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2025
Qualify for a Low-Income Subsidy (Extra Help) and/or Medicaid? We have options for you

HMO-POS Network

BlueCHiP for Medicare

Value

Monthly premium

$0.00

Max Out-of-Pocket

$5,250

PCP Copay

$0

Prescriptions

$0 - Tier 1; $5 - Tier 2

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HMO-POS Network

BlueCHiP for Medicare

Extra

Monthly premium

$111.00

Max Out-of-Pocket

$4,500

PCP Copay

$0

Prescriptions

$0 - Tiers 1 and 2

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HMO-POS Network

BlueCHiP for Medicare

Enhanced

Monthly premium

$38.00

Max Out-of-Pocket

$4,800

PCP Copay

$0

Prescriptions

$0 - Tier 1; $3 - Tier 2

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HMO-POS Network

BlueCHiP for Medicare

Access

Monthly premium

$0.00

Max Out-of-Pocket

$5,000

PCP Copay

$0

Prescriptions

$0

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HMO Network

BlueCHiP for Medicare

Plus

Monthly premium

$120.00

Max Out-of-Pocket

$3,500

PCP Copay

$0

Prescriptions

$3 - Tier 1; $6 - Tier 2

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HMO-POS Network

BlueCHiP for Medicare

Preferred

Monthly premium

$227.00

Max Out-of-Pocket

$3,000

PCP Copay

$0

Prescriptions

$3 - Tier 1; $6 - Tier 2

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HMO Network

BlueCHiP for Medicare

Core

Monthly premium

$0.00

Max Out-of-Pocket

$4,000

PCP Copay

$0

Prescriptions

Not Covered

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