Monthly premium
Do you qualify for Medicare + Medicaid? If so, this plan will give you the most $0 benefits that we offer. You'll also get your very own Health Navigator to answer your questions, help with paperwork and appointments, and much more.
Questions? Call us at (401) 459-5477 or 1-855-430-9293 (TTY: 711).
Not sure what plan you need? Use the plan recommendation tool.
Medical
- $0 monthly premium
- $0 copay for primary care visits
- $0 specialist visits
- $0 labs/X-rays
- $0 inpatient hospital stay
- $0 outpatient surgery copay
- $0 skilled nursing facility
- $0 physical/speech/occupational therapy
Prescription Drugs
- $0 prescription drugs**
Dental/Hearing/Vision
- $0 hearing aids
- $0 preventive and comprehensive dental
- $0 for routine hearing and vision screenings
- Get $300/year for eyewear
- Get $1,500/year for dental and hearing (Flexible Benefit Card)
Extras
- $0 fitness benefit
- Get $165/month for groceries and over-the-counter (OTC) everyday health items (Flexible Benefit Card)**
- 72 one-way rides/year
Tools to help you choose:
Note: Plan does NOT have out-of-network coverage
Ambulance
$0
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
$0
Outpatient Hospital/Surgery
$0
Hearing Services
Routine hearing
$0
Non-routine hearing
$0 copay
Hearing aids
$0 per hearing aid (2 aids every year)
Primary Care Physician Visit
$0
Specialist Visit
$0
Vision Visit
Routine vision
$0
Non-routine vision
$0
Vision hardware
Our plan offers a $300/year allowance for vision hardware.
Preventive Care
$0
Inpatient Hospital Care
$0 Days 1 and beyond
Skilled Nursing Facility
$0 per day for days 1-100
Our plan covers up to 100 days in a skilled nursing facility.
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 copay for Tiers 1 and 2
Hours: Monday through Friday, 8:00 a.m. to 8:00 p.m. (Open seven days a week, 8:00 a.m. to 8:00 p.m., October 1 – March 31.)You can use our automated answering system outside of these hours.
*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 LIS or "Extra Help" to receive the Over-the-Counter (OTC) + Grocery Food Card 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 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.