2022 HealthMate for Medicare (PPO)

HealthMate for Medicare (PPO) H3557-001 is a 2022 Medicare Advantage Plan or Part-C by Blue Cross and Blue Shield of Rhode Island available to residents in Rhode Island. This plan includes additional prescription drug (Part-D) coverage. The HealthMate for Medicare (PPO) has a monthly premium of $132.00 and has an in-network maximum out-of-pocket limit of $4,250 (MOOP). This means that if you get sick or need a high cost procedure the co-pays are capped once you pay $4,250 out-of-pocket. This can be a extremely nice safety net.

HealthMate for Medicare (PPO) is a Local PPO. A preferred provider organization (PPO) is a Medicare plan that has created contracts with a network of "preferred" providers for you to choose from at reduced rates. You do not need to select a primary care physician and you do not need referrals to see other providers in the network. Offering you a little more flexibility overall. You can get medical attention from a provider outside of the network but you will have to pay the difference between the out-of-network bill and the PPOs discounted rate.

Blue Cross and Blue Shield of Rhode Island works with Medicare to provide significant coverage beyond Part A and Part B benefits. If you decide to sign up for HealthMate for Medicare (PPO) you still retain Original Medicare. But you will get additional Part A (Hospital Insurance) and Part B (Medical Insurance) coverage from Blue Cross and Blue Shield of Rhode Island and not Original Medicare. With Medicare Advantage you are always covered for urgently needed and emergency care. Plus you receive all the benefits of Original Medicare from Blue Cross and Blue Shield of Rhode Island except hospice care. Original Medicare still provides you with hospice care even if you sign up for Medicare Advantage.

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2022 Blue Cross and Blue Shield of Rhode Island Medicare Advantage Plan Costs

HealthMate for Medicare (PPO) Part-C Premium

Blue Cross and Blue Shield of Rhode Island charges a $132.00 Part-C premium. The Part C premium covers Medicare medical, hospital benefits and supplemental benefits if offered. You generally are also responsible for paying the Part B premium.

H3557-001 Part-D Deductible and Premium

HealthMate for Medicare (PPO) has a monthly drug premium of $0.00 and a $0.00 drug deductible. This Blue Cross and Blue Shield of Rhode Island plan offers a $0.00 Part-D Basic Premium that is not below the regional benchmark. This covers the basic prescription benefit only and does not cover enhanced drug benefits such as medical benefits or hospital benefits. The Part D Supplemental Premium is $0.00 this Premium covers any enhanced plan benefits offered by Blue Cross and Blue Shield of Rhode Island above and beyond the standard PDP benefits. This can include additional coverage in the gap, lower co-payments and coverage of non-Part D drugs. The Part D Total Premium is $0.00 . The Part D Total Premium is the addition of the supplemental and basic premiums for some plans this amount can be lowered due to negative basic or supplemental premiums.

Blue Cross and Blue Shield of Rhode Island Gap Coverage

In 2022 once you and your plan provider have spent $4430 on covered drugs. (combined amount plus your deductible) You will be in the coverage gap. (AKA "donut hole") You will be required to pay 25% for prescription drugs unless your plan offers additional coverage. This Blue Cross and Blue Shield of Rhode Island plan does offer additional coverage through the gap.

H3557-001 Formulary or Drug Coverage

HealthMate for Medicare (PPO) formulary is divided into Tiers or levels of coverage based on usage and according to the medication costs. Each tier will have a defined copay that you must pay to receive the drug. Drugs in lower tiers will usually cost less than those in higher tiers. By reviewing different Medicare Drug formularies, you can pick a Medicare Advantage plan that covers your medications. Additionally, you can choose a plan that has your drugs listed at a lower price. You can see complete 2022 HealthMate for Medicare (PPO) H3557-001 Formulary here.

Drug Tier	Copay Preferred Pharmacy	Copay Nonpreferred Pharmacy
Tier 1	NA	$0
Tier 2	NA	$0
Tier 3	NA	$47
Tier 4	NA	$100
Tier 5	NA	33%

*Initial Coverage Phase and 30 day supply

2021 HealthMate for Medicare (PPO) Summary of Benefits

*This will be updated with 2022 data when available.

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Additional Benefits

No

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Comprehensive Dental

Diagnostic services	Not covered
Endodontics	$0 copay
Endodontics	50% coinsurance (Out-of-Network)
Extractions	$0 copay
Extractions	50% coinsurance (Out-of-Network)
Non-routine services	$0 copay
Non-routine services	50% coinsurance (Out-of-Network)
Periodontics	$0 copay
Periodontics	50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	50% coinsurance (Out-of-Network)
Prosthodontics, other oral/maxillofacial surgery, other services	$0 copay
Restorative services	50% coinsurance (Out-of-Network)
Restorative services	$0 copay

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Deductible

$0

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Diagnostic Tests and Procedures

Diagnostic radiology services (e.g., MRI)	$200 copay (Out-of-Network)
Diagnostic radiology services (e.g., MRI)	$100 copay
Diagnostic tests and procedures	$0 copay
Diagnostic tests and procedures	$10 copay (Out-of-Network)
Lab services	$0 copay
Lab services	$10 copay (Out-of-Network)
Outpatient x-rays	$10 copay (Out-of-Network)
Outpatient x-rays	$0 copay

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Doctor Visits

Primary	$25 copay per visit (Out-of-Network)
Primary	$0-10 copay per visit
Specialist	$40-60 copay per visit (Out-of-Network)
Specialist	$25 copay per visit

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Emergency care/Urgent Care

Emergency	$90 copay per visit (always covered)
Urgent care	$50 copay per visit (always covered)

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Foot Care (podiatry services)

Foot exams and treatment	$40-60 copay (Out-of-Network)
Foot exams and treatment	$25 copay
Routine foot care	$25 copay
Routine foot care	$40-60 copay (Out-of-Network)

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Ground Ambulance

$150 copay (Out-of-Network)
$150 copay

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Hearing

Fitting/evaluation	$0 copay
Fitting/evaluation	$40-60 copay (Out-of-Network)
Hearing aids	50% coinsurance (Out-of-Network)
Hearing aids	$0 copay
Hearing exam	$25 copay
Hearing exam	$40-60 copay (Out-of-Network)

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Inpatient Hospital Coverage

$275 per day for days 1 through 5 $0 per day for days 6 through 90
20% per stay (Out-of-Network)

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Medical Equipment/Supplies

Diabetes supplies	$25 copay per item (Out-of-Network)
Diabetes supplies	$0 copay per item
Durable medical equipment (e.g., wheelchairs, oxygen)	30% coinsurance per item (Out-of-Network)
Durable medical equipment (e.g., wheelchairs, oxygen)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	20% coinsurance per item
Prosthetics (e.g., braces, artificial limbs)	30% coinsurance per item (Out-of-Network)

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Medicare Part B Drugs

Chemotherapy	30% coinsurance (Out-of-Network)
Chemotherapy	20% coinsurance
Other Part B drugs	20% coinsurance
Other Part B drugs	30% coinsurance (Out-of-Network)

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Mental Health Services

Inpatient hospital - psychiatric	$275 per day for days 1 through 4 $0 per day for days 5 through 90
Inpatient hospital - psychiatric	20% per stay (Out-of-Network)
Outpatient group therapy visit	$40-60 copay (Out-of-Network)
Outpatient group therapy visit	$25 copay
Outpatient group therapy visit with a psychiatrist	$40-60 copay (Out-of-Network)
Outpatient group therapy visit with a psychiatrist	$25 copay
Outpatient individual therapy visit	$40-60 copay (Out-of-Network)
Outpatient individual therapy visit	$25 copay
Outpatient individual therapy visit with a psychiatrist	$25 copay
Outpatient individual therapy visit with a psychiatrist	$40-60 copay (Out-of-Network)

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MOOP

$4,000 In and Out-of-network $4,000 In-network

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Option

No

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Optional supplemental benefits

No

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Outpatient Hospital Coverage

$500 copay per visit (Out-of-Network)
$250 copay per visit

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Preventive Care

$0 copay
$25 copay (Out-of-Network)

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Preventive Dental

Cleaning	50% coinsurance (Out-of-Network)
Cleaning	$0 copay
Dental x-ray(s)	$0 copay
Dental x-ray(s)	50% coinsurance (Out-of-Network)
Fluoride treatment	Not covered
Oral exam	$0 copay
Oral exam	50% coinsurance (Out-of-Network)

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Rehabilitation Services

Occupational therapy visit	$25 copay
Occupational therapy visit	$40-60 copay (Out-of-Network)
Physical therapy and speech and language therapy visit	$25 copay
Physical therapy and speech and language therapy visit	$40-60 copay (Out-of-Network)

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Skilled Nursing Facility

$0 per day for days 1 through 20 $130 per day for days 21 through 45 $0 per day for days 46 through 100
20% per stay (Out-of-Network)

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Transportation

50% coinsurance (Out-of-Network)
$0 copay

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Vision

Contact lenses	$0 copay
Contact lenses	$0 copay (Out-of-Network)
Eyeglass frames	$0 copay
Eyeglass frames	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay (Out-of-Network)
Eyeglass lenses	$0 copay
Eyeglasses (frames and lenses)	$0 copay
Eyeglasses (frames and lenses)	$0 copay (Out-of-Network)
Other	Not covered
Routine eye exam	$0 copay
Routine eye exam	$40-60 copay (Out-of-Network)
Upgrades	Not covered

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Wellness Programs (e.g. fitness nursing hotline)

Covered

CMS Star Ratings for HealthMate for Medicare (PPO) H3557

Staying Healthy, Screening, Testing, & Vaccines

Managing Chronic And Long Term Care for Older Adults

Member Experience with Health Plan

Member Complaints and Changes in HealthMate for Medicare (PPO) Plans Performance

Health Plan Customer Service Rating for HealthMate for Medicare (PPO)

HealthMate for Medicare (PPO) Drug Plan Customer Service Ratings

Ratings For Member Complaints and Changes in the Drug Plans Performance

Member Experience with the Drug Plan

Drug Safety and Accuracy of Drug Pricing

Ready to Enroll?

Click Here

Or Call
1-855-778-4180
Mon-Fri 8am-8pm EST
Sat 8am-8pm EST

Coverage Area for HealthMate for Medicare (PPO)

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Source: CMS.
Data as of September 1, 2021.
Notes: Data are subject to change as contracts are finalized. For 2022, enhanced alternative may offer additional cost sharing reductions in the gap on a sub-set of the formulary drugs, beyond the standard Part-D benefit. Includes 2022 approved contracts. Employer sponsored 800 series and plans under sanction are excluded.