Medicare in Rhode Island

Medicare is a federal health insurance program for adults aged 65+ and younger residents with certain disabilities. It includes Part A and Part B. The former is free for most people and covers vital services, including emergency care, inpatient treatments, nursing home care and home health care. For a monthly premium in 2023 of $164.90, Part B covers outpatient and preventative care services. These include outpatient care, diagnostic tests, medical supplies and equipment and medical transportation. The most recent data reveals Medicare cost the state of Rhode Island almost $1.1 billion in 2021.

Medicare Advantage, also known as Part C, integrates the benefits of Parts A and B into one comprehensive plan, minus hospice care. As of 2023, 39 plans are available in Rhode Island, each designed for specific needs. These may include dental care, home-delivered meals and prescription drugs. Medicare Part D exclusively covers prescription drugs for Original Medicare recipients and Medicare Advantage beneficiaries whose policies don’t offer this coverage. Premium costs vary considerably because they’re linked to enrollees’ prescriptions and the tiers of the drugs they need. Seniors looking to control their out-of-pocket expenses might consider a Medicare Supplement Plan, or Medigap, which can cover coinsurance, copayments and deductibles.

While the Centers for Medicare & Medicaid Services (CMS) administer Original Medicare, private insurance companies approved by the CMS handle Medicare Advantage and are free to design their plans within federal rules and regulations. In Rhode Island, as of July 2023, 52% of eligible residents have signed up for a plan. This figure exceeds the previous year’s 48% — which is also the national average. The 4% increase means Part C has now surpassed Original Medicare as the preference of Rhode Island’s seniors. The pace of uptake appears to be accelerating. Between 2022 and 2023, the number of eligible residents grew by 2.77%, and the percentage of them that purchased a plan also increased by 7.37% in the same period. 

This guide covers medical insurance options and how seniors can personalize their coverage. It also includes information about additional resources in Rhode Island.

Options for Medicare Coverage in Rhode Island

Medicare beneficiaries are generally very satisfied with their health insurance, but Original Medicare may not cover all the treatments, drugs, equipment and other health care needs of some seniors in Rhode Island. Thankfully, seniors have quite a few coverage options that can fill the gaps in their benefits, many of which are very low cost. 

Original Medicare (Parts A & B)

Since Original Medicare’s provider network isn’t limited, beneficiaries can obtain care anywhere in Rhode Island and throughout the country, including while vacationing or moving to another state. However, most of the time, Medicare won’t pay for care obtained in a foreign country. Therefore, the U.S. Department of State strongly recommends citizens traveling abroad get health insurance suitable for their destination. 

Medicare beneficiaries pay for services at the time of receipt. Part A’s annual deductible in 2023 is $1,600, and Part B’s is $226. Medicare covers 80% of eligible costs, with the beneficiary covering the rest.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage offers beneficiaries a wealth of coverage options, as opposed to Original Medicare’s fixed coverage. Seniors can choose from five different types of plans:

• Health Maintenance Organization (HMO)
• Preferred Provider Organization (PPO)
• Private Fee-for-Service plans (PFFS)
• Special Needs Plans (SNPs)
• Medicare Savings Account (MSA)

Each is designed to appeal to a specific type of senior. For example, SNP is suitable for those needing customized care for a specialized health condition, while PPO offers a wider network of health care providers, which enhances its flexibility. As they’re all different, so too are the eligibility requirements and likely premiums.

Who Should Consider Medicare Advantage

Seniors should consider a Medicare Advantage plan if they:

• Are generally healthy, so may benefit from lower premiums Prefer more options even if it costs a bit more
• Have special health needs that require unique coverage
• Will accept managed care
• Want limits on their out-of-pocket expenses

The Top Medicare Advantage Plans in Rhode Island

The table below lists the Medicare Advantage plans in Rhode Island with the highest enrollment numbers. Since providers usually offer more than one plan, the table lists the costs in a range. The information in this table is up to date as of August 2023.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Rhode Island

Medicare is a very large program that can be difficult for many seniors to understand and navigate. Seniors in Rhode Island can get the help they need to successfully benefit from Medicare by taking advantage of the following resources. These resources provide information, give one-on-one guidance and advocate for the rights of beneficiaries.