BlueCHiP for Medicare Essential (HMO-POS) Medicare Advantage Plan H4152-023 • 2027 • Kent County, RI
- Monthly Premium
- $0.00Plus Part B premium.
- Medical Deductible
- $0.00
- Maximum Out-of-Pocket
- $6750.00In-network
- Part B Giveback
- Not offered
- Prescription Coverage
- Enhanced, $500.00 deductible
- Additional Benefits
- Dental, Vision, Hearing
- Service Area
- Kent County, RI
- Local Enrollment
- 146 beneficiaries in Kent County
BlueCHiP for Medicare Essential (HMO-POS) Introduction
BlueCHiP for Medicare Essential is a Medicare Advantage HMO-POS plan offered by Blue Cross & Blue Shield of Rhode Island. It uses a Health Maintenance Organization with a Point of Service (HMO-POS) provider network and comes with prescription drug coverage. For the 2027 plan year it has a $0.00 monthly premium, $0.00 medical deductible, and $6750.00 in-network maximum out-of-pocket. CMS Plan ID H4152-023 identifies this plan. The 2027 Part D prescription drug deductible is $500.00.
You must live in Kent County, Rhode Island to enroll in this plan. CMS reports 146 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
Compare this plan with the two most-enrolled HMO-POS plans available in Kent County, Rhode Island. Enrollment is based on CMS local enrollment data.
| Plan Detail | BlueCHiP for Medicare Essential | BlueCHiP for Medicare Enhanced | BlueCHiP for Medicare Extra |
|---|---|---|---|
| CMS Plan ID | H4152-023-0 |
H4152-013-0 |
H4152-018-0 |
| Local Enrollment | 146 | 9,715 | 2,766 |
| Monthly Premium | $0.00 | $39.00 | $159.00 |
| Medical Deductible | $0.00 | $0.00 | $0.00 |
| Maximum Out-of-Pocket | $6,750.00 | $6,750.00 | $6,000.00 |
| Part B Giveback | Not offered | Not offered | Not offered |
| Primary Care | $0 copay | $0 copay | $0 copay |
| Specialist | $0-$50 copay | $0-$40 copay | $0-$35 copay |
| Part D Deductible | $500.00 | $500.00 | $450.00 |
| CMS Star Rating | 3.5 | 3.5 | 3.5 |
| Dental | $0 copay | $0 copay | $0 copay |
| Vision | $0 copay | $0 copay | $0 copay |
| Hearing | $0 copay | $0 copay | $0 copay |
Want to explore more options? Browse all Medicare Advantage plans in Kent County, or compare Medicare Advantage plans across Rhode Island, including premiums, out-of-pocket costs, CMS ratings, and enrollment.
Plan Benefits
BlueCHiP for Medicare Essential 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 H4152-023.
You can also compare 2027 costs and coverage with last year, side-by-side: Plan H4152-023-0 Cost Compare.
Office Visits
- Primary care
- In-network: $0 copay
Out-of-network: 40% coinsurance - Specialist
- In-network: $0-$50 copay
Out-of-network: 40% coinsurance
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
- Not covered
- Health transportation (non-emergency)
- Coming soon
Diagnostic, Lab, and Imaging Services
- Diagnostic radiology services
- In-network: $0-$250 copay
Out-of-network: 40% coinsurance - Lab services
- In-network: $0 copay
Out-of-network: 40% coinsurance - Outpatient x-rays
- In-network: $25 copay
Out-of-network: 40% coinsurance - Diagnostic tests and procedures
- In-network: $50 copay
Out-of-network: 40% coinsurance
Emergency and Urgent Care Services
- Emergency room care
- $130 copay
- Worldwide emergency care
- Coming soon
- Urgent care
- $50 copay
- Inpatient hospital care
- In-network:
Tier 1
$458 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
40% per day for days 1-90
0% per stay - Skilled Nursing Facility
- In-network:
Tier 1
$10 per day for days 1-20
$218 per day for days 21-100
Out-of-network:
40% per day for days 1-100
0% per stay - Ground ambulance
- In-network: $200 copay
Out-of-network: $200 copay
Mental Health Services
- Outpatient individual therapy
- In-network: $0-$50 copay
Out-of-network: 40% coinsurance - Outpatient group therapy
- In-network: $0-$50 copay
Out-of-network: 40% coinsurance - Inpatient psychiatric hospital care
- In-network:
Tier 1
$458 per day for days 1-6
$0 per day for days 7-90
$0 per stay
Out-of-network:
40% per day for days 1-90
0% per stay
Rehabilitation Services
- Physical therapy and speech and language therapy
- In-network: $0-$50 copay
Out-of-network: 40% coinsurance - Occupational therapy
- In-network: $0-$50 copay
Out-of-network: 40% coinsurance
Medical Equipment and Supplies
- Diabetes supplies
- In-network: 0%-25% coinsurance
Out-of-network: 40% coinsurance - Durable medical equipment
- In-network: 25% coinsurance
Out-of-network: 40% coinsurance - Prosthetics
- In-network: 25% coinsurance
Out-of-network: 40% coinsurance
Medicare Part B Drugs
- Chemotherapy
- In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance - Other Part B drugs (Medicare-covered)
- In-network: 0%-20% coinsurance
Out-of-network: 40% coinsurance
Dental Services
- Oral exam
- In-network: $0 copay
- Dental x-rays
- In-network: $0 copay
- Cleaning
- In-network: $0 copay
- Periodontics
- Not covered
- Endodontics
- Not covered
- Restorative services
- Not covered
- Implant services
- Not covered
- Orthodontics
- Not covered
- Oral/Maxillofacial surgery
- Not covered
Vision Services
- Routine eye exam
- In-network: $0 copay
Out-of-network: 40% coinsurance - 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
Out-of-network: 40% coinsurance - 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 Essential as a Part B benefit.
Prescription Drug Coverage
BlueCHiP for Medicare Essential includes a Medicare Part D prescription drug plan (PDP). Plan type and coverage level are defined by CMS and may vary between basic and enhanced benefit designs.
This plan includes an enhanced benefit Medicare Part D plan (PDP), providing coverage beyond the standard CMS-defined minimum.
Prescription Drug Plan Premium
The Part D prescription drug plan premium is included in the overall Medicare Advantage plan cost. Additional adjustments may apply through the Low-Income Subsidy (LIS) program, also known as Extra Help, administered by Social Security. LIS benefits are separate from Medicare Special Needs Plan coverage.
| Part D Premium Component | Amount |
|---|---|
| Basic Part D Premium: | $0.00 |
| Supplemental Part D Premium: | $$0.00 |
| Total Part D Premium: | $0.00 |
| Low-Income Premium Subsidy: | $33.82 |
| Low-Income Premium Subsidy Paid by CMS: | $0.00 |
| Low-Income Subsidy Premium: | $0.00 |
For more details, visit the Social Security Extra Help program .
Prescription Drug Plan Deductible
This plan has a $500.00 annual Part D deductible. You'll pay this deductible at the pharmacy before Blue Cross & Blue Shield of Rhode Island starts contributing towards your prescription costs.
Prescription Drug Plan Out-of-Pocket Costs
Beyond premiums and deductibles, BlueCHiP for Medicare Essential may have additional costs at pharmacies. The table below outlines out-of-pocket expenses by drug tier.
| Drug Tier | Retail | Mail Order |
|---|---|---|
| Preferred Generic | $0.00 copay | Coming soon |
| Generic | $0.00 copay | Coming soon |
| Preferred Brand | 25% coinsurance | Coming soon |
| Non-Preferred Drug | 30% coinsurance | Coming soon |
| Specialty Tier | 28% coinsurance | Coming soon |
| *Deductible does not apply. | ||
CMS 5-Star Performance Ratings (Contract ID: H4152)
The Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (Part C) and Part D prescription drug plans each year using a 5-star system. These ratings measure plan performance in areas such as preventive care, management of chronic conditions, and member experience.
| 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
- New Member Part D Help
- (800)505-2583
- New Member Part D TTY Users
- 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 Essential 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
| 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.
| 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 | Compare Original Medicare & Medicare Advantage | 25 May, 2025 |
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Data provenance is documented in accordance with the U.S. Core Data for Interoperability (USCDI) Provenance standard.
Page content independently curated and maintained by David W. Bynon, Editorial Steward, using a standardized, data-driven methodology for accurate, non-commercial Medicare plan interpretation and resolution.