BlueCHiP for Medicare Advance (HMO)


Medicare Plan Details

2021 Plan
Monthly Premium
(select county for price)

 

by Blue Cross & Blue Shield of Rhode Island
Additional Coverage
Hearing Vision
Overall Government Star Rating
 4.0
out of 5 stars

State: Rhode Island

Select your county to view the price for this plan

 


Plan Type

Medicare Advantage (Part C) with Prescription Drug (Part D)

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

 

$0
$0
$0
$0
$5,000 In-network
No
Yes
Yes
No

Medical Benefits

Doctor Services

$0 copay
$35 copay per visit

Tests, labs, & imaging

$5 copay
$5 copay
$200 copay
$5 copay
$90 copay per visit (always covered)
$60 copay per visit (always covered)

Hospital Services

$375 per day for days 1 through 5
$0 per day for days 6 through 90
$350 copay per visit

Skilled nursing facility

$0 per day for days 1 through 20
$160 per day for days 21 through 45
$0 per day for days 46 through 100

Preventive services

$0 copay

Ambulance

$150 copay

Therapy services

$40 copay
$40 copay

Mental health services

$40 copay
$40 copay
$40 copay
$40 copay

Opioid treatment services

Covered

Other services

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

Prescription Drug Benefits

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

TiersInitial coverage phaseGap coverage phaseCatastrophic coverage phase
Preferred Generic$10.00 copay


Generic drugs :
25%

Brand-name drugs :
25%


Generic drugs :
$3.70 copay or 5% (whichever costs more)

Brand-name drugs :
$9.20 copay or 5% (whichever costs more)

Generic$17.00 copay
Preferred Brand$47.00 copay
Non-Preferred Drug$100.00 copay
Specialty Tier29%

Part B Drugs

20% coinsurance
20% coinsurance

Extra Benefits

Hearing

$35 copay
$0 copay
$0 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
 4
 4
 4
 3
 5
 5
 4.5
 5
 5
 3
 5

When Can I Sign Up for Medicare?

Enter your birthday month and year to learn when you can sign up for different Medicare plan options.

 

 


Advertisement

Medicare Signup Help

Quote & Compare

 

Medicare65quote

Get Quote  

 

-or call-

(888) 763-2752

TTY 711

Find your plan online or speak with a licensed insurance agent to compare your options and get help signing up for the right plan for you!