PCP $0 cost sharing
All PCP visits (including sick visits) will now have a $0 copay for dates of services on or after 1 de janeiro, 2025.
Tiering of ASC/OP hospital cost sharing
Please continue to check member benefits to see if their plan is now part of tiered cost sharing.
Inpatient acute/MH care benefit period
The inpatient acute/MH care benefit period is moving to per admission and a five-day copay structure for both inpatient acute and mental health stays.
Radiation therapy benefit change
The radiation therapy benefit is moving to a 20% coinsurance.
Covered acupuncture
As a reminder, it is important for all acupuncture providers to check member eligibility and benefits when the new year approaches as some members may change their plans. Acupuncture benefits vary across all Medicare plans.
Movement of telemedicine cost sharing to match office cost sharing
All services rendered as telemedicine on or after 1 de janeiro, 2025 will apply the member’s in-office copay.
Autorização para artigos de visão
The following Medicare Advantage plans will experience an enhancement to the existing vision hardware benefit allowance on 1 de janeiro, 2025:
- BlueCHiP for Medicare Extra – $400 allowance
- BlueCHiP for Medicare Value – $250 allowance
- NEW! BlueCHiP for Medicare Access – $300 allowance
Introduction of new plan – BlueCHiP for Medicare Access
2025 will mark the launch of a new low-income plan in place of the ACCESS program. This plan will be named BlueCHiP for Medicare Access and has $0 benefits for those who qualify for Extra Help, also known as Low-Income Subsidy.
Elimination of individual HealthMate PPO but continuation of group HealthMate PPO
We will eliminate the individual HealthMate PPO Medicare Advantage plan. Group HealthMate will continue.
Current HealthMate PPO members will need to actively enroll in a new plan during the Annual Enrollment Period (AEP) or they will drop to Original Medicare and not have Part D coverage. Members will also have a Special Enrollment Period (SEP) to enroll in a new plan but if they fail to make an active selection before 31 de dezembro, 2024, they will have a lapse in Part D coverage.
Members who choose to move from HealthMate PPO to a BlueCHiP for Medicare plan will need referrals for services as of 1 de janeiro, 2025. Referrals can be entered for the members prior to 1 de janeiro, 2025 as long as the member has selected their new BlueCHiP for Medicare plan. PCPs will need to change the “As of" date from the date of entry to 1 de janeiro, 2025 as that is when the new product will be active for the member. If the member is not active in BCBSRI’s system at the time of entry, they will not be found.
Elimination of transportation for many plans
Transportation will only be an offered benefit for members on a low-income plan. Transportation is available for Access plans (12 one-way rides) and the BlueRI for Duals D-SNP plan (72 one-way rides).
Elimination of Papa Pals for all plans
We have eliminated the Papa Pals benefit for all Medicare Advantage plans effective 1 de janeiro, 2025.