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BlueCHiP for Medicare Access (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCHiP for Medicare Access (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 Access (HMO-POS) in 2026, please refer to our full plan details page.
BlueCHiP for Medicare Access (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 Access (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 Access (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 Access (HMO-POS), the main costs are as follows:
Monthly Premium
The Monthly Premium for this plan is $27.30. 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 $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 $6000.00 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:
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Drug Coverage
The BlueCHiP for Medicare Access (HMO-POS) plan features an annual prescription drug deductible of $615. This means you will need to pay this amount out of pocket for your covered medications before the plan begins to pay its share. Specific drug tier details, including individual copayments and coinsurance rates, are currently unavailable for this plan. To understand your exact costs for specific prescriptions, it is recommended to review the plan's formulary or contact the provider directly.
Additional Benefits
The BlueCHiP for Medicare Access (HMO-POS) plan offers comprehensive coverage with predictable out-of-pocket costs, featuring no copay and no coinsurance for primary care visits, telehealth, home health, and preventive services. For specialized care, specialist visits and physical therapy require copays up to $35 with no coinsurance. Inpatient hospital stays have no coinsurance, charging a $400 daily copay for the first six days of acute care, while emergency room visits carry a $130 copay that is waived if you are admitted. Members also benefit from dental, vision, and hearing coverage, including no copay for covered dental services up to a $1,500 annual limit and a $35 copay for annual eye and hearing exams. Select medical equipment and dialysis services are covered with no copay and a 20% coinsurance. Additionally, the plan includes practical extras like up to 12 one-way trips to approved health locations and a $50 quarterly allowance for over-the-counter items with no copay.
Inpatient Hospital See details
BlueCHiP for Medicare Access (HMO-POS) offers partially covered inpatient hospital services with no coinsurance, excluding upgrades and non-Medicare-covered stays. For covered stays, there is a $400 copay for days 1 to 6 of acute care and a $390 copay for days 1 to 6 of psychiatric care, with no copay for subsequent days.
Outpatient Services See details
BlueCHiP for Medicare Access (HMO-POS) covers outpatient services with no coinsurance, including outpatient hospital services with a $0 to $400 copay and observation services with a $400 copay per stay. Ambulatory surgical center and outpatient blood services are covered with no copay and no coinsurance, while outpatient substance abuse sessions have a copay of $0 to $35 and no coinsurance.
Partial Hospitalization See details
Partial hospitalization is covered by BlueCHiP for Medicare Access (HMO-POS) with a $100 copay and no coinsurance. This benefit ensures you have access to necessary care with clear and predictable out-of-pocket costs.
Ambulance and Transportation Services See details
BlueCHiP for Medicare Access (HMO-POS) covers ground and air ambulance services with a $200 copay and no coinsurance, requiring prior authorization. Transportation services are partially covered, offering up to 12 one-way trips per year to plan-approved health-related locations with no copay and no coinsurance, while transportation to any health-related location is not covered.
Emergency Services See details
BlueCHiP for Medicare Access (HMO-POS) covers emergency services with a $130 copay, which is waived if admitted to the hospital within one day, and urgently needed services with a $50 copay, both with no coinsurance. Worldwide emergency, urgent, and transportation services are also covered with no coinsurance and copays of $130, $50, and $200 respectively.
Primary Care See details
BlueCHiP for Medicare Access (HMO-POS) offers primary care doctor visits and telehealth services with no copay and no coinsurance. Specialist visits, physical therapy, mental health, and podiatry services have copays ranging from $0 to $35 with no coinsurance, while routine and other chiropractic services are not covered.
Preventive Services See details
Preventive services are partially covered under BlueCHiP for Medicare Access (HMO-POS) with no copay and no coinsurance for covered options like annual physicals, kidney disease education, and diabetes training. Several additional services are not covered, including personal emergency response systems, re-admission prevention, wigs, weight management, alternative therapies, therapeutic massage, adult day health, home-based palliative care, in-home support, caregiver support, home and bathroom safety devices, and counseling.
Hearing Services See details
Hearing services are covered by BlueCHiP for Medicare Access (HMO-POS), offering annual routine hearing exams and fittings for a $35 copay and no coinsurance. Prescription hearing aids are partially covered with no coinsurance and a copay ranging from $200 to $1,675 for up to two aids per year, though inner ear, outer ear, over the ear, and OTC hearing aids are not covered.
Vision Services See details
Vision Services are partially covered by BlueCHiP for Medicare Access (HMO-POS) with no deductibles, featuring one annual routine eye exam with a $35 copay and no coinsurance. Eyewear is also covered with no copay or coinsurance up to a $200 yearly limit, but other eye exam services and eyewear upgrades are not covered.
Dental Services See details
BlueCHiP for Medicare Access (HMO-POS) partially covers dental services, offering Medicare-covered dental with no copay and a 20% coinsurance, and other covered dental services with no copay and no coinsurance up to a $1,500 annual maximum. Uncovered services include other diagnostic, other preventive, maxillofacial prosthetics, implant services, and orthodontics.
Home Infusion bundled Services See details
BlueCHiP for Medicare Access (HMO-POS) covers home infusion bundled services with no copay. Under this benefit, Medicare Part B insulin drugs require a $35 copay and no coinsurance, while chemotherapy and other Part B drugs have a coinsurance ranging from 0% (no coinsurance) to 20%.
Dialysis Services See details
BlueCHiP for Medicare Access (HMO-POS) covers dialysis services with no copay and a 20% coinsurance.
Medical Equipment See details
BlueCHiP for Medicare Access (HMO-POS) covers medical equipment with no copays and a 20% coinsurance for durable medical equipment, prosthetic devices, medical supplies, and diabetic therapeutic shoes and inserts. This benefit is partially covered, as diabetic supplies are not covered under the plan.
Diagnostic and Radiological Services See details
BlueCHiP for Medicare Access (HMO-POS) covers diagnostic and radiological services with prior authorization, though lab services are not covered. Diagnostic procedures require a $50 copay with no coinsurance, diagnostic radiological services have no copay or coinsurance, outpatient X-rays require a $25 copay and coinsurance, and therapeutic radiological services require 20% coinsurance.
Home Health Services See details
Home health services are covered by BlueCHiP for Medicare Access (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 Access (HMO-POS) with no copay and no coinsurance, but some services are covered in practice as cardiac, intensive cardiac, pulmonary, and SET for PAD rehabilitation services are not covered.
Skilled Nursing Facility (SNF) See details
BlueCHiP for Medicare Access (HMO-POS) covers Skilled Nursing Facility (SNF) services with no coinsurance and does not require a prior three-day hospital stay, though prior authorization is required. There is no copay for days 1 to 20 and days 46 to 100, a $218 daily copay for days 21 to 45, and additional days beyond the 100-day limit are not covered.
Other Services See details
BlueCHiP for Medicare Access (HMO-POS) partially covers other services, featuring over-the-counter (OTC) items with no copay and no coinsurance up to a maximum of $50 every three months. Acupuncture, meal benefits, and naloxone are not covered under this plan.
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