Medicare AdvantageCoverageHigh impact
2025 Medicare changes
Blue Cross Blue Shield of Rhode Island·RI·Provider Update
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
BlueCross BlueShield of Rhode Island announces significant 2025 Medicare Advantage changes including $0 PCP copays, tiered cost sharing for outpatient services, telemedicine copays matching office visits, elimination of individual HealthMate PPO plans, and major pharmacy formulary changes affecting 470+ drugs. New BlueCHiP for Medicare Access plan launches for low-income members.
Action Required
By January 1, 2025: Update billing system to reflect $0 copays for all PCP visits and match telemedicine copays to office visit rates for BCBSRI Medicare Advantage members. Verify patient eligibility for members transitioning from eliminated HealthMate PPO plans to new BlueCHiP plans and ensure referrals are entered with 'As of' date set to January 1, 2025. Update prior authorization workflows for members moving to BlueCHiP plans that require referrals. Review formulary changes for 470 drugs moving off formulary and assist with coverage exceptions through Prime Therapeutics when needed.