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

Why We Like This Plan

  • has both Health and Drug Coverage

All cost-sharing assumes in-network healthcare providers.

Plan Details

Costs and Other Important Information

Plan Year:
2016
Optional Supplemental Benefits?
Yes
Choice of Doctors?
Plan Doctors for Most Services
Prescription Drugs Covered?
Yes
Out-Of-Pocket Spending Limit
$2,800 In-network
Other Health Plan Deductibles?
No
Health Plan Deductible
$0
Monthly Drug Plan Premium
$82.40
Monthly Health Plan Premium
$73.60

Benefits

Service
Cost
Ambulance
$75
Doctor's office visits
Primary Physician
$0-5 per visit
Specialist
$30 per visit
Durable medical equipment (wheelchairs, oxygen, etc.)
20% per item
Emergency care
$65 per visit (always covered)
Home health care
You pay nothing
Mental health care
$190 for days 1 through 4
$0 for days 5 through 90
Outpatient hospital
$150 per visit
Renal dialysis
$25 per visit
Inpatient hospital care
$190 for days 1 through 5
$0 for days 6 through 90
Skilled Nursing Facility (SNF)
$0 for days 1 through 20
$135 for days 21 through 45
$0 for days 46 through 100

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$3 copay$3 copayNot offered
Tier 2: Non-Preferred Generic$6 copay$6 copayNot offered
Tier 3: Preferred Brand Name$47 copay$47 copayNot offered
Tier 4: Non-Preferred Brand Name$100 copay$100 copayNot offered
Tier 5: Specialty Tier33% coinsurance33% coinsurance33% coinsurance
90 Day SupplyPreferred Retail PharmaciesNon-Preferred Retail PharmaciesMail-Order Pharmacies
Tier 1: Preferred Generic$9 copay$9 copay$3 copay
Tier 2: Non-Preferred Generic$18 copay$18 copay$6 copay
Tier 3: Preferred Brand Name$141 copay$141 copay$117.5 copay
Tier 4: Non-Preferred Brand Name$300 copay$300 copay$250 copay
Tier 5: Specialty Tier

CMS Ratings

Staying healthy - screenings, tests and vaccines

Breast cancer screening
Colorectal cancer screening
Annual flu vaccine
Improving or maintaining physical health
Improving or maintaining mental health
Monitoring physical ability
Adult BMI assessment

Managing Chronic Conditions

Special needs plan care management
Not Rated
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
Controlling blood pressure
Rheumatoid arthritis management
Reducing the risk of falling
Plan all-cause readmissions

Member Experience with Health Plan

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

Member Complaints, and Changes in Health Plan's Performance

Complaints about the health plan
Members choosing to leave the health plan
Beneficiary access and performance problems
Health plan quality improvement

Health Plan Customer Service

Plan makes timely decision about appeals
Reviewing appeals decisions
Call center – foreign language interpreter and TTY/TDD availability - Medical

Drug Plan Customer Service

Call center – foreign language interpreter and TTY/TDD availability - Drugs
Appeals auto-forward
Appeals upheld
Not Rated

Member Complaints, and Changes in Drug Plan's Performance

Complaints about the drug plan
Members choosing to leave the drug plan
Beneficiary access and performance problems
Drug plan quality improvement

Member Experience with Drug Plan

Rating of drug plan
Getting needed prescription drugs

Drug Pricing and Patient Safety

MPF Price Accuracy
High risk medication
Part D medication adherence for diabetes
Part D medication adherence for hypertension
Part D medication adherence for cholesterol
Medication Therapy Management program completion rate

Physician Finder

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

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KHATIB, PERVEZ
100 CURTIS ST
PROVIDENCE, RI 02909
BASSEN, DAISY
340 BROADWAY
PROVIDENCE, RI 02909
VANDYCK, WALTER
SPRINGFIELD MIDDLE SCHOOL, PROVIDENE SCHOOL DEPARTMENT
PROVIDENCE, RI 02909
SALAK, JESSICA
100 CURTIS ST
PROVIDENCE, RI 02909
MASTROSTEFANO, PASQUALE
347 BROADWAY
PROVIDENCE, RI 02909
NG, KAREN
100 CYRTIS STREET
PROVIDENCE, RI 02909
CLARK-MEDYESY, MELANIE
176 CONGRESS AVE
PROVIDENCE, RI 02907
SCOTT, WALTER
655 BROAD ST
PROVIDENCE, RI 02907
MUKAND, JON
21 PEACE ST
PROVIDENCE, RI 02907
KELLY, CARRIE
21 PEACE ST
PROVIDENCE, RI 02907
SKURKOVICH, BORIS
239 CRANSTON ST
PROVIDENCE, RI 02907
HODOSH, STEVEN
243 ELMWOOD AVE
PROVIDENCE, RI 02907
THOMAS, LONICE
239 CRANSTON ST
PROVIDENCE, RI 02907
GURNEY, ELLEN
239 CRANSTON ST.
PROVIDENCE, RI 02907
STUTZ, STANLEY
21 PEACE ST
PROVIDENCE, RI 02907
TAMAN, MAGED
21 PEACE STREET
PROVIDENCE, RI 02907
CECE, JOHN
230 RESERVOIR AVE
PROVIDENCE, RI 02907
ABEJUELA, MARIE
21 PEACE ST
PROVIDENCE, RI 02907
PHILBIN, SHARON
239 CRANSTON ST
PROVIDENCE, RI 02907
RODRIGUEZ-PERIS, EMILIO
655 BROAD STREET
PROVIDENCE, RI 02907
MAGLIO, DAVID
178 DEXTER ST
PROVIDENCE, RI 02907
GODLEY, FREDERICK
845 N MAIN ST
PROVIDENCE, RI 02904
PIZZARELLO, PETER
868 ADMIRAL ST
PROVIDENCE, RI 02904
SOUTHERN NEW ENGLAND RETINA ASSOCIATES, PC
1 RANDALL SQ
PROVIDENCE, RI 02904
GREENBERG, PAUL
ONE RANDALL SQUARE
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

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