BlueCHiP for Medicare Core (HMO)

Medicare Plan Details (2022 Plan)


Monthly Premium

 

by Blue Cross Blue Shield of Rhode Island
Additional Coverage
HearingVision
Overall Government Star Rating
 5.0
out of 5 stars

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Plan Type

Medicare Advantage (Part C)

Medicare Advantage combines Part A and Part B. This plan = Part A + Part B

 

$0
$0
$0
$0
$3,500 In-network
No
Yes
Yes
No

Doctor Services

$0-5 copay per visit
$25 copay per visit

Tests, labs, & imaging

$0 copay
$0 copay
$130 copay
$0 copay
$90 copay per visit (always covered)
$50 copay per visit (always covered)

Hospital Services

$180 per day for days 1 through 5
$0 per day for days 6 through 90
$150 copay per visit

Skilled nursing facility

$0 per day for days 1 through 20
$130 per day for days 21 through 45
$0 per day for days 46 through 100

Preventive services

$0 copay

Ambulance

$150 copay

Therapy services

$15 copay
$15 copay

Mental health services

$25 copay
$25 copay
$25 copay
$25 copay

Opioid treatment services

Covered

Other services

20% coinsurance per item
20% coinsurance per item
$0 copay per item

Tier drug costs for: Standard retail pharmacy drug cost for 1-month

Part B Drugs

20% coinsurance
20% coinsurance

Hearing

$25 copay
$0 copay
$200-1,675 copay

Preventive Dental

Not covered
Not covered
Not covered
Not covered

Comprehensive dental

Not covered
Not covered
Not covered
Not covered
Not covered
Not covered
Not covered

Vision

$0 copay
$0 copay
$0 copay
$0 copay
$0 copay
Not covered

Other benefits

Limited coverage
Limited coverage
Limited coverage
Not covered
Limited coverage
Limited coverage
Limited coverage
 5
 5
 4
 4
 5
 5

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