Need help? Call the Medicare Sales team at 1-800-505-2583 (TTY:711).
Questions? Call the Medicare Concierge team at (401) 277-2958 or 1-800-267-0439 (TTY: 711).
Come back at the start of the Annual Election Period (October 15) to select and enroll in a plan.

BlueCHiP for Medicare

Standard with Drugs

Monthly premium


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One of our original BlueCHiP for Medicare plans that offers comprehensive coverage, the state’s largest Medicare Advantage network, and many extras, like a fitness benefit and a Flexible Benefit Card, all for a low monthly premium.


  • $0 copay for PCMH PCP visits
  • $0 labs/X-rays
  • $0 virtual doctors' visits 24/7
  • $15 acupuncture benefit 
  • $35 specialist visits
  • Flat dollar outpatient surgery copay

Prescription Drugs

  • $0 drug deductible
  • $0 Tier 1 and Tier 2 prescription copays at preferred pharmacies
  • $20 preferred insulin copay (30-day supply) or $50 (90-day). Copays will not increase, even through the coverage gap.*


  • $0 preventive and comprehensive dental
  • $0 for routine hearing and vision screenings
  • 2 hearing aids, starting at $0, annually
  • $200 vision hardware allowance
  • $220/year allowance for dental and hearing (Flexible Benefit Card)


  • $90/quarter over-the-counter (OTC) benefit for everyday health items (Flexible Benefit Card)
  • $0 fitness benefit
  • $0 rides
  • 40 hours/year of household help
Qualify for Extra Help and/or Medicaid? We have options for you.

What's covered

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Copays & Details
Outpatient Care and Services1,2



Dental Services

Medicare-covered: 20% of the cost

Preventive: $0
Comprehensive: $0

$1,500 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

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
$125 for high-tech radiology services (for example, MRIs)

Emergency Care

$90 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: $0
Non-routine hearing: $35 copay per visit

Hearing aids
$0-$1,475 copay per hearing aid (2 aids every year)

Outpatient Hospital/Surgery

Up to $275 copay per visit

Primary Care Provider Visit

$0 PCMH or $10 non-PCMH copay per visit

Specialist Visit

$35 copay per visit

Referral is required for specialist visits.

Vision Visit

Routine vision: $0
Non-routine vision: $35 copay per visit

Vision Hardware
Our plan offers a $200/year allowance for vision hardware.

Preventive Care


Inpatient Care1,2

Inpatient Hospital Care

$290 copay per day for days 1-5, $0 Days 6+

Our plan covers an unlimited number of days for an inpatient hospital stay.

Skilled Nursing Facility (SNF)

$0 copay per day for days 1-20
$140 copay per day for days 21-45
$0 copay per day for days 46-100

Our plan covers up to 100 days in a SNF.

Prescription Deductible

No deductible

Initial Coverage (up to 30-day supply)3

Tier 1 (Preferred Generic)

$0 copay

$8 copay

Tier 2 (Non-preferred Generic)

$0 copay

$16 copay

Tier 3 (Preferred Brand)

$47 copay

$47 copay

Tier 4 (Non-preferred Drug)

$100 copay

$100 copay

Tier 5 (Specialty Tier)

33% of the cost

33% of the cost

Preferred Mail Order (90-day Supply)

$0 copay for Tiers 1 and 2


Preferred Insulins (30-day Supply)



*$20 preferred insulin copay (30-day supply) or $50 (90-day) for preferred insulins on Tier 3. Tier 4 formulary insulins will have a $35 (30-day supply) or $105 (90-day) copay.

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 (HMO-POS), 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 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 Deductible stage, Initial Coverage stage, Coverage Gap stage, and the Catastrophic level stage.