BlueRI for Duals

BlueRI for Duals (HMO D-SNP)

This plan offers more benefits for $0 to members who are enrolled in both Medicare and Medicaid. A dedicated care team makes accessing high-quality care and services easy!

  • $0 monthly premium*
  • $0 copay for PCP & specialist visits
  • $0 copay for labs/X-rays
  • $0 copay for Part D drugs**
  • $0 drug deductible
  • $3,000 dental benefit including dentures and implants
  • $150/month grocery and over-the-counter (OTC) allowance (Flexible Benefit Card)**
  • $300/year vision hardware allowance (Flexible Benefit Card)
  • $1,500/year allowance for dental, hearing, and vision services (Flexible Benefit Card)
  • $0 rides (72 one-way rides)
  • Monthly fitness center benefit for $0
  • 120 hours/year of household help
  • $200 annual wellness reimbursement
  • $0 copay for virtual doctors’ visits 24/7
  • $0 copay for peer recovery services
  • $0 copay for acupuncture
  • $0 copay for non-skilled home health
  • 2 hearing aids for $0
  • $100 caregiver reimbursement
Need help?
Call 1-800-505-2583 (TTY: 711)
Need help?
Call (401) 277-2958 or 1-800-267-0439 (TTY: 711)

Monthly premium


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Copays & Details

Outpatient Care and Services1,2



Dental Services

Medicare-covered: $0
Preventive: $0
Comprehensive: $0
$3,000 limit on all covered dental services for preventive and comprehensive dental services. All preventive and comprehensive services must be provided by an in-network plan-contracted dentist.

Diabetes Supplies and Services

In-network: $0
You must use OneTouch plan-designated monitors and test strips.

Diagnostic Tests, Lab and Radiology Services, and X-Rays

$0 for lab services
$0 for diagnostic tests and X-rays
$0 for high-tech radiology services (for example, MRIs)

Emergency Care


Outpatient Hospital/Surgery


Hearing Services

Routine hearing: $0
Non-routine hearing: $0 copay
Hearing aids:
$0 per hearing aid (2 aids every 3 years)

Primary Care Physician Visit


Specialist Visit


Vision Visit

Routine vision: $0
Non-routine vision: $0
Vision hardware:
$300/year vision hardware allowance (Flexible Benefit Card)

Preventive Care


Inpatient Care1,2

Inpatient Hospital Care

$0 Days 1 and beyond
Our plan covers an unlimited number of days for an in-network inpatient hospital stay.

Skilled Nursing Facility

$0 per day for days 1-100
Our plan covers up to 100 days in a skilled nursing facility.



Prescription Deductible

No deductible

Initial Coverage (up to 30-day supply)**3

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

Mail Order (90-day Supply)


$0 copay for Tiers 1 and 2

Gap Coverage


$0 copay

* Your premium may be higher than this amount depending on your Low-Income Subsidy program (LIS) level. If you are eligible for Medicare cost-sharing assistance under Medicaid, you pay $0 for your deductible, doctor office visits, and inpatient hospital stays. If you lose your Medicaid, you will be responsible to pay copays.

** You must receive Low-Income Subsidy (LIS) or Extra Help to receive the grocery and over-the-counter (OTC) allowance as well as $0 Part D drug copays.

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 Extra, BlueCHiP for Medicare Preferred (HMO-POS), or the HealthMate for Medicare (PPO) plan. If you select the BlueCHiP for Medicare Value, BlueCHiP for Medicare Extra, BlueCHiP for Medicare Preferred, or the HealthMate for Medicare 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, Coverage Gap stage and the Catastrophic level stage.