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BlueRI for Duals (HMO D-SNP)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueRI for Duals (HMO D-SNP). The information on this page is a summary only.
For a complete listing of all available benefits and cost information on BlueRI for Duals (HMO D-SNP) in 2025, please refer to our full plan details page.
BlueRI for Duals (HMO D-SNP) is a HMO D-SNP 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 BlueRI for Duals (HMO D-SNP) is a Medicare Advantage (MA) Plan with drug coverage. That means that this plan covers both medical services and prescription drugs.
Important:
BlueRI for Duals (HMO D-SNP)is a Special Needs Type (SNP) plan. This means you can only enroll in this plan if you meet specific criteria. See our full plan details page for more information.
Key Plan Facts
Below are a few key facts and commonly-asked questions about BlueRI for Duals (HMO D-SNP).
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 BlueRI for Duals (HMO D-SNP), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $40.50. This is the amount you must pay every month. Additionally, this plan comes with a Part B Premium reduction of $3.30. You must continue to pay paying your reduced 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 $590.00 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 $9350.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $0.00 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 BlueRI for Duals (HMO D-SNP) plan has a $590 deductible for prescription drugs. After the deductible is met, you will pay the costs for drugs in each tier until your total drug costs reach $2000, at which point you enter the next coverage phase. Those who qualify for the low-income subsidy may have their premium reduced.
Additional Benefits
The BlueRI for Duals (HMO D-SNP) plan offers a range of benefits with varying cost-sharing. Inpatient hospital stays have a $2035 copay per admission, and emergency services have a $110 copay, while many services, such as preventive care, home health services, and diagnostic services, have no copay. Outpatient services, primary care, and other services have a 20% coinsurance. The plan also includes coverage for hearing, vision, and dental services, with specific limits and cost-sharing. Hearing aids have a $1,000 annual allowance, vision care includes a $300 annual eyewear benefit, and dental services have a $3,000 annual maximum. Additionally, the plan covers ambulance services, transportation, and offers an over-the-counter (OTC) allowance of $165 per month.
Inpatient Hospital See details
Inpatient Hospital benefits, including Acute and Psychiatric, are covered by the BlueRI for Duals (HMO D-SNP) plan. For both Acute and Psychiatric Inpatient Hospital stays, the copay is $2035 per admission or stay, and additional days are covered with no limit.
Outpatient Services See details
Outpatient services including hospital services, observation services, and substance abuse services are covered, with a 20% coinsurance for outpatient hospital services and observation services. Outpatient blood services are also covered, including services not usually covered by Medicare plans, with a waived three-pint deductible.
Partial Hospitalization See details
Partial Hospitalization is covered by the BlueRI for Duals (HMO D-SNP) plan, with an $80 copay.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered by the BlueRI for Duals (HMO D-SNP) plan. Ground and air ambulance services have a 20% coinsurance, and transportation services to a plan-approved health-related location are covered for up to 72 one-way trips per year.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BlueRI for Duals (HMO D-SNP) plan. Emergency Services have a $110 copay and no coinsurance, while Urgently Needed Services have a $45 copay and no coinsurance. Worldwide Emergency Services, Worldwide Emergency Coverage, Worldwide Urgent Coverage, and Worldwide Emergency Transportation are all covered, with no coinsurance and no maximum plan benefit coverage.
Primary Care See details
The BlueRI for Duals (HMO D-SNP) plan covers Primary Care services with a 20% coinsurance. Chiropractic Services are covered with a 20% coinsurance, but routine chiropractic care is not covered. Occupational Therapy Services, Physician Specialist Services, Physical Therapy, and Speech-Language Pathology Services are covered with a 20% coinsurance, and Mental Health and Psychiatric services are covered with a 20% coinsurance for individual and group sessions.
Preventive Services See details
The BlueRI for Duals (HMO D-SNP) plan covers preventive services, including annual physical exams, with no copay. Additional preventive services are covered, though some services have a 20% coinsurance. Several services are not covered, including In-Home Safety Assessment, 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, Support for Caregivers of Enrollees, and Counseling Services.
Hearing Services See details
Hearing services include routine hearing exams with a coinsurance of 20% and fitting/evaluation for hearing aids with a limit of 1 visit per year, and prescription hearing aids with a plan-specified amount of $1,000 per year, with a limit of 2 visits per year for all types of prescription hearing aids. Prescription hearing aids for the inner ear, outer ear, and over the ear are not covered, and OTC hearing aids are also not covered.
Vision Services See details
Vision services are covered, including eye exams and eyewear. Eye exams have a 20% coinsurance, and you are covered for one routine eye exam every year. Eyewear has a combined maximum benefit of $300 every year for contact lenses, eyeglasses (lenses and frames), eyeglass lenses, and eyeglass frames, and upgrades are not covered.
Dental Services See details
Dental Services are covered, with a 20% coinsurance for Medicare Dental Services. Other Dental Services are covered up to a maximum of $3,000 per year, and include coverage for oral exams (1 visit per year), dental x-rays (1 per year), prophylaxis (cleaning) (2 per year), and fluoride treatments (1 per year). Maxillofacial Prosthetics and Orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services, including Medicare Part B Insulin Drugs, Medicare Part B Chemotherapy/Radiation Drugs, and Other Medicare Part B Drugs, are covered. For Medicare Part B Insulin Drugs, there is a $35 copay, while the coinsurance for Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs ranges from 0% to 20%.
Dialysis Services See details
Dialysis Services are covered by the BlueRI for Duals (HMO D-SNP) plan. You will pay 20% coinsurance for these services.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with a 20% coinsurance and no copay, Prosthetics/Medical Supplies with a 20% coinsurance and no copay, and Diabetic Equipment, but Durable Medical Equipment for use outside the home, Diabetic Supplies and Diabetic Therapeutic Shoes/Inserts are not covered.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered, with no copay for all diagnostic and radiological services. Diagnostic Procedures/Tests, Diagnostic Radiological Services, Therapeutic Radiological Services, and Outpatient X-Ray Services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the BlueRI for Duals (HMO D-SNP) 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 not covered by the BlueRI for Duals (HMO D-SNP) plan. The plan does not cover Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Medicare-covered Supervised Exercise Therapy (SET) for Symptomatic Peripheral Artery Disease (PAD) Services, or Additional Cardiac Rehabilitation Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueRI for Duals (HMO D-SNP) plan. There is no copay for days 1-20, but there is a $214 copay for days 21-100. Additional days beyond Medicare-covered for SNF, and non-Medicare-covered stays for SNF are not covered.
Other Services See details
The BlueRI for Duals (HMO D-SNP) plan covers acupuncture with a limit of 12 treatments per year. The plan also offers over-the-counter (OTC) items with a maximum benefit coverage amount of $165.00 per month. The plan also includes a meal benefit for chronic illness. The plan does not cover Dual Eligible SNPs with Highly Integrated Services, 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.
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