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BlueCHiP for Medicare Essential (HMO-POS)
Benefits Summary and Overview
This page is a benefits summary and overview of key plan information for BlueCHiP for Medicare Essential (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 Essential (HMO-POS) in 2026, please refer to our full plan details page.
BlueCHiP for Medicare Essential (HMO-POS) is a HMO-POS plan offered by Blue Cross & Blue Shield of Rhode Island available for enrollment in 2026 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 Essential (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 Essential (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 Essential (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 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 $15000.00 for in-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $15000.00 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 $6750.00 for out-of-network services. You will pay copays, coinsurance, and deductibles toward this amount. Once your total out-of-pocket costs reach $15000.00 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 Essential (HMO-POS) plan features an annual drug deductible of $615. For Tier 1 preferred generic drugs, there is no copay at standard pharmacies or through preferred mail order for multi-month supplies. Tier 2 generic medications cost as low as a $2 copay for a one-month supply at standard pharmacies, and they feature no copay for two-month and three-month supplies filled through preferred mail order. Higher-tier medications under this plan are subject to coinsurance instead of flat copays. Tier 3 preferred brands and Tier 5 specialty drugs both require a 25% coinsurance across standard pharmacies and mail order options. Tier 4 non-preferred drugs carry a 30% coinsurance for standard pharmacy and mail order fills.
Additional Benefits
BlueCHiP for Medicare Essential (HMO-POS) offers affordable everyday healthcare with no copay or coinsurance for primary care, telehealth, preventive care, and home health services. When specialized care is needed, the plan utilizes predictable copays, such as $50 for specialist visits, $130 for emergency room care, and a daily copay of $458 for the first six days of acute inpatient hospital stays. Most outpatient and inpatient services feature no coinsurance, helping to keep your medical costs manageable. For routine specialty care, members pay a $50 copay for annual hearing and eye exams, while preventive dental care is covered with no copay or coinsurance up to a $500 limit. Durable medical equipment and dialysis services require no copay but carry coinsurance rates of 25% and 20% respectively. This plan provides a balanced mix of no-cost routine services and clear, structured cost-sharing for advanced medical care.
Inpatient Hospital See details
BlueCHiP for Medicare Essential (HMO-POS) provides partially covered inpatient hospital services with no coinsurance, requiring a daily copay of $458 for days 1 through 6 of acute stays and $390 for days 1 through 6 of psychiatric stays. There is no copay for additional days, but upgrades and non-Medicare-covered stays are not covered.
Outpatient Services See details
BlueCHiP for Medicare Essential (HMO-POS) covers outpatient services with no coinsurance, including ambulatory surgical center and blood services which feature no copay. Outpatient hospital services require a $0 to $550 copay, observation services have a $550 copay per stay, and outpatient substance abuse sessions have a copay of $0 to $50.
Partial Hospitalization See details
Partial hospitalization is covered by BlueCHiP for Medicare Essential (HMO-POS) with a $140.00 copay and no coinsurance.
Ambulance and Transportation Services See details
BlueCHiP for Medicare Essential (HMO-POS) covers ground and air ambulance services with a $200 copay and no coinsurance, although prior authorization is required. Transportation services to plan-approved or other health-related locations are not covered under this plan.
Emergency Services See details
BlueCHiP for Medicare Essential (HMO-POS) covers emergency services with a $130 copay, waived if admitted to the hospital within one day, and urgently needed services with a $50 copay, both with no coinsurance and subject to the plan-level deductible. Worldwide emergency, urgent, and emergency transportation services are also covered with no coinsurance and copays of $130, $50, and $200, respectively.
Primary Care See details
BlueCHiP for Medicare Essential (HMO-POS) covers primary care and telehealth services with no copay and no coinsurance, while specialist visits, mental health, and physical therapy have copays ranging from $0 to $50 and no coinsurance. Podiatry and opioid treatment services require a $50 copay and no coinsurance, but chiropractic services are not covered.
Preventive Services See details
BlueCHiP for Medicare Essential (HMO-POS) offers partially covered preventive services with no copay and no coinsurance for covered benefits such as annual physical exams, kidney disease education, and health education. However, some specific supplemental services, including personal emergency response systems, weight management programs, and in-home support services, are not covered.
Hearing Services See details
BlueCHiP for Medicare Essential (HMO-POS) covers one routine hearing exam every year with a $50 copay, no coinsurance, and no deductible. Hearing aid fittings, evaluations, prescription hearing aids, and over-the-counter (OTC) hearing aids are not covered.
Vision Services See details
BlueCHiP for Medicare Essential (HMO-POS) covers one routine eye exam per year with a $50 copay, no coinsurance, and no deductible, though other eye exam services are not covered. Eyewear is partially covered with no copay, no coinsurance, and no deductible up to a $100 annual maximum for contacts and eyeglasses, excluding upgrades.
Dental Services See details
BlueCHiP for Medicare Essential (HMO-POS) dental services are partially covered, featuring Medicare-covered dental care with no copay and a 20% coinsurance. Preventive services including exams, cleanings, x-rays, and fluoride are covered with no copay and no coinsurance up to a $500 annual limit, though restorative, endodontic, and orthodontic services are not covered.
Home Infusion bundled Services See details
BlueCHiP for Medicare Essential (HMO-POS) covers home infusion bundled services with no copay and no coinsurance. Covered Medicare Part B chemotherapy and other infusion drugs require no copay and a coinsurance ranging from no coinsurance to 20%, while Part B insulin is covered with a $35 copay and no coinsurance.
Dialysis Services See details
Dialysis Services are covered by BlueCHiP for Medicare Essential (HMO-POS) with no copay and a 20% coinsurance.
Medical Equipment See details
BlueCHiP for Medicare Essential (HMO-POS) partially covers medical equipment with no copay and a 25% coinsurance for durable medical equipment, prosthetics, medical supplies, and diabetic therapeutic shoes, though diabetic supplies are not covered. Prior authorization is required for durable medical equipment, and select equipment may be limited to preferred vendors or manufacturers.
Diagnostic and Radiological Services See details
BlueCHiP for Medicare Essential (HMO-POS) partially covers diagnostic and radiological services, as lab services are not covered. Diagnostic tests require a $50 copay and no coinsurance, diagnostic radiological services have no copay or coinsurance, outpatient X-rays require a $25 copay and coinsurance, and therapeutic radiological services require a copay and 20% coinsurance.
Home Health Services See details
Home health services are covered under BlueCHiP for Medicare Essential (HMO-POS) with no copay and no coinsurance. Prior authorization is required to receive these services.
Cardiac Rehabilitation Services See details
Cardiac rehabilitation services are covered by BlueCHiP for Medicare Essential (HMO-POS) with no coinsurance, though some services are not covered, including standard and intensive cardiac rehabilitation (each with a $40 copay), pulmonary rehabilitation ($35 copay), and supervised exercise therapy for peripheral artery disease ($25 copay).
Skilled Nursing Facility (SNF) See details
Skilled Nursing Facility (SNF) services are covered by BlueCHiP for Medicare Essential (HMO-POS) with no coinsurance, requiring a $10 daily copay for days 1 through 20 and a $218 daily copay for days 21 through 100. This benefit requires prior authorization, does not require a prior three-day hospital stay, and is partially covered as additional days beyond standard Medicare limits are not covered.
Other Services See details
BlueCHiP for Medicare Essential (HMO-POS) technically covers other services, but in practice, acupuncture, over-the-counter (OTC) items, and meal benefits are not covered. Because these supplemental benefits are not covered by the plan, members do not have a copay or coinsurance and must pay the full cost out of pocket.
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