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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 2026, 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 out of 5 stars in 2026.
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 $35.80. 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 $615.00 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 $9250.00 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) Medicare plan features an annual drug deductible of $615. For Tier 1 preferred generics and Tier 2 generics, members pay no copay for 1-month, 2-month, and 3-month supplies at standard pharmacies, as well as for multi-month supplies through preferred mail order. Standard mail order options are also available for these generic tiers with copays ranging from $16 to $48 depending on the supply. For brand-name and specialty medications, costs are structured around coinsurance rather than flat copays. Tier 3 preferred brands and Tier 5 specialty drugs require a 25% coinsurance across standard pharmacies and mail-order options, while Tier 4 non-preferred drugs require a 29% coinsurance. Understanding these cost-sharing tiers helps you accurately estimate your out-of-pocket prescription expenses with this plan.
Additional Benefits
BlueRI for Duals (HMO D-SNP) offers robust medical coverage with no copays for primary care, specialist visits, and outpatient services, though a 20% coinsurance typically applies to these visits. Inpatient hospital stays require a $1,925 copayment per admission with no coinsurance, while emergency room visits have a $115 copay. Diagnostic tests, dialysis, and durable medical equipment are also covered with no copay and a 20% coinsurance. The plan features generous supplemental benefits, including up to $2,500 in dental coverage and up to 60 one-way transportation trips per year with no copay or coinsurance. Routine vision and hearing services feature no copays, alongside annual allowances of $200 for eyewear and $1,000 per ear for prescription hearing aids. Additionally, members receive an over-the-counter benefit of up to $151 per month with no copay or coinsurance.
Inpatient Hospital See details
BlueRI for Duals (HMO D-SNP) covers inpatient acute and psychiatric hospital stays with a $1,925 copayment per admission and no coinsurance. This benefit is partially covered because unlimited additional days are included, but upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
Outpatient services under BlueRI for Duals (HMO D-SNP) are covered with no copay, although a 20% coinsurance applies to outpatient hospital, ambulatory surgical center, and outpatient substance abuse services. Outpatient blood services are covered with no copay, no coinsurance, and no deductible.
Partial Hospitalization See details
BlueRI for Duals (HMO D-SNP) covers partial hospitalization services with a $105.00 copay and no coinsurance.
Ambulance and Transportation Services See details
Ambulance and transportation services are covered by BlueRI for Duals (HMO D-SNP), with ground and air ambulance services requiring prior authorization and a 20% coinsurance with no copay. Transportation services are partially covered, offering up to 60 one-way trips per year to plan-approved locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
BlueRI for Duals (HMO D-SNP) covers emergency services with a $115 copay and no coinsurance, with the copay waived if admitted to the hospital within one day. Urgently needed services require a $40 copay and no coinsurance, while worldwide emergency, urgent, and transportation services are covered with no copay and no coinsurance.
Primary Care See details
BlueRI for Duals (HMO D-SNP) covers primary care, specialist, therapy, mental health, psychiatric, and podiatry services with no copay and a 20% coinsurance, while chiropractic services are not covered. Opioid treatment program services are covered with no copay and no coinsurance, and additional telehealth benefits are also included.
Preventive Services See details
BlueRI for Duals (HMO D-SNP) covers preventive services, including annual physical exams, kidney disease education, and in-home support, with no copay and no coinsurance. While some benefits like weight management programs and personal emergency response systems are not covered, other services such as digital rectal exams and post-welcome-visit EKGs require a 20% coinsurance with no copay.
Hearing Services See details
Hearing Services under BlueRI for Duals (HMO D-SNP) are partially covered, offering routine exams with no copay and 20% coinsurance, and fitting evaluations with no copay. Prescription hearing aids are covered with no copay and no coinsurance up to $1,000 per ear yearly, though OTC, inner ear, outer ear, and over the ear hearing aids are not covered.
Vision Services See details
BlueRI for Duals (HMO D-SNP) covers vision services with no deductible, offering one annual routine eye exam with no copay and a 20% coinsurance, though other eye exam services are not covered. Eyewear is covered with no copay or coinsurance up to a $200 annual maximum for contacts, lenses, and frames, but upgrades are not covered.
Dental Services See details
Dental services are partially covered by BlueRI for Duals (HMO D-SNP), featuring Medicare-covered dental services with no copay and 20% coinsurance, alongside other dental benefits up to $2,500 annually with no copay and no coinsurance. While preventive and restorative care like cleanings, exams, and implants are included, other diagnostic dental, other preventive dental, maxillofacial prosthetics, and orthodontics are not covered.
Home Infusion bundled Services See details
BlueRI for Duals (HMO D-SNP) covers home infusion bundled services with no copay, though associated prescription drugs have varying cost-sharing requirements. Covered Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy, radiation, and other Part B drugs carry a coinsurance ranging from 0% to 20%.
Dialysis Services See details
Dialysis services are covered under the BlueRI for Duals (HMO D-SNP) plan with no copay and a 20% coinsurance.
Medical Equipment See details
BlueRI for Duals (HMO D-SNP) covers medical equipment with no copays, though a 20% coinsurance applies to durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes or inserts. This benefit is partially covered as diabetic supplies are not covered under the plan, and prior authorization is required for durable medical equipment.
Diagnostic and Radiological Services See details
Diagnostic and radiological services are partially covered by BlueRI for Duals (HMO D-SNP) with no copays, though prior authorization is required. Covered services, including diagnostic procedures, diagnostic and therapeutic radiological services, and outpatient X-rays, are subject to a 20% coinsurance, while laboratory services are not covered.
Home Health Services See details
BlueRI for Duals (HMO D-SNP) covers Home Health Services with no copay and no coinsurance, though prior authorization is required.
Cardiac Rehabilitation Services See details
BlueRI for Duals (HMO D-SNP) covers some cardiac rehabilitation services with no copay, but several sub-services are not covered. Specifically, Medicare-covered cardiac, intensive cardiac, pulmonary, and supervised exercise therapy (SET) for peripheral artery disease (PAD) services are not covered and require a 20% coinsurance.
Skilled Nursing Facility (SNF) See details
BlueRI for Duals (HMO D-SNP) covers Skilled Nursing Facility (SNF) services with no coinsurance, requiring no copay for days 1 through 20 and a $218 daily copay for days 21 through 100. Prior authorization is required, a prior three-day hospital stay is not needed for admission, and additional days beyond the standard Medicare limit are not covered.
Other Services See details
BlueRI for Duals (HMO D-SNP) partially covers Other Services, providing Over-the-Counter (OTC) items with no copay and no coinsurance up to a maximum of $151 per month. Acupuncture, meal benefits, and Naloxone are not covered under this benefit.
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