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Questions about Medicare are common and expected. See if your question has already been answered below.
Or watch our trusted community advisors explain benefits and networks in easy, simple terms.
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What is the “donut hole” for drug coverage?
This is a stage of Medicare Part D prescription drug coverage known as the coverage gap, when medications have limited coverage. Some Medicare Advantage plans, such as HealthMate for Medicare (PPO), provide additional coverage through the gap.
Are my medications covered?
Have a look at the list of prescription drugs that are covered by your plan. It’s called a formulary. These are often divided into levels, or tiers. Drugs listed in the lower tiers cost you less.
Find 2023 formulary here
I’ll need new glasses next year. Is that covered?
All BCBSRI Medicare Advantage plans cover routine vision office visit at $0. Benefits for vision hardware range from $100 to $300.
Compare all the plans
How do I know if my doctor or pharmacy is in-network?
You can find in-network doctors, dentists, and pharmacies on our Find a Doctor page. (Tip: Choose the plan you are considering from the list on that page.) You also can get help by calling one of our Medicare advisors.
How do I get materials about a plan I’m considering?
We have collected all the plan materials on one page here. If you have a specific question, such as whether a certain doctor is in-network, you can call one of our Medicare advisors for the most up-to-date information.
What is a PCMH?
A patient-centered medical home (PCMH) is a type of doctor’s office with a team of people committed to improving your health and helping you live a healthier lifestyle. Your PCMH team can help you achieve your health goals. For example, they might help you quit smoking, control your diabetes or asthma, lose weight, or manage your stress.
Most BCBSRI Medicare Advantage plans offer $0 office visits at PCMHs.
Can I set up premium payments online?
Yes, you will be able to set up recurring payments in the Billing Center on myBCBSRI.
Will I need a referral?
The HealthMate for Medicare (PPO) plan does not require referrals. BlueCHiP for Medicare plans do require referrals. Some services, however, don’t need them. Learn more here. You can get more specific answers by calling one of our Medicare advisors.
How do I compare copays for each plan?
You can view the most common copays across each of our Medicare Advantage plans here.
Which plans cover dental?
All of our Medicare Advantage plans include dental coverage.
How do Medicare Advantage plans differ from Original Medicare?
Generally, a Medicare Advantage plan (Medicare Part C) offers more coverage than Original Medicare. Many people think Original Medicare alone is enough coverage without realizing that it usually pays for only 80% of many costs. In general, you pay a 20% coinsurance and deductibles for services received under Medicare.
- A Medicare Advantage plan may:
- Simplify your coverage, with only one benefit plan and one membership card
- Offer more benefits than Original Medicare covers
- Have different cost-sharing (for example, copays and coinsurance) than Original Medicare
- Offer out-of-pocket cost limits on some services
- Provide Part D prescription drug coverage
- Use provider networks, which means that you will generally have lower costs if you use doctors and hospitals within the plan's network
- Charge a monthly premium in addition to the Part B premium
How do I enroll in a plan?
You have many options for enrolling, from online to on the phone to in person.
Can someone help me sign up?
Absolutely! BCBSRI Medicare Specialists understand how Medicare works, so they can:
- Check to make sure you are enrolling in the plan that works best for you
- Answer all of your questions
- Help you fill out your enrollment form
Can I get help paying for a plan?
Programs do exist to help pay for your costs. My Advocate Helps can provide you with education and assistance for enrolling into Medicare Savings Programs (MSP) and for Part D Extra Help. Call 1-866-866-7680 (TTY: 1-877-644-3244).
Can I change my plan?
The simple answer is yes. But you're only able to switch your plan at certain times. The Medicare Advantage Annual Enrollment Period, from October 15 – December 7 each year, is when you can make changes to your coverage for it to be effective on January 1 of the next year. If you have had a change in your circumstance, you might be eligible for a Special Enrollment Period.
Also, the Centers for Medicare and Medicaid Services (CMS) allows 5-Star plans to offer an additional SEP. Since CMS rated all of our 2023 Medicare Advantage plans 5-Stars, our members have the additional opportunity to switch from one BCBSRI Medicare Advantage plan to another.
- Online - request a change
- Mail - complete the Plan Change Request Form (also available in Spanish and Portuguese) in its entirety, and then mail it to:
Blue Cross & Blue Shield of Rhode Island
Attn: Medicare Advantage Membership Department
500 Exchange Street
Providence, RI 02903-2699