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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 2025, 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 4.5 out of 5 stars in 2025.
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 $6.00. 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 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 $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 $5000.00 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 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. If you qualify for the low-income subsidy (LIS), you will pay $6.00 for Part D drugs. During the catastrophic coverage phase, you pay nothing for covered drugs after your yearly out-of-pocket drug costs reach $2000.
Additional Benefits
The BlueCHiP for Medicare Access (HMO-POS) plan offers a range of benefits with varying costs. Inpatient hospital stays have a copay, but many outpatient services have either no copay or a low copay, including primary care and preventive services. Additional benefits include coverage for hearing and vision services, and dental services with a maximum annual benefit. Emergency services, ambulance services, and transportation to health-related locations are covered, with copays applying. The plan also covers home health services and skilled nursing facility stays with specific copay structures. However, some services like cardiac rehabilitation, acupuncture, and certain home-based services are not covered.
Inpatient Hospital See details
Inpatient Hospital benefits include Inpatient Hospital-Acute and Inpatient Hospital Psychiatric, with a copay of $395 for days 1-5 and no copay for days 6-90. Additional days for both Inpatient Hospital-Acute and Psychiatric are covered, but non-Medicare-covered stays and upgrades are not covered.
Outpatient Services See details
Outpatient Services, including outpatient hospital services and observation services, are covered. Outpatient hospital services have a copay between $0 and $375, and observation services have a $375 copay. Ambulatory Surgical Center (ASC) Services have no copay, and outpatient substance abuse services have a $35 copay for both individual and group sessions. Outpatient blood services are also covered.
Partial Hospitalization See details
Partial Hospitalization is covered under the BlueCHiP for Medicare Access (HMO-POS) plan. You will have a $50 copay for this benefit.
Ambulance and Transportation Services See details
Ambulance and Transportation Services are covered, including both ground and air ambulance services with a $175 copay. Transportation Services to a plan-approved health-related location are covered for up to 12 one-way trips per year, with the mode of transportation including taxi, bus/subway, medical transport, or other, while transportation to any health-related location is not covered.
Emergency Services See details
Emergency Services, Urgently Needed Services, and Worldwide Emergency Services are covered by the BlueCHiP for Medicare Access (HMO-POS) plan. Emergency Services has a $125 copay, Urgently Needed Services has a $55 copay, Worldwide Emergency Coverage has a $125 copay, Worldwide Urgent Coverage has a $55 copay, and Worldwide Emergency Transportation has a $175 copay; all services have no coinsurance.
Primary Care See details
The BlueCHiP for Medicare Access (HMO-POS) plan covers Primary Care Physician Services, Occupational Therapy Services, Mental Health Specialty Services (Individual and Group Sessions), Psychiatric Services (Individual and Group Sessions), Physical Therapy and Speech-Language Pathology Services, Additional Telehealth Benefits, and Opioid Treatment Program Services. Chiropractic Services require a doctor referral and have a $20 copay, Physician Specialist Services require a referral and have a $30 copay, and the plan also covers Podiatry Services, and Other Health Care Professional services, with copays of $30, and between $15-$30 respectively.
Preventive Services See details
The BlueCHiP for Medicare Access (HMO-POS) plan covers preventive services, including Medicare-covered services with no copay, annual physical exams, and additional preventive services with a copay for remote access technologies, ranging from $0 to $35. The plan also covers 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, kidney disease education services, glaucoma screening, diabetes self-management training, barium enemas, digital rectal exams, and EKGs following a welcome visit. However, 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 Services include routine hearing exams with a $30 copay, fitting/evaluation for hearing aids, and prescription hearing aids with a copay between $0 and $1475. Prescription Hearing Aids - Inner Ear, Prescription Hearing Aids - Outer Ear, Prescription Hearing Aids - Over the Ear, and OTC Hearing Aids are not covered.
Vision Services See details
Vision services include coverage for eye exams with a $30 copay, and eyewear with a combined maximum benefit of $200 every year. Contact lenses, eyeglasses (lenses and frames), and eyeglass lenses and frames are covered, but 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 $1500 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). Maxillofacial prosthetics, implant services, and orthodontics are not covered.
Home Infusion bundled Services See details
Home Infusion bundled Services are covered, including Medicare Part B Insulin Drugs with a $35 copay. Medicare Part B Chemotherapy/Radiation Drugs and Other Medicare Part B Drugs have a coinsurance between 0% and 20%.
Dialysis Services See details
Dialysis Services are covered under the BlueCHiP for Medicare Access (HMO-POS) plan with a coinsurance of 20%.
Medical Equipment See details
Medical Equipment benefits include Durable Medical Equipment (DME) with 20% coinsurance and no copay, Prosthetic Devices with 20% coinsurance and no copay, and Medical Supplies with 20% coinsurance and no copay. Durable Medical Equipment for use outside the home and Diabetic Supplies are not covered, and Diabetic Therapeutic Shoes/Inserts have a 20% coinsurance and no copay.
Diagnostic and Radiological Services See details
Diagnostic and Radiological Services are covered by the BlueCHiP for Medicare Access (HMO-POS) plan. Diagnostic procedures, tests, and lab services are not covered, while diagnostic radiological services have a maximum copay of $150, and therapeutic radiological services have a coinsurance of at most 20%.
Home Health Services See details
Home Health Services are covered by the BlueCHiP for Medicare Access (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 not covered under the BlueCHiP for Medicare Access (HMO-POS) plan. This includes Medicare-covered Intensive Cardiac Rehabilitation Services, Medicare-covered Pulmonary Rehabilitation Services, Additional Cardiac Rehabilitation Services and SET for PAD Services.
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by the BlueCHiP for Medicare Access (HMO-POS) plan, but require prior authorization. There is no copay for days 1-20 and days 46-100, but there is a $214 copay for days 21-45.
Other Services See details
The BlueCHiP for Medicare Access (HMO-POS) plan does not cover acupuncture, 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, or Self-Directed Personal Assistance Services. Over-the-counter items are covered with a maximum benefit of $60 every three months, including Nicotine Replacement Therapy (NRT), while the meal benefit is covered for a chronic illness.
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