A non-government entity
BlueCHiP for Medicare Value (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCHiP for Medicare Value (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 Value (HMO-POS) in 2025, please refer to our full plan details page.
BlueCHiP for Medicare Value (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 Value (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 Value (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 Value (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $0.00. 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 $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 $5250.00 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:
Sign up for BlueCHiP for Medicare Value (HMO-POS)
Need help deciding? Talk with one of our licensed insurance specialists 1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
Drug Coverage
The BlueCHiP for Medicare Value (HMO-POS) plan has a $0 deductible for prescription drugs. In the initial coverage phase, you will pay different amounts depending on the drug tier and pharmacy you use. For example, you will pay a $5 copay for preferred generic drugs at a standard pharmacy. After your total drug costs reach $2000, you enter the catastrophic coverage phase, where you pay nothing for covered drugs. However, you may still have to pay for excluded drugs.
Additional Benefits
The BlueCHiP for Medicare Value (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a $350 copay for the first five days, while outpatient services, including primary care, have copays that range from $0 to $350. The plan also covers emergency services with a $100 copay, and offers additional benefits like hearing, vision, and dental services, along with coverage for home health and skilled nursing facilities. Additional benefits include coverage for preventive services, hearing exams, and vision care with a $30 copay for eye exams, and an allowance for eyewear. Dental services are covered with a $2,000 annual maximum benefit. The plan also includes coverage for home infusion, dialysis, and medical equipment with varying cost-sharing, as well as some other services such as acupuncture.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, both of which require prior authorization. For Inpatient Hospital-Acute, you will pay a $350 copay for days 1-5, and no copay for days 6-90. For Inpatient Hospital Psychiatric, you will pay a $350 copay for days 1-5, and no copay for days 6-60. Non-Medicare-covered stays and upgrades for Inpatient Hospital-Acute are not covered, and Non-Medicare-covered stays for Inpatient Hospital Psychiatric are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services, observation services, and outpatient substance abuse services, are covered. Outpatient hospital services have a copay between $0 and $350, and observation services have a $350 copay. Ambulatory Surgical Center (ASC) Services have no copay, while individual and group sessions for outpatient substance abuse have a copay of $30.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueCHiP for Medicare Value (HMO-POS) plan, with a $50 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueCHiP for Medicare Value (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, and Worldwide Emergency Services are covered by the BlueCHiP for Medicare Value (HMO-POS) plan. Emergency Services have a $100 copay, and 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 Value (HMO-POS) plan covers primary care physician services, chiropractic services (with a $20 copay), occupational therapy services (with a $30 copay), physician specialist services (with a $30 copay), mental health specialty services (with a $30 copay for individual and group sessions), podiatry services (with a $30 copay for covered services and routine foot care), other health care professional services (with a copay between $15 and $30), psychiatric services (with a $30 copay for individual and group sessions), physical therapy and speech-language pathology services (with a $30 copay), additional telehealth benefits, and opioid treatment program services (with a $30 copay).
Preventive Services See details
Preventive Services include coverage for Medicare-covered services with no copay, an annual physical exam, additional preventive services, health education, medical nutrition therapy, post-discharge in-home medication reconciliation, additional sessions of smoking and tobacco cessation counseling, a fitness benefit, enhanced disease management, telemonitoring services, remote access technologies, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. The plan does not cover 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, or counseling services. Remote access technologies have a copay between $0 and $30.
Hearing Services See details
Hearing services with the BlueCHiP for Medicare Value (HMO-POS) plan include routine hearing exams with a $30 copay, and fitting/evaluation for hearing aids with no copay. Prescription hearing aids are partially covered, 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 for BlueCHiP for Medicare Value (HMO-POS) include eye exams with a $30 copay, routine eye exams once per year, and eyewear with a combined maximum of $250 per year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses are also covered, while upgrades are not covered.
Dental Services See details
Dental Services are covered, including Medicare Dental Services with 20% coinsurance. Other Dental Services have a maximum benefit of $2,000 per year, and include oral exams (1 visit per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), and fluoride treatment (1 per year). Orthodontic Services are covered under Diagnostic and Preventive Dental. Maxillofacial Prosthetics, Implant Services, and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered by the BlueCHiP for Medicare Value (HMO-POS) plan, 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 a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis services are covered by the BlueCHiP for Medicare Value (HMO-POS) plan. There is a 20% coinsurance for dialysis services.
Medical Equipment See details
Medical Equipment is covered, with a 20% coinsurance for Durable Medical Equipment, Prosthetic Devices, Medicare-covered Medical Supplies, and Diabetic Therapeutic Shoes/Inserts. The plan does not have a copay for any of these services. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered.
Diagnostic and Radiological Services See details
The BlueCHiP for Medicare Value (HMO-POS) plan's Diagnostic and Radiological Services benefit includes coverage for all diagnostic services with no copay, but diagnostic procedures/tests and lab services are not covered. Diagnostic Radiological Services have a maximum copay of $150, and Therapeutic Radiological Services have a coinsurance of 20%.
Home Health Services See details
Home Health Services are covered by the BlueCHiP for Medicare Value (HMO-POS) plan with no copay and no coinsurance. However, additional hours of care and personal care services are not covered.
Cardiac Rehabilitation Services See details
Cardiac Rehabilitation Services are generally covered, but Intensive Cardiac Rehabilitation Services, Pulmonary Rehabilitation Services, and SET for PAD Services are not covered. There is a copay for Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, and Additional Cardiac Rehabilitation Services, but the exact amount of the copay is not specified.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCHiP for Medicare Value (HMO-POS) plan, but require prior authorization. For days 1-20 and 46-100, there is no copay, but for days 21-45, there is a $214 copay.
Other Services See details
The "BlueCHiP for Medicare Value (HMO-POS)" plan covers acupuncture with a $15 copay, and offers over-the-counter (OTC) items up to $75 every three months, including nicotine replacement therapy (NRT), but not Naloxone, and does not cover all drugs on the CMS OTC list. The plan also offers a meal benefit for chronic illness. 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.
Get Personalized Help from a licensed insurance agent
1-877-649-2073 / TTY 711. 8am-11pm EST. 7 days a week
*/SMID: MULTIPLAN_HCIHNMEDADVRX25_HCI_M
MedicareAdvantageRX.com is owned and operated by Dog Media Solutions LLC.
This is a promotional communication.
Every year, Medicare evaluates plans based on a 5-star rating system.
Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.
* Benefit(s) mentioned may be part of a special supplemental program for chronically ill members with one of the following conditions: Diabetes mellitus, Cardiovascular disorders, Chronic and disabling mental health conditions, Chronic lung disorders, Chronic heart failure. This is not a complete list of qualifying conditions. Having a qualifying condition alone does not mean you will receive the benefit(s). Other requirements may apply.
Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period
We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.
We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan's contract renewal.
Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.
Please contact Medicare.gov ,1-800-MEDICARE , or your local State Health Insurance Program (SHIP) to get information on all of your options.
Medicare has neither approved nor endorsed any information on this site.
Speak with a licensed insurance agent: 1-877-649-2073 / TTY 711 | 8am - 11pm ET | 7 days a week
© 2023 Dog Media Solutions LLC. All rights reserved