At a glance: Medicare health insurance in Rhode Island
- Nearly 217,000 Rhode Island residents are enrolled in Medicare.
- Of Rhode Island Medicare beneficiaries, 37 percent have Medicare Advantage coverage as of 2017.
- Residents in most parts of Rhode Island can select from among 19 Medicare Advantage plans in 2019; Kent County residents have 18 options available.
- Ten insurers offer Medigap plans in Rhode Island, but only BCBSRI offers coverage (Medigap Plan A) 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
216,980 Rhode Island residents were enrolled in Medicare as of November 2018. That’s more than 20 percent of the state’s total population, compared with a little more than 18 percent of the United States population enrolled in Medicare.
82 percent of Medicare beneficiaries in Rhode Island are eligible due to age (ie, being at least 65), while the other 18 percent are eligible due to a disability. Nationwide, 84 percent of Medicare beneficiaries are eligible due to age, while 16 percent are eligible due to disability.
But 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
37 percent of Rhode Island Medicare beneficiaries were enrolled in private Medicare Advantage plans in 2017. Nationwide, the average was 33 percent. The other 63 percent of the state’s Medicare beneficiaries had opted instead for coverage under Original Medicare.
Medicare Advantage availability varies by county, but it’s quite uniform throughout Rhode Island. There are five counties in the state, and in four of them, 19 Medicare Advantage plans are available in 2019. In the fifth (Kent County), there are 18 plans available.
Medicare beneficiaries can switch from Original Medicare to Medicare Advantage, and vice versa, during the annual election period each fall (October 15 through December 7), with coverage effective January 1. And as of 2019, there’s 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 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.
Rhode Island’s 2016 consumer guide to Medigap plans lists ten insurers that offer Medigap plans in the state. Blue Cross Blue Shield of Rhode Island is the only one that shows rates for enrollees under the age of 65, and only for Medigap Plan A. Blue Cross Blue Shield of Rhode Island confirmed by phone that they are the only Medigap insurer in the state that offers coverage to people under the age of 65, although they only offer Plan A to those enrollees. BCBSRI has made the choice to offer this coverage — there is no state requirement that they do so, but they felt that with their long history in the state’s market, it was important to ensure that all Medicare beneficiaries would have access to Medigap plans. Plan A 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.
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), or a stand-alone Part D plan.
As of November 2018, there were 73,303 Medicare beneficiaries in Rhode Island who were enrolled in stand-alone Part D prescription drug plans. An additional 93,476 beneficiaries had Part D coverage integrated with their Medicare Advantage coverage.
For 2019 coverage, there are 26 stand-alone Part D plans available in Rhode Island, with premiums ranging from $14 to $128 per month.
Medicare spending in Rhode Island
In 2016, Original Medicare spent an average of $8,907 per 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 $9,533 per enrollee, so Medicare spending in Rhode Island was 7 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 $11,399, and lowest in Hawaii, at $6,441.
You can read more about Medicare in Rhode Island in our state Medicare guide. You can also contact the Rhode Island Senior Health Insurance Program (SHIP), with questions related to Medicare coverage in Rhode Island.
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.