Go Back

BlueCHiP for Medicare Access (HMO-POS)

H4152 - 022 - 0
4.5 out of 5 stars (4.5 / 5)

BlueCHiP for Medicare Access (HMO-POS) is a Medicare Advantage Plan by Blue Cross & Blue Shield of Rhode Island.

This page features plan details for 2025 BlueCHiP for Medicare Access (HMO-POS) H4152 – 022 – 0 available in State of Rhode Island.

Locations

BlueCHiP for Medicare Access (HMO-POS) is offered in the following locations.

Bristol County, Rhode Island
Kent County, Rhode Island
Newport County, Rhode Island

Click to see more locations

Plan Overview

BlueCHiP for Medicare Access (HMO-POS) offers the following coverage and cost-sharing.

Insurer:Blue Cross & Blue Shield of Rhode Island
Health Plan Deductible:$0
MOOP:$5,000 In-network
$10,000 Out-of-network
Drugs Covered:Yes

Ready to sign up for BlueCHiP for Medicare Access (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Premium Breakdown

BlueCHiP for Medicare Access (HMO-POS) has a monthly premium of $6.00. This amount includes your Part C and D premiums but does not include your Part B premium. The following is a breakdown of your monthly premium with Part B costs included.
Part B Part C Part D Part B Give Back Total
$185.00 $0.00 $6.00 $ $
Please Note:
  • Your Part B premium may differ based on factors including late enrollment, income, and disability status.
  • You may also qualify for “Extra Help” on drug costs. See the Part D Premium Reduction section below for more details.

Drug Info

BlueCHiP for Medicare Access (HMO-POS) provides the following cost-sharing on drugs. Please check the plan’s formulary for specific drugs covered.

Drug Deductible: $590.00
Drug Out-Of-Pocket maximum: $2,000.00
Drug Benefit Type: Defined Standard

Part D Premium Reduction

The Low-Income Subsidy (also known as LIS or “Extra Help”) helps people with Medicare lower the cost of prescription drugs.

The table below shows how the LIS impacts the Part D premium of this plan.

Part DLIS Full
$6.00$0.00

Initial Coverage Phase

After you pay your $590.00 drug deductible, you will pay the following costs for drugs in each tier until your total drug costs (including what this plan has paid and what you have paid) reach $2,000.00. Once you reach that amount, you will enter the next coverage phase.

Catastrophic Coverage Phase

After your yearly out-of-pocket drug costs (including drugs purchased through your retail pharmacy and through mail order) reach $2,000.00, you pay nothing for Medicare Part D covered drugs.

Additional Benefits

BlueCHiP for Medicare Access (HMO-POS) also provides the following benefits.

Additional benefits and/or reduced cost-sharing for enrollees with certain health conditions?

    • In-Network: Yes, contact plan for further details

Comprehensive Dental

  • Adjunctive General Services
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Endodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Oral and Maxillofacial Surgery
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Periodontics
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Prosthodontics, fixed
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Prosthodontics, removable
    • In-Network: No Coins – No Co pay (Limits Apply)
  • Restorative Services
    • In-Network: No Coins – No Co pay (Limits Apply)

Diagnostic and Preventive Dental

  • Dental X-Rays
    • In-Network: No Coins – No Copay
  • Fluoride Treatment
    • In-Network: No Coins – No Copay
  • Oral Exams
    • In-Network: No Coins – No Copay
  • Prophylaxis (cleaning)
    • In-Network: No Coins – No Copay

Diagnostic procedures/lab services/imaging

  • Outpatient x-rays
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Diagnostic radiology services (e.g., MRI)
    • In-Network: $150 copay (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Outpatient x-rays
    • In-Network: $0 copay (Authorization Required)
  • Lab services
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Diagnostic tests and procedures
    • In-Network: $0 copay (Authorization Required)
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Lab services
    • In-Network: $0 copay (Authorization Required)

Doctor visits

  • Primary
    • In-Network: $0 copay
  • Specialist
    • Out-of-Network: 20% coinsurance per visit (Referral Required)
    • In-Network: $30 copay per visit (Referral Required)
  • Primary
    • Out-of-Network: 20% coinsurance per visit

Emergency care/Urgent care

  • Emergency
    • $125 copay per visit (always covered)
  • Urgent care
    • $55 copay per visit (always covered)

Foot care (podiatry services)

  • Routine foot care
    • In-Network: $30 copay (Referral Required)
  • Foot exams and treatment
    • In-Network: $30 copay (Referral Required)
    • Out-of-Network: 20% coinsurance (Referral Required)

Ground ambulance

    • In-Network: $175 copay
    • Out-of-Network: $175 copay

Health plan deductible

    • $0

Hearing

  • Hearing aids
    • In-Network: $0-1,475 copay (Limits Apply)
  • Hearing aids OTC
    • Not covered
  • Medicare-Covered Hearing Exam
    • In-Network: $30 copay
  • Fitting/evaluation
    • In-Network: $0 copay (Limits Apply)
  • Medicare-Covered Hearing Exam
    • Out-of-Network: 20% coinsurance

Inpatient hospital coverage

    • In-Network: $395 per day for days 1 through 5
      $0 per day for days 6 through 90 (Authorization Required)
    • Out-of-Network: 20% per day for days 1 through 90 (Authorization Required)

Maximum out-of-pocket enrollee responsibility (does not include prescription drugs)

    • $5,000 In-network
      $10,000 Out-of-network

Medical equipment/supplies

  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • In-Network: 20% coinsurance per item (Authorization Required)
  • Prosthetics (e.g., braces, artificial limbs)
    • In-Network: 20% coinsurance per item
    • Out-of-Network: 20% coinsurance per item
  • Diabetes supplies
    • In-Network: $0 copay
    • Out-of-Network: 20% coinsurance per item
  • Durable medical equipment (e.g., wheelchairs, oxygen)
    • Out-of-Network: 20% coinsurance per item (Authorization Required)

Medicare Part B drugs

  • Chemotherapy
    • In-Network: 0-20% coinsurance
    • Out-of-Network: 20% coinsurance
  • Other Part B drugs
    • In-Network: 0-20% coinsurance
    • Out-of-Network: 20% coinsurance

Mental health services

  • Inpatient hospital – psychiatric
    • Out-of-Network: 20% per day for days 1 through 90
  • Outpatient group therapy visit with a psychiatrist
    • Out-of-Network: 20% coinsurance
  • Outpatient individual therapy visit
    • In-Network: $35 copay
  • Outpatient group therapy visit
    • Out-of-Network: 20% coinsurance
  • Outpatient group therapy visit with a psychiatrist
    • In-Network: $35 copay
  • Outpatient individual therapy visit
    • Out-of-Network: 20% coinsurance
  • Inpatient hospital – psychiatric
    • In-Network: $395 per day for days 1 through 5
      $0 per day for days 6 through 90
  • Outpatient individual therapy visit with a psychiatrist
    • In-Network: $35 copay
  • Outpatient group therapy visit
    • In-Network: $35 copay
  • Outpatient individual therapy visit with a psychiatrist
    • Out-of-Network: 20% coinsurance

Optional supplemental benefits

    • No

Other health plan deductibles?

    • In-Network: No

Outpatient hospital coverage

    • Out-of-Network: 20% coinsurance per visit (Authorization Required)
    • In-Network: $0-375 copay per visit (Authorization Required)

Preventive care

    • Out-of-Network: 20% coinsurance
    • In-Network: $0 copay

Rehabilitation services

  • Occupational therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • In-Network: $35 copay (Authorization Required)
  • Occupational therapy visit
    • Out-of-Network: 20% coinsurance (Authorization Required)
  • Physical therapy and speech and language therapy visit
    • Out-of-Network: 20% coinsurance (Authorization Required)

Skilled Nursing Facility

    • In-Network: $0 per day for days 1 through 20
      $214 per day for days 21 through 45
      $0 per day for days 46 through 100 (Authorization Required)
    • Out-of-Network: 20% per day for days 1 through 100 (Authorization Required)

Transportation

    • In-Network: $0 copay (Limits Apply)

Vision

  • Contact lenses
    • In-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • Out-of-Network: 20% coinsurance (Limits Apply)
  • Eyeglass lenses
    • In-Network: $0 copay (Limits Apply)
  • Eyeglass frames
    • In-Network: $0 copay (Limits Apply)
  • Routine eye exam
    • In-Network: $0 copay (Limits Apply)
  • Upgrades
    • Not covered
  • Eyeglasses (frames and lenses)
    • In-Network: $0 copay (Limits Apply)
  • Other
    • Not covered

Wellness programs (e.g., fitness, nursing hotline)

    • Covered

Ready to sign up for BlueCHiP for Medicare Access (HMO-POS) ?

Get help from a licensed insurance agent.

Call 1-877-354-4611 / TTY 711.

M-F: 8:00 am – 10:00 pm EST

Sat-Sun: 8:00 am – 9:00 pm EST

Table of Contents

Get Help Enrolling

Get help enrolling in a Medicare Advantage or Medicare Prescription Drug Plan by calling a licensed insurance agent today.

Medicare Advantage and Part D plans and benefits offered by the following carriers: Aetna Medicare, Anthem Blue Cross Blue Shield, Anthem Blue Cross, Aspire Health Plan, Capital Blue Cross, Cigna Healthcare, Dean Health Plan, Devoted Health, Florida Blue Medicare, GlobalHealth, Health Care Service Corporation, Healthy Blue, Humana, Molina Healthcare, Mutual of Omaha, Premera Blue Cross, Medica Central Health Plan, SCAN Health Plan, Baylor Scott & White Health Plan, Simply, UnitedHealthcare(R), Wellcare, WellPoint

SMID: MULTIPLAN_HCIHNDOGMED01PY25_M

Factsonmedicare.com is a free-to-use informational website by Dog Media Solutions LLC. All insurance agents and enrollment platforms linked to this site have their own terms and conditions.

Medicare has neither approved nor endorsed any information on this site.

This is a promotional communication.

Every year, Medicare evaluates plans based on a 5-star rating system.

Part B premium reduction is not available with all plans. Availability varies by carrier and location. Actual Part B premium reduction could be lower. Deductibles, copays and coinsurance may apply.

All plan-related information on this site is from CMS.gov and Medicare.gov. We only use data released publicly each year. While our goal is always to provide fact-based, accurate information, information is subject to change, and some data may be inaccurate. Contact a plan for a Summary of Benefits.

Enrollment in Medicare/Medicare Advantage may be limited to certain times of the year unless you qualify for a Special Enrollment Period.

We do not offer every plan available in your area. Currently, we represent 18 organizations, which offer 52,101 products in your area. Please contact Medicare.gov, 1-800-MEDICARE, or your local State Health Insurance Program (SHIP) to get information on all of your options.

We represent Medicare Advantage HMO, PPO and PFFS organizations and stand-alone PDP prescription drug plans that are contracted with Medicare. Enrollment depends on the plan’s contract renewal.

Not all plans offer all of these benefits. Benefits may vary by carrier and location. Limitations and exclusions may apply.

© All rights reserved | About | Contact | Legal and Privacy