Medicare in Rhode Island

Medicare Advantage is an alternative to Original Medicare, offered by private health insurance companies. Medicare Advantage plans cover all of the healthcare benefits that Original Medicare covers (ie, hospital services, and outpatient/medical/physician services), but the out-of-pocket costs can be very different, as Advantage plans set their own copays, coinsurance, and deductible (within parameters defined by CMS).

Most Medicare Advantage plans also cover prescription drugs with integrated Part D coverage, and many provide additional benefits, such as dental and vision coverage. But Advantage plans tend to have localized provider networks, as opposed to Original Medicare’s nationwide access to medical providers. There are pros and cons to either option.

Thirty-seven percent of Rhode Island Medicare beneficiaries were enrolled in private Medicare Advantage plans in 2018. Nationwide, the average was 34% at that point. The other 63% of Rhode Island’s Medicare beneficiaries had opted instead for coverage under Original Medicare as of 2018. But Medicare Advantage enrollment has been steadily increasing. As of mid-2023, there were 135,391 people enrolled in Medicare Advantage plans in Rhode Island, which was more than 57% of the state’s total Medicare population.

Nationwide, about 48% of Medicare beneficiaries were enrolled in private Advantage plans as of 2023, but Rhode Island was among the states where the majority of beneficiaries had selected Advantage plans instead of Original Medicare.

Medicare Advantage availability and service areas vary by county in most states, but they are quite uniform throughout Rhode Island. There are five counties in the state, and they all have between 35 and 39 Medicare Advantage plans available as of 2023.

Medicare Advantage enrollment is an option when a person is first eligible for Medicare. There is also an annual election period each fall (October 15 – December 7) during which Medicare beneficiaries can switch from Original Medicare to Medicare Advantage, and vice versa, with coverage effective January 1. There is also a Medicare Advantage open enrollment period (January 1 to March 31) during which people who are already enrolled in Medicare Advantage plans can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

Because Original Medicare has out-of-pocket costs that can be substantial (and there is no cap on how high out-of-pocket healthcare costs can be with Original Medicare), many enrollees use Medigap plans to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that people would otherwise incur if they only had Original Medicare on its own.

According to Medicare’s plan finder tool, there are 15 insurers that offer Medigap plans in Rhode Island as of 2023. Medigap plans are standardized under federal rules, and people are granted a six-month window, when they turn 65 and enroll in Original Medicare, during which coverage is guaranteed issue for Medigap plans. Federal rules do not, however, guarantee access to a Medigap plan if you’re under 65 and eligible for Medicare as a result of a disability.

Prior to mid-2021, Rhode Island was among the states where Medigap insurers were not required to offer plans to disabled beneficiaries under the age of 65, and only two of Rhode Island’s Medigap insurers voluntarily offered plans to people under the age of 65. But starting in July 2023, all Rhode Island Medigap insurers must offer Medigap Plan A to applicants who are under 65, as long as they submit an application within six months of becoming eligible for Medicare Part B. The state also created a special enrollment window, from July 1 through August 30, 2023, when existing under-65 Medicare beneficiaries in the state had an opportunity to sign up for any insurer’s Medigap Plan A.

As is the case in most states, enrollees under the age of 65 pay higher premiums for their Medigap coverage. They have another enrollment window that starts when they turn 65, during which they can switch to any Medigap plan available in the state, at the lower premiums that are charged when an applicant is 65.

Rhode Island’s minimum standards for Medigap plans can be seen here.

Unlike Medicare Advantage plans and Medicare Part D plans, there is no annual enrollment window for Medigap plans.

Original Medicare does not cover outpatient prescription drugs. But Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Medicare Part D prescription drug plan.

For 2023 coverage, there are 24 stand-alone Part D plans available in Rhode Island, with premiums that start as low as $6.80/month.

As of mid-2023, there were 60,647 Medicare beneficiaries in Rhode Island who were enrolled in stand-alone Medicare Part D plans. An additional 130,713 beneficiaries had Part D coverage integrated with their Medicare Advantage coverage.

The annual Medicare open enrollment period (October 15 to December 7) is an opportunity for Medicare beneficiaries to change their Medicare Part D coverage, with the new plan taking effect January 1. Enrollment in Part D is optional, but there’s a late enrollment penalty for people who don’t enroll when they’re first eligible (and aren’t covered under other creditable coverage) and then enroll later on during a future open enrollment period.

Learn more: Seven rules for shopping Medicare Part D plans.

Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.

Our guide to financial assistance for Medicare enrollees in Rhode Island includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.

If you need help with Medicare enrollment in Rhode Island or Medicare eligibility in Rhode Island, you can contact the Rhode Island Senior Health Insurance Program (SHIP). They can provide information and assistance, and help with a variety of questions related to Medicare coverage in Rhode Island.

The Rhode Island Insurance Division oversees, regulates, and licenses the insurance companies that offer coverage in the state, including Medigap plans (and although CMS has most of the regulatory control over Medicare Advantage and Part D plans, the state Insurance Division is responsible for ensuring that the carriers are licensed in the state and fiscally solvent), as well as the agents and brokers who sell the plans. Their office can provide information and address inquiries and complaints about a wide range of insurance topics.

The Medicare Rights Center is a nationwide service that can provide information and assistance with Medicare enrollment, eligibility, and benefits.