Medicare AdvantageCoverageHigh impact
2025 Medicare Changes
Blue Cross Blue Shield of Rhode Island·RI · Family Medicine, Internal Medicine, Oncology +1 more·Provider Update
Effective date
Jan 1, 2025
We identified it
Jun 19, 2026
Summary
BCBS Rhode Island Medicare Advantage plans are implementing significant benefit and cost-sharing changes effective January 1, 2025, including $0 PCP copays, telemedicine copay alignment, radiation therapy moving to 20% coinsurance, and major pharmacy formulary changes affecting nearly 1,500 medications. A new BlueCHiP for Medicare Access plan launches while Individual HealthMate PPO is eliminated.
Action Required
By December 31, 2024: Billing team must update copay schedules to reflect $0 PCP visits, align telemedicine copays with office visit copays, change radiation therapy billing to 20% coinsurance structure, and verify patient eligibility for new BlueCHiP Access plans. Front desk staff must check member benefits for tiered cost-sharing changes and ensure HealthMate PPO members have enrolled in new plans to avoid coverage gaps. Update referral processes for members switching from HealthMate PPO to BlueCHiP plans with 1/1/25 effective dates.