PARTCRX

Plan Summary

Insurance Type
Medicare Advantage Plan (Part C w/ RX)
Insurance Provider
Blue Cross Blue Shield of Rhode Island
CMS Rating
Plan Type
HMO
Annual Deductible
$0.00

What To Know About This Plan

  • This plan has health and drug coverage

Plan Details

Costs and Other Important Information

Plan Year:
2014
Optional Supplemental Benefits?
No
Choice of Doctors?
Plan Doctors Only
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$2,950 In-Network
Other Deductibles?
In Network: No. Out of Network: No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$57.60
Monthly Health Plan Premium
$103.40

Benefits

Service
In Network
Out of Network
Doctor Office Visits
$5 maximum per visit
Not Applicable
Specialist Office Visit
$30 maximum per visit
Not Applicable
Outpatient Services
20% maximum per visit
Not Applicable
Emergency Care
$65 maximum per visit
Not Applicable
Ambulance Services
$200 maximum
Not Applicable
Kidney Disease and Conditions
$25 maximum per visit
Not Applicable
Home Health Care
$0
Not Applicable
Durable Medical Equipment
20% maximum per item
Not Applicable
Inpatient Hospital Care
Days 1-8: $240 copay per day. Days 9-90: $0 copay per day
Not Applicable
Skilled Nursing Facility (SNF)
Days 1-30: $80 copay per day. Days 31-100: $0 copay per day
Not Applicable
Inpatient Mental Health Care
Days 1-7: $240 copay per day. Days 8-90: $0 copay per day
Not Applicable

Cost Sharing Information

Prescription Drug Copay/Coninsurance Details - Initial Coverage Limit

30 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$4 copay$4 copayNot offered
Tier 2: Non-Preferred Generic$45 copay$45 copayNot offered
Tier 3: Preferred Brand Name$95 copay$95 copayNot offered
Tier 4: Non-Preferred Brand Name33% coinsurance33% coinsurance33% coinsurance
Tier 5: Specialty Tier
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$12 copay$12 copay$8 copay
Tier 2: Non-Preferred Generic$135 copay$135 copay$112.5 copay
Tier 3: Preferred Brand Name$285 copay$285 copay$237.5 copay
Tier 4: Non-Preferred Brand Name
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Not Rated
Colorectal cancer screening
Cholesterol screening for patients with heart disease
Glaucoma testing
Annual flu vaccine
Pneumonia vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Access to primary care doctor visits
Adult BMI assessment

Managing Chronic Conditions

Care for older adults – medication review
Not Rated
Care for older adults – functional status assessment
Not Rated
Care for older adults – Pain screening
Not Rated
Osteoporosis management in women who had a fracture
Diabetes care – eye exam
Diabetes care – kidney disease monitoring
Diabetes care – blood sugar controlled
Diabetes care – cholesterol controlled
Controlling blood pressure
Rheumatoid arthritis management
Improving bladder control
Reducing the risk of falling
Plan all-cause readmissions

Ratings of Plan Responsiveness and Care

Getting needed care
Getting appointments and care quickly
Customer service
Overall rating of health care quality
Overall rating of plan

Member Complaints, Problems Getting Services, and Choosing to Leave the Plan

Complaints about the health plan
Beneficiary access and performance problems
Members choosing to leave the plan
Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability

Physician Finder

Physicians that accept BlueCHiP for Medicare Plus (HMO) for Rhode Island

/
KHATIB, PERVEZ
100 CURTIS ST
PROVIDENCE, RI 02909
MASTROSTEFANO, PASQUALE
347 BROADWAY
PROVIDENCE, RI 02909
VANDYCK, WALTER
SPRINGFIELD MIDDLE SCHOOL, PROVIDENE SCHOOL DEPARTMENT
PROVIDENCE, RI 02909
GURNEY, ELLEN
239 CRANSTON ST.
PROVIDENCE, RI 02907
LESPINASSE, MAGGY
239 CRANSTON ST
PROVIDENCE, RI 02907
THOMAS, LONICE
239 CRANSTON ST
PROVIDENCE, RI 02907
SKURKOVICH, BORIS
239 CRANSTON ST
PROVIDENCE, RI 02907
MAGLIO, DAVID
178 DEXTER ST
PROVIDENCE, RI 02907
CECE, JOHN
230 RESERVOIR AVE
PROVIDENCE, RI 02907
STUTZ, STANLEY
21 PEACE ST
PROVIDENCE, RI 02907
PEREZ, VIDAL
645 ELMWOOD AVE
PROVIDENCE, RI 02907
TAMAN, MAGED
21 PEACE STREET
PROVIDENCE, RI 02907
RODRIGUEZ-PERIS, EMILIO
655 BROAD STREET
PROVIDENCE, RI 02907
KELLY, CARRIE
21 PEACE ST
PROVIDENCE, RI 02907
MUKAND, JON
21 PEACE ST
PROVIDENCE, RI 02907
SCOTT, WALTER
655 BROAD ST
PROVIDENCE, RI 02907
CLARK-MEDYESY, MELANIE
176 CONGRESS AVE
PROVIDENCE, RI 02907
ABEJUELA, MARIE
21 PEACE ST
PROVIDENCE, RI 02907
JOYCE, DONALD
825 N MAIN ST
PROVIDENCE, RI 02904
OLDENBURG, NICKLAS
825 N MAIN ST
PROVIDENCE, RI 02904
ABADI, CHRISTOPHER
1076 NORTH MAIN STREET
PROVIDENCE, RI 02904
JARBEAU, JENNIFER
1076 NORTH MAIN STREET
PROVIDENCE, RI 02904
INDEGLIA, ROBERT
208 COLLYER ST
PROVIDENCE, RI 02904
ROSENBERG, JERROLD
827 N MAIN ST
PROVIDENCE, RI 02904
ESTRADA, ELKIN
1076 N MAIN ST
PROVIDENCE, RI 02904
Details
PERVEZ KHATIB, MD
Phone Number
(401) 444-0540
Office Locations
100 CURTIS ST
PROVIDENCE, RI 02909
100 CURTIS ST PROVIDENCE RI, 02909

Community Q&A

Do you have questions about this plan?

Get answers from the HealthPocket community.
1 question
Trial period
Q:What are conditions for the one year trial period leading to guranteed enrollment in Plan65. Can one sign up for Part D if exercised?
Asked by Joseph Dobrott 
Know the Answer? Answer this Question

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