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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 2025, 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 4.5 out of 5 stars in 2025.
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 $111.00. 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 $4500.00 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 Extra (HMO-POS) plan has a $0 deductible for prescription drugs. During the initial coverage phase, you will pay different copays or coinsurance amounts depending on the drug tier and pharmacy. For example, you will pay no copay for preferred generic drugs at standard pharmacies, while standard generic drugs have a $47 copay at standard pharmacies. For non-preferred drugs, you will pay 33% coinsurance. Once your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs.
Additional Benefits
The BlueCHiP for Medicare Extra (HMO-POS) plan offers a range of benefits, including inpatient and outpatient hospital services, with varying copays. Primary care visits have no copay, and there are copays for specialist visits, therapy, and other services. Emergency, ambulance, and worldwide emergency services are covered, with copays. Additional benefits include preventive, hearing, vision, and dental services, with copays or coinsurance for some. The plan also covers home health services, skilled nursing facility stays, and other services like acupuncture and over-the-counter items. The plan covers home infusion services, dialysis, and medical equipment, with coinsurance applying to some of these services.
Inpatient Hospital See details
Inpatient Hospital benefits are covered, including Inpatient Hospital-Acute and Inpatient Hospital Psychiatric services. For Inpatient Hospital-Acute, you pay a $275 copay for days 1-5, and no copay for days 6-90; additional days are covered with no copay. For Inpatient Hospital Psychiatric, you pay a $275 copay for days 1-5, and no copay for days 6-60; additional days are covered with no copay. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services include coverage for all outpatient hospital services, with copays ranging from $0 to $275, and observation services with a $275 copay. Ambulatory Surgical Center (ASC) Services have no copay, while outpatient substance abuse individual and group sessions have a $25 copay. Outpatient blood services are also covered, with the three-pint deductible waived.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueCHiP for Medicare Extra (HMO-POS) plan with a $40 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueCHiP for Medicare Extra (HMO-POS) plan. Both 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, and Worldwide Emergency Services are covered by the BlueCHiP for Medicare Extra (HMO-POS) plan. Emergency Services has a $100 copay, while Urgently Needed Services has a $30 copay; both have no coinsurance. Worldwide Emergency Coverage has a $100 copay, Worldwide Urgent Coverage has a $30 copay, and Worldwide Emergency Transportation has a $175 copay; all three have no coinsurance.
Primary Care See details
The BlueCHiP for Medicare Extra (HMO-POS) plan covers Primary Care Physician Services with no copay, Chiropractic Services with a $20 copay, Occupational Therapy Services with a $25 copay, Physician Specialist Services with a $25 copay, and Physical Therapy and Speech-Language Pathology Services with a $25 copay. Mental Health, Podiatry, Other Health Care Professional, Psychiatric, and Opioid Treatment Program Services are also covered, each with a minimum copay of $25.
Preventive Services See details
The BlueCHiP for Medicare Extra (HMO-POS) plan covers various preventive services, including Medicare-covered services with no copay, annual physical exams, additional preventive services, 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, Remote Access Technologies with a copay between $0 and $25, Kidney Disease Education Services, and other preventive services such as glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKG following welcome visits. In-home safety assessments, personal emergency response systems, 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 are not covered.
Hearing Services See details
Hearing exams are covered with a $25 copay. Routine hearing exams and fitting/evaluation for hearing aids are covered once per year. Prescription hearing aids are covered, with a copay between $0 and $1475, but inner ear, outer ear, and over the ear hearing aids are not covered, and OTC hearing aids are not covered.
Vision Services See details
Vision services are covered under the BlueCHiP for Medicare Extra (HMO-POS) plan, including routine eye exams with a $25 copay. Eyewear, including contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames, is covered, with a combined maximum of $400 per year for all eyewear, and upgrades are not covered.
Dental Services See details
The BlueCHiP for Medicare Extra (HMO-POS) plan covers dental services with a 20% coinsurance, and a maximum of $2,500 per year. Some services covered include oral exams (1 per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), and fluoride treatment (1 per year).
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay, and Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs with a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueCHiP for Medicare Extra (HMO-POS) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment is covered under the BlueCHiP for Medicare Extra (HMO-POS) plan. Durable Medical Equipment (DME) has a 10% coinsurance and requires authorization, but Durable Medical Equipment for use outside the home is not covered; Prosthetic Devices and Medical Supplies have a 10% coinsurance, with no copay; Diabetic Therapeutic Shoes/Inserts have a 10% coinsurance, but Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are partially covered by the BlueCHiP for Medicare Extra (HMO-POS) plan. Diagnostic services do not have a copay, but Diagnostic Procedures/Tests and Lab Services are not covered. Diagnostic Radiological Services have a copay of at most $100, and Therapeutic Radiological Services have a coinsurance of at most 20%, while Outpatient X-Ray Services are not covered.
Home Health Services See details
Home Health Services are covered by the BlueCHiP for Medicare Extra (HMO-POS) 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 technically covered, but none of the sub-services including Cardiac Rehabilitation Services, Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are covered under the BlueCHiP for Medicare Extra (HMO-POS) plan.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCHiP for Medicare Extra (HMO-POS) 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 SNF stays are not covered.
Other Services See details
The BlueCHiP for Medicare Extra (HMO-POS) plan covers acupuncture with a $15 copay per visit, up to 12 treatments per year, and also covers over-the-counter (OTC) items with a maximum benefit of $100 every three months, including nicotine replacement therapy. The plan also provides a meal benefit for chronic illnesses. However, 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, and Self-Directed Personal Assistance Services are not covered.
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