- Nearly 225,000 Rhode Island residents are enrolled in Medicare.
- Of Rhode Island Medicare beneficiaries, nearly half are enrolled in Medicare Advantage plans.
- Residents in most parts of Rhode Island can select from among 27 Medicare Advantage plans in 2021; Kent County residents have 26 plan options available.
- 19 insurers offer Medigap plans in Rhode Island, but only two (BCBSRI and United American) offer coverage to enrollees under age 65.
- About a third of Rhode Island Medicare beneficiaries have stand-alone Part D prescription coverage.
- Per-enrollee Medicare spending in Rhode Island is a little lower than the national average.
Medicare enrollment in Rhode Island
224,876 people were enrolled in Medicare in Rhode Island as of September 2020. That’s more than 21 percent of the state’s total population, compared with about 19 percent of the United States population enrolled in Medicare.
For most people, filing for Medicare benefits is part of turning 65. But Medicare eligibility is also triggered by a diagnosis of ALS or kidney failure, or by a disability that lasts more than two years. Nationwide, 85 percent of Medicare beneficiaries are eligible due to age (ie, being at least 65). In Rhode Island, 83 percent of Medicare beneficiaries are eligible due to age, while the other 17 percent of people with Medicare in Rhode Island are under the age of 65.
Rhode Island has a higher percentage of disabled residents than the US as a whole, so it makes sense that a larger-than-average share of the state’s Medicare beneficiaries would be eligible due to a disability, and that total enrollment as a percentage of the state’s population would also be higher than the US average.
Medicare Advantage 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.
37 percent of Rhode Island Medicare beneficiaries were enrolled in private Medicare Advantage plans in 2018. Nationwide, the average was 34 percent. The other 63 percent of Rhode Island’s Medicare beneficiaries had opted instead for coverage under Original Medicare. But Medicare Advantage enrollment has been steadily increasing. As of September 2020, there were 108,464 people enrolled in Medicare Advantage plans in Rhode Island, which was more than 48 percent of the state’s total Medicare population.
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 in four of them, 27 Medicare Advantage plans are available for 2021. In the fifth (Kent County), there are 26 plans available.
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.
Medigap in Rhode Island
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.
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.
There are 19 insurers that offer Medigap plans in Rhode Island as of 2020 (rate filing details for several of them are available here). Rhode Island is among the states where Medigap insurers are not required to offer plans to disabled beneficiaries under the age of 65, and only two of Rhode Island’s Medigap insurers voluntarily offer plans to people under the age of 65.
Blue Cross Blue Shield of Rhode Island offers Plan A to those enrollees (enrollees under the age of 65 pay standard rates, as they are not eligible for the discounted rates that BCBSRI offers to people who are at least 65 years old). United American Insurance company offers Plan B, as well as high-deductible Plan F for beneficiaries who became eligible for Medicare prior to 2020 (federal rules prevent the sale of Medigap plan C and Plan F to anyone who first becomes eligible for Medicare after the end of 2019).
Unlike Medicare Advantage plans and Medicare Part D plans, there is no annual enrollment window for Medigap plans.
Medicare Part D in Rhode Island
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), Medicaid (for people who are eligible for both Medicare and Medicaid), or a stand-alone Medicare Part D prescription drug plan.
As of September 2020, there were 73,450 Medicare beneficiaries in Rhode Island who were enrolled in stand-alone Medicare Part D plans. An additional 103,911 beneficiaries had Part D coverage integrated with their Medicare Advantage coverage.
For 2021 coverage, there are 27 stand-alone Part D plans available in Rhode Island, with premiums ranging from $7 to $135 per month.
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
Medicare spending in Rhode Island
In 2018, the federal government spent an average of $9,261 per Original Medicare beneficiary in Rhode Island, based on data that were standardized to eliminate regional differences in payment rates (the data did not include costs for Medicare Advantage enrollees). The national average that year was $10,096 per enrollee, so Medicare spending in Rhode Island was 8 percent lower than the national average. For perspective on the range of spending, average per-beneficiary costs for Original Medicare were highest in Louisiana, at $11,932, and lowest in Hawaii, at $6,971.
How does Medicaid provide financial assistance to Medicare beneficiaries in Rhode Island?
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.
Medicare in Rhode Island: Resources for beneficiaries and their caregivers
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.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.