Monthly premium
The new Access (HMO-POS) plan, with its $0 premium*, offers a more affordable range of benefits. And when you qualify for Extra Help, you get even more $0 coverage and benefits like:
- A monthly allowance for groceries* and everyday health items
- $0 rides to appointments
- $0 copays for all Part D drugs*
Our wide (and growing) network includes 12,000 providers and all Rhode Island hospitals, making it easier to get the care you need without traveling far.
Not sure what plan you need? Use the plan recommendation tool.
Medical
- $0 monthly premium*
- $0 copay for primary care visits
- $0 labs/X-rays
- $30 specialist visits:
$0 if you have a High-Value Provider^ - $35 physical/speech/occupational therapy:
$0 if you have a High-Value Provider^ - Out-of-network coverage
Prescription Drugs
- $0 drug deductible
- $0 Part D drugs*
Dental/Hearing/Vision
- $0 preventive and comprehensive dental
- $1,500/year dental benefit maximum
- $0 for routine hearing and vision screenings
- Get $175/year allowance for dental and hearing (Flexible Benefit Card)
- Get $200/year allowance for eyewear
Extras
- $0 gym and home fitness benefit
- $0 rides (12 one-way rides)
- Get $75/month* to spend on groceries* and over-the-counter (OTC) everyday health items (Flexible Benefit Card)
Qualify for Medicare + Medicaid?
Tools to help you choose:
See if your doctor is in the network
Ambulance
$175 copay per trip
$100 copay per trip
Diagnostic Tests, Lab and Radiology Services, and X-rays
In-network
$0 for lab services
$0 for diagnostic tests and X-rays
$150 for high-tech radiology services (for example, MRIs)
Out-of-network
20% of the cost
In-network
$0 for lab services
$0 for diagnostic tests and X-rays
$75 for high-tech radiology services (for example, MRIs)
Out-of-network
20% of the cost
Emergency Care
$125 copay per visit
If you are admitted to the hospital within 24 hours, you do not have to pay your share of the cost for emergency care.
$50 copay per visit
If you are admitted to the hospital within 24 hours, you do not have to pay your share of the cost for emergency care.
Hearing Services
Routine hearing
In-network: $0
Out-of-network: 20% of the cost
Non-routine hearing
In-network: $30 copay per visit
Out-of-network: 20% of the cost
Hearing aids
$0-$1,475 copay per hearing aid (2 aids every 3 years)
Routine hearing
In-network: $0
Out-of-network: 20% of the cost
Non-routine hearing
In-network: $0 copay per visit
Out-of-network: 20% of the cost
Hearing aids
$0-$1,475 copay per hearing aid (2 aids every 3 years)
Outpatient Hospital/Surgery
In-network:
Up to $275 copay per visit for ambulatory surgical center based services.
Up to $375 copay per visit for hospital based services.
Out-of-network:
20% of the cost
In-network:
Up to $150 copay per visit for ambulatory surgical center based services.
Up to $150 copay per visit for hospital based services.
Out-of-network:
20% of the cost
Specialist Visit
In-network: $30 copay per visit
Out-of-network: 20% of the cost
Referral is required for specialist visits.
In-network: $0 copay per visit
Out-of-network: 20% of the cost
Referral is required for specialist visits.
Vision Visit
Routine vision
In-network: $0
Out-of-network: 20% of the cost
Non-routine vision
In-network: $30 copay per visit
Out-of-network: 20% of the cost
Vision Hardware
Our plan offers a $200/year allowance for vision hardware.
Routine vision
In-network: $0
Out-of-network: 20% of the cost
Non-routine vision
In-network: $0 copay per visit
Out-of-network: 20% of the cost
Vision Hardware
Our plan offers a $200/year allowance for vision hardware.
Inpatient Hospital Care
In-network
$395 copay per day for days 1-5
$0 Days 6+
Out-of-network
20% of the cost
In-network
$150 copay per day for days 1-5
$0 Days 6+
Out-of-network
20% of the cost
Skilled Nursing Facility (SNF)
In-network
$0 copay per day for days 1-20
$214 copay per day for days 21-45
$0 copay per day for days 46-100
Out-of-network
20% of the cost
Our plan covers up to 100 days in a SNF.
In-network
$0 copay per day for days 1-20
$100 copay per day for days 21-45
$0 copay per day for days 46-100
Out-of-network
20% of the cost
Our plan covers up to 100 days in a SNF.
No deductible
Tier 1 (Preferred Generic)
$0 copay
Tier 2 (Non-preferred Generic)
$0 copay
Tier 3 (Preferred Brand)
$0 copay
Tier 4 (Non-Preferred Drug)
$0 copay
Tier 5 (Specialty Tier)
$0 copay
Insulins (30-day supply)
$0 copay
Mail Order (100-day Supply)
$0 for Tiers 1 and 2
*Premium and benefits displayed are for members who qualify for Extra Help, also known as Low-Income Subsidy. Medicare approved Blue Cross & Blue Shield of Rhode Island to provide these benefits and lower co-payments as part of the Value-Based Insurance Design program. This program lets Medicare try new ways to improve Medicare Advantage plans.
^Additional Benefits are available to members who have selected a High-Value Provider as their Primary Care Provider. High-Value Provider network consists of Care New England, Oak Street Health, and Prospect CharterCARE primary care provider (PCP) groups. This list is current as of July 1, 2024, and is subject to change. Visit bcbsri.com/finddoctor for the most up-to-date provider listing. High-Value Providers (HVP) are PCP groups with patient-centered and innovative care models that coordinate interdisciplinary care. HVPs offer programs that focus on improving member health outcomes and have offices in historically underserved areas.
1 The out-of-pocket maximum includes only Medicare-covered services. This is the most a member would pay for these services during a calendar year. You must receive all routine care from plan providers unless you select the BlueCHiP for Medicare Value (HMO-POS), BlueCHiP for Medicare Enhanced (HMO-POS), BlueCHiP for Medicare Extra (HMO-POS), BlueCHiP for Medicare Preferred (HMO-POS), or the BlueCHiP for Medicare Access (HMO-POS) plan. If you select the BlueCHiP for Medicare Value, BlueCHiP for Medicare Enhanced (HMO-POS), BlueCHiP for Medicare Extra, BlueCHiP for Medicare Preferred, or the BlueCHiP for Medicare Access (HMO-POS) plan, with the exception of emergency or urgent care, ambulance, or dialysis services, it may cost more to get care from out-of-network providers.
2 A preauthorization may be required. Review may include but is not limited to pre-authorization and/or continued treatment by the plan and/or plan designee. Contact Plan for details.
3 You must use network pharmacies to access your prescription drug benefit, except under non-routine circumstances, quantity limitations and restrictions may apply. Please refer to the Summary of Benefits or the Evidence of Coverage for prescription drug cost share information in a long-term care setting, mail order and extended day retail supplies as well as detailed benefit information concerning the Initial Coverage stage, and the Catastrophic level stage.