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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 2026, 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 out of 5 stars in 2026.
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 $35.00. 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 a $500.00 drug deductible. You will need to pay this amount towards covered prescriptions before your insurance coverage for prescription medications kicks in.
Out-of-Pocket Maximums
This plan has a Maximum Out-Of-Pocket cost of $10000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 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 $5750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $10000.00 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 features an annual drug deductible of $500. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay when filling prescriptions through a standard pharmacy or preferred mail order. If you utilize standard mail order for these generic drugs, you will pay copays ranging from $16 to $48 depending on the tier and supply length. For brand-name and specialty medications, your costs are based on coinsurance rather than flat copays. Tier 3 preferred brand drugs require a 25% coinsurance, while Tier 4 non-preferred drugs carry a 30% coinsurance across standard pharmacies and mail order options. Specialty medications in Tier 5 are covered with a 27% coinsurance for a one-month supply.
Additional Benefits
The BlueCHiP for Medicare Enhanced (HMO-POS) plan offers comprehensive coverage with predictable cost-sharing, featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For more intensive medical needs, members pay flat copayments with no coinsurance, including a $400 daily copay for the first six days of inpatient hospital stays and a $130 copay for emergency room visits. Outpatient services and specialist visits are also highly accessible, with specialist copays ranging from $0 to $40 and outpatient hospital copays capped at $450. For supplemental care, the plan provides robust dental benefits up to a $2,000 annual maximum and eyewear coverage up to a $200 annual limit, both with no copay. Routine eye and hearing exams require a $40 copay, while covered hearing aids carry copays ranging from $300 to $1,775 with no coinsurance. Additionally, durable medical equipment and dialysis services are covered with no copay and a standard 20% coinsurance.
Inpatient Hospital See details
BlueCHiP for Medicare Enhanced (HMO-POS) partially covers inpatient hospital services, excluding upgrades and non-Medicare-covered stays. Acute inpatient stays require no coinsurance and a $400 copay per day for days 1 through 6, with no copay for day 7 and beyond. Psychiatric inpatient stays also feature no coinsurance, with a $375 copay per day for days 1 through 6 and no copay for days 7 through 90.
Outpatient Services See details
BlueCHiP for Medicare Enhanced (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services with no copay. Outpatient hospital services require prior authorization and have a copay ranging from $0 to $450, while outpatient substance abuse sessions carry a copay of $0 to $40.
Partial Hospitalization See details
BlueCHiP for Medicare Enhanced (HMO-POS) covers partial hospitalization services with a $100 copay and no coinsurance.
Ambulance and Transportation Services See details
BlueCHiP for Medicare Enhanced (HMO-POS) covers ground and air ambulance services with a $200 copay and no coinsurance, though prior authorization is required. Regarding transportation benefits, some services are covered, but transportation to plan-approved or any health-related locations is not covered.
Emergency Services See details
BlueCHiP for Medicare Enhanced (HMO-POS) 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 and urgent services are also covered with no coinsurance, requiring copays of $130 for emergency care, $50 for urgent care, and $200 for emergency transportation.
Primary Care See details
BlueCHiP for Medicare Enhanced (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist, therapy, and mental health services require copays ranging from $0 to $40 and no coinsurance. Podiatry and opioid treatment services have a $40 copay and no coinsurance, and although some chiropractic services are covered, routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered by BlueCHiP for Medicare Enhanced (HMO-POS) with no copay and no coinsurance for covered care such as annual physicals, kidney disease education, and health education. However, some sub-services are not covered, including personal emergency response systems, 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
Hearing services are partially covered by BlueCHiP for Medicare Enhanced (HMO-POS), which offers annual routine exams and fittings for a $40 copay and no coinsurance. Up to two prescription hearing aids are covered per year with no coinsurance and a copay ranging from $300 to $1,775, while OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
BlueCHiP for Medicare Enhanced (HMO-POS) partially covers vision services, offering one routine eye exam per year with a $40 copay and no coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay and no coinsurance up to a $200 annual maximum for contacts and eyeglasses, but upgrades are not covered.
Dental Services See details
BlueCHiP for Medicare Enhanced (HMO-POS) partially covers dental services, offering Medicare-covered dental care with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $2,000 annual maximum. While preventive, restorative, and surgical services are included, other diagnostic and preventive services, maxillofacial prosthetics, implants, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueCHiP for Medicare Enhanced (HMO-POS) covers home infusion bundled services with no copay, while associated Medicare Part B insulin drugs require a $35 copay and no coinsurance. Other covered Medicare Part B drugs, including chemotherapy, require a coinsurance ranging from 0% to 20%.
Dialysis Services See details
BlueCHiP for Medicare Enhanced (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
BlueCHiP for Medicare Enhanced (HMO-POS) partially covers medical equipment with no copays and a 20% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes. Prior authorization is required for durable medical equipment, and diabetic supplies are not covered under this benefit.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are covered under BlueCHiP for Medicare Enhanced (HMO-POS), though diagnostic services are only partially covered since lab services are excluded. Covered diagnostic tests require a $50 copay and no coinsurance, while radiological services require prior authorization and range from no copay for diagnostic radiology to a $25 copay for X-rays and a 20% coinsurance for therapeutic radiology.
Home Health Services See details
Home Health Services are covered by BlueCHiP for Medicare Enhanced (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered with no coinsurance under BlueCHiP for Medicare Enhanced (HMO-POS), but in practice, only some services are covered. Standard cardiac rehabilitation (with a $40 copay), intensive cardiac rehabilitation (with a $40 copay), pulmonary rehabilitation, and SET for PAD services (with a $25 copay) are not covered.
Skilled Nursing Facility (SNF) See details
Skilled nursing facility (SNF) care is covered by BlueCHiP for Medicare Enhanced (HMO-POS) with no coinsurance, requiring a daily copay of $10 for days 1 to 20, $218 for days 21 to 45, and no copay for days 46 to 100. Prior authorization is required, and although a prior three-day hospital stay is not required, additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BlueCHiP for Medicare Enhanced (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $25 every three months. Supplemental benefits such as acupuncture, meal benefits, and naloxone are not covered under this plan.
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