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BlueCHiP for Medicare Core (HMO) Medicare Advantage Plan H4152-004 • 2027 • Kent County, RI

CMS Rating: ☆☆☆☆☆ (3.5 out of 5 stars*)
Monthly Premium
$0.00Plus Part B premium.
Medical Deductible
$0.00
Maximum Out-of-Pocket
$5000.00In-network
Part B Giveback
Not offered
Prescription Coverage
Not Included
Additional Benefits
Dental, Vision, Hearing
Service Area
Kent County, RI
Local Enrollment
141 beneficiaries in Kent County
Last update:

BlueCHiP for Medicare Core (HMO) Introduction

BlueCHiP for Medicare Core is a Medicare Advantage HMO plan offered by Blue Cross & Blue Shield of Rhode Island. It uses a Health Maintenance Organization (HMO) provider network and comes without prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $5000.00 in-network maximum out-of-pocket. CMS Plan ID H4152-004 identifies this plan.

You must live in Kent County, Rhode Island to enroll in this plan. CMS reports 141 beneficiaries enrolled in this plan in Kent County. For assistance with this plan, new members can call (800)505-2583 (TTY 711).

Compare Similar Plans in Kent County

No other HMO plans are available in Kent County, Rhode Island using the same plan-type comparison criteria.

Although no other HMO plans meet the comparison criteria in Kent County, you may have other Medicare Advantage options. Browse all Medicare Advantage plans available in Kent County, or explore our Rhode Island Medicare Advantage plan directory for statewide information on plan availability, premiums, out-of-pocket costs, CMS ratings, and enrollment.

Plan Benefits

BlueCHiP for Medicare Core has cost-sharing, meaning there are out-of-pocket costs when receiving covered healthcare services. The tables below detail the most common in-network out-of-pocket expenses for plan H4152-004.

You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4152-004-0 Cost Compare.

Office Visits

Primary care
In-network: $0 copay
Specialist
In-network: $0-$30 copay

Preventive and Wellness Services

Annual wellness exam
In-network: $0 copay
Telehealth benefit
In-network: $0 copay
Routine chiropractic
Not covered
Fitness benefits
Coming soon
Health education
In-network: $0 copay
Counseling services
Not covered
Over-the-counter drug benefits
In-network: $0 copay
Health transportation (non-emergency)
Coming soon

Diagnostic, Lab, and Imaging Services

Diagnostic radiology services
In-network: $0-$150 copay
Lab services
In-network: $0 copay
Outpatient x-rays
In-network: $25 copay
Diagnostic tests and procedures
In-network: $50 copay

Emergency and Urgent Care Services

Emergency room care
$130 copay
Worldwide emergency care
Coming soon
Urgent care
$50 copay
Inpatient hospital care
Tier 1
$275 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Skilled Nursing Facility
Tier 1
$0 per day for days 1-20
$218 per day for days 21-45
$0 per day for days 46-100
Ground ambulance
In-network: $200 copay

Mental Health Services

Outpatient individual therapy
In-network: $0-$30 copay
Outpatient group therapy
In-network: $0-$30 copay
Inpatient psychiatric hospital care
Tier 1
$275 per day for days 1-6
$0 per day for days 7-90
$0 per stay

Rehabilitation Services

Physical therapy and speech and language therapy
In-network: $0-$30 copay
Occupational therapy
In-network: $0-$30 copay

Medical Equipment and Supplies

Diabetes supplies
In-network: 0%-20% coinsurance
Durable medical equipment
In-network: 20% coinsurance
Prosthetics
In-network: 20% coinsurance

Medicare Part B Drugs

Chemotherapy
In-network: 0%-20% coinsurance
Other Part B drugs (Medicare-covered)
In-network: 0%-20% coinsurance

Dental Services

Oral exam
In-network: $0 copay
Dental x-rays
In-network: $0 copay
Cleaning
In-network: $0 copay
Periodontics
In-network: $0 copay
Endodontics
In-network: $0 copay
Restorative services
In-network: $0 copay
Implant services
Not covered
Orthodontics
Not covered
Oral/Maxillofacial surgery
In-network: $0 copay

Vision Services

Routine eye exam
In-network: $0 copay
Contact lenses
In-network: $0 copay
Eyeglass frames only
In-network: $0 copay
Eyeglass lenses only
In-network: $0 copay
Eyeglasses (frames & lenses)
In-network: $0 copay
Upgrades
Not covered

Hearing Services

Hearing exam
In-network: $0 copay
Fitting/evaluation
In-network: $0 copay
Prescription hearing aids
In-network: $300-$1775 copay
OTC hearing aids
Not covered

Additional and Special Needs Services

Adult day health services
Not covered
Home-based palliative care
Not covered
Personal emergency response system
Coming soon
Weight management programs
Not covered
Wigs for chemotherapy-related hair loss
Coming soon
Alternative therapies
Not covered
Massage therapy
Not covered
Home/bathroom safety devices
Not covered

Certain preventive services are covered 100% by BlueCHiP for Medicare Core as a Part B benefit.

Prescription Drug Coverage

This plan does not include a Medicare Part D plan for prescriptions.

CMS 5-Star Performance Ratings (Contract ID: H4152)

Medicare Advantage (Part C) and Part D plans are rated each year by CMS on a 5-star scale. Ratings summarize plan performance across clinical care and member experience measures.

2027 Medicare Star Ratings for Contract H4152
CMS Measure Star Rating
2027 Overall Rating ☆☆☆☆☆
Staying Healthy: Screenings, Tests, Vaccines ☆☆☆☆☆
Managing Chronic (Long Term) Conditions ☆☆☆☆☆
Member Experience with Health Plan ☆☆☆☆☆
Complaints and Changes in Plans Performance ☆☆☆☆☆
Health Plan Customer Service ☆☆☆☆☆
Drug Plan Customer Service ☆☆☆☆☆
Complaints and Changes in the Drug Plan ☆☆☆☆☆
Member Experience with the Drug Plan ☆☆☆☆☆
Drug Safety and Accuracy of Drug Pricing ☆☆☆☆☆

Contact Information for Blue Cross & Blue Shield of Rhode Island

Website
Blue Cross & Blue Shield of Rhode Island Plan Page
Providers
Blue Cross & Blue Shield of Rhode Island Providers Page
Formulary
Blue Cross & Blue Shield of Rhode Island Formulary Page
Pharmacy
Blue Cross & Blue Shield of Rhode Island Pharmacy Page
New Member Health Plan Help
(800)505-2583
New Member Health Plan TTY
711

Enrollment status and eligibility information are available through the Social Security Administration. Additional information about Medicare Advantage is available at Medicare.gov.

Medicare Advantage Plan Availability

BlueCHiP for Medicare Core is available to eligible Medicare beneficiaries residing in Kent County, Rhode Island, including communities such as Coventry, West Greenwich, East Greenwich, Greene, Warwick, West Warwick, and other areas throughout the county. Enrollment eligibility is based on county of residence, not city.

Medicare Plan Data Sources and Methodology
Primary CMS datasets used for this Medicare Advantage Plan resource.
Data Source Publisher Last Accessed
Landscape Source Files Centers for Medicare & Medicaid Services October 5, 2026
Medicare Part C & D Performance Centers for Medicare & Medicaid Services October 5, 2026
Plan Benefits Package Centers for Medicare & Medicaid Services October 5, 2026
Monthly Enrollment by Contract/Plan/State/County Centers for Medicare & Medicaid Services October 5, 2026

Data sources and methodology documentation.

Official plan information and secondary Medicare references.
Publisher Reference Last Accessed
Blue Cross & Blue Shield of Rhode Island (official source) http://www.BCBSRI.com/Medicare October 4, 2026
Medicare.gov Understanding Medicare Advantage Plans 25 May, 2025
NCOA.org 5 Steps to Choosing the Right Medicare Plan for You 25 May, 2025
Medicare.gov Explore your Medicare coverage options 25 May, 2025

MedicarePlans.com operates as an independent, non-government informational resource and is not affiliated with or endorsed by the U.S. Government or the federal Medicare program.

Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.