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BlueCHiP for Medicare Extra (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCHiP for Medicare Extra (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 Extra (HMO-POS) in 2026, please refer to our full plan details page.
BlueCHiP for Medicare Extra (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 Extra (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 Extra (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 Extra (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $143.00. 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 $350.00 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 $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 $5000.00 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 Extra (HMO-POS) plan features an annual drug deductible of $350. For Tier 1 preferred generic and Tier 2 generic medications, you will pay no copay for one-, two-, or three-month fills at standard pharmacies, or for two- and three-month fills via preferred mail order. Standard mail order fills for these generic tiers range from a $16 to $36 copay depending on the supply. For Tier 3 preferred brand drugs, standard pharmacy copays start at $47 for a one-month supply, with preferred mail order offering a reduced copay of $117.50 for a three-month supply. Tier 4 non-preferred drugs require a 30% coinsurance across all pharmacy and mail order options. Specialty Tier 5 medications are subject to a 29% coinsurance for a one-month supply.
Additional Benefits
BlueCHiP for Medicare Extra (HMO-POS) offers comprehensive medical coverage featuring no copay and no coinsurance for primary care visits, preventive services, and home health care. For inpatient hospital stays, members pay a daily copay of $325 for the first six days and no copay for days seven and beyond, while emergency room visits carry a $130 copay. Outpatient care and specialist visits are also highly accessible, with costs ranging from no copay up to a $400 copay depending on the service. This plan also includes valuable supplemental benefits, such as dental care up to a $2,500 annual limit and eyewear up to a $300 yearly maximum, both with no copay. Routine hearing and vision exams require a $35 copay, while skilled nursing facility stays offer no copay for the first 20 days. Additionally, members can access over-the-counter items with no copay up to a $40 allowance every three months.
Inpatient Hospital See details
BlueCHiP for Medicare Extra (HMO-POS) partially covers inpatient hospital services with no coinsurance, requiring a $325 copay per day for days 1 through 6 and no copay for days 7 and beyond for both acute and psychiatric stays. Prior authorization is required for acute care, and upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueCHiP for Medicare Extra (HMO-POS) covers outpatient services with no coinsurance, featuring a copay of $0 to $400 for outpatient hospital services and a $400 copay per stay for observation services. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions range from no copay to a $35 copay.
Partial Hospitalization See details
BlueCHiP for Medicare Extra (HMO-POS) covers partial hospitalization services. Members are responsible for a $100.00 copay and no coinsurance for these covered services.
Ambulance and Transportation Services See details
BlueCHiP for Medicare Extra (HMO-POS) covers ground and air ambulance services with a $200 copay and no coinsurance, subject to prior authorization. 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 Extra (HMO-POS) covers emergency services with a $130 copay (waived if admitted within one day) and urgent care with a $50 copay, both with no coinsurance. Worldwide emergency 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 Extra (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, therapies, and mental health services feature copays ranging from $0 to $35 with no coinsurance. Podiatry and opioid treatment services require a $35 copay and no coinsurance, while chiropractic services are not covered under this plan.
Preventive Services See details
Preventive services are partially covered by BlueCHiP for Medicare Extra (HMO-POS) with no copay and no coinsurance for covered services like annual physicals, nutritional therapy, and diabetes training. However, several 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 safety devices, and counseling.
Hearing Services See details
BlueCHiP for Medicare Extra (HMO-POS) covers routine hearing exams and evaluations with a $35 copay and no coinsurance. Hearing aids are partially covered with a copay between $200 and $1,675 and no coinsurance for up to two prescription aids per year, while OTC, inner ear, outer ear, and over-the-ear hearing aids are not covered.
Vision Services See details
BlueCHiP for Medicare Extra (HMO-POS) partially covers vision services, providing one routine eye exam per year with a $35 copay and no coinsurance, while other eye exam services are not covered. Eyewear is also partially covered with no copay, no coinsurance, and no deductible up to a $300 annual maximum for contacts and eyeglasses, though upgrades are excluded.
Dental Services See details
Dental services under BlueCHiP for Medicare Extra (HMO-POS) are partially covered, featuring Medicare-covered dental with no copay and 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $2,500 annual maximum. However, other diagnostic dental services, other preventive dental services, maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueCHiP for Medicare Extra (HMO-POS) covers home infusion bundled services with no copay, with Medicare Part B insulin drugs requiring a $35 copay and no coinsurance. Other covered Part B chemotherapy, radiation, and miscellaneous drugs have a 0% to 20% coinsurance.
Dialysis Services See details
Dialysis Services are covered by BlueCHiP for Medicare Extra (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
BlueCHiP for Medicare Extra (HMO-POS) covers durable medical equipment and prosthetics with no copay and a 10% coinsurance. Diabetic equipment is partially covered with no copay and a 10% coinsurance for therapeutic shoes and inserts, but diabetic supplies are not covered.
Diagnostic and Radiological Services See details
BlueCHiP for Medicare Extra (HMO-POS) covers diagnostic and radiological services with prior authorization, though lab services are not covered. Diagnostic procedures require a $50 copay and no coinsurance, while diagnostic radiological services have no copay and no coinsurance. Outpatient X-rays carry a $25 copay with coinsurance, and therapeutic radiological services require a 20% coinsurance.
Home Health Services See details
Home Health Services are covered under BlueCHiP for Medicare Extra (HMO-POS) with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are covered by BlueCHiP for Medicare Extra (HMO-POS) with no copayment and no coinsurance. While the overall category is covered, some services are covered but cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
BlueCHiP for Medicare Extra (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring prior authorization but no prior three-day inpatient hospital stay. There is no copay for days 1 through 20 and days 46 through 100, while days 21 through 45 require a $218 daily copay, and additional days beyond the standard Medicare-covered limit are not covered.
Other Services See details
BlueCHiP for Medicare Extra (HMO-POS) partially covers other services, offering over-the-counter (OTC) items with no copay and no coinsurance up to a maximum benefit of $40 every three months. Acupuncture, meal benefits, and naloxone coverage are not covered.
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