 and no copay for days 6-90. Additional days for inpatient hospital are covered, while non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including all outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient hospital services have a copay between $0 and $325. Individual and group sessions for outpatient substance abuse have a copay of $30. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueCHiP for Medicare Enhanced (HMO-POS) plan. You will have a $50 copay for this service.
Ambulance and Transportation Services See details
Ambulance services are covered by the BlueCHiP for Medicare Enhanced (HMO-POS) plan, with a $175 copay for both ground and air ambulance services 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 Enhanced (HMO-POS) plan. Emergency Services have a $100 copay, Urgently Needed Services have a $30 copay, Worldwide Emergency Coverage has a $100 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $175 copay.
Primary Care See details
The BlueCHiP for Medicare Enhanced (HMO-POS) plan covers primary care physician services, occupational therapy services, and additional telehealth benefits. The plan has a $20 copay for chiropractic services, a $30 copay for occupational therapy, physician specialist services, physical therapy and speech-language pathology services, and a $30 copay for individual and group mental health and psychiatric sessions, and opioid treatment program services.
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, as well as additional services such as annual physical exams, health education, medical nutrition therapy, post-discharge in-home medication reconciliation, additional sessions of smoking and tobacco cessation counseling, fitness benefits, enhanced disease management, telemonitoring services, and remote access technologies. Some services are not covered, including in-home safety assessment, personal emergency response system, re-admission prevention, wigs for hair loss related to chemotherapy, 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.
Hearing Services See details
Hearing Services include hearing exams with a $30 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $0 and $1475 depending on the type. Prescription Hearing Aids - Inner Ear, Outer Ear, and Over the Ear are not covered, nor are OTC hearing aids.
Vision Services See details
The BlueCHiP for Medicare Enhanced (HMO-POS) plan covers vision services, including routine eye exams with a $30 copay, contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames. The plan offers a combined maximum of $300 per year for eyewear, and 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 $2,250 maximum benefit per year. Oral exams, dental x-rays, and fluoride treatments are each limited to one visit per year, and prophylaxis (cleaning) is limited to two visits per year. 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, are covered by the BlueCHiP for Medicare Enhanced (HMO-POS) plan. Medicare Part B Insulin Drugs have a $35 copay, while Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have between 0% and 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by the BlueCHiP for Medicare Enhanced (HMO-POS) plan. You will pay 20% coinsurance.
Medical Equipment See details
Medical Equipment is covered, including Durable Medical Equipment (DME) with 20% coinsurance, and Prosthetics/Medical Supplies with 20% coinsurance. Some Diabetic Equipment is covered, including Diabetic Therapeutic Shoes/Inserts with 20% coinsurance, but Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered under the BlueCHiP for Medicare Enhanced (HMO-POS) plan. Diagnostic Radiological Services have a copay of up to $125, while Therapeutic Radiological Services have a coinsurance of up to 20%.
Home Health Services See details
Home Health Services are covered 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 covered, but not the Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, or SET for PAD Services. The plan has a copay for Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Additional Cardiac Rehabilitation Services, but the copay amount is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCHiP for Medicare Enhanced (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20, a $214 copay for days 21-45, and no copay for days 46-100.
Other Services See details
Other Services include acupuncture with a $15 copay, and over-the-counter items with a maximum benefit coverage amount of $85 every three months. The plan also offers a meal benefit. However, Early and Periodic Screening, Diagnostic, and Treatment (EPSDT) Services, Private Duty Nursing Services, Case Management (Long Term Care), and several other services are not covered.
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1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
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