Rhode Island Medicare Guide

Get personalized Medicare advice from a licensed Rhode Island Medicare Advisor! Schedule a free consultation or give us a call at (888) 604-0055 to get started.

This guide is intended to help you understand the basics of Medicare in Rhode Island. This will help you make informed decisions that get you the best value from Medicare!

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A Snapshot of Medicare in Rhode Island

There are 228,000 Rhode Island Medicare beneficiaries, making up 21% of the state’s population. Most people are on Medicare due to age, but about 15% of Rhode Island residents are on Medicare because they have a disability. 20% of Rhode Island Medicare recipients also receive Medicaid benefits. When it comes to Original Medicare vs. Medicare Advantage, 49% of beneficiaries stay on Original Medicare and 51% choose to move to a Medicare Advantage plan.

Rhode Island Medicare Eligibility and Enrollment Steps

All US citizens who meet one of the following requirements are eligible for Medicare:

You’re 65 or older
You have certain disabilities like ALS and End-Stage Kidney Disease

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B)

Most people age into Medicare when they turn 65 years old. If you’re already receiving Social Security, you’ll be automatically enrolled in Medicare when you turn 65. Otherwise, you can enroll as soon as your Initial Enrollment Period (IEP) starts. Your IEP starts three months before the month you turn 65 and ends three months after it.

Some people who are still working after turning 65 years old choose to delay their Part B enrollment. We recommend comparing your employer coverage to Medicare to see which one makes the most sense for your health and financial needs. In many cases Medicare is the better option! If you do choose to delay Part B enrollment, just be sure you’re eligible for the Part B Special Enrollment Period—or you may incur a late enrollment penalty.

2. Compare additional coverage options

Medicare beneficiaries have options. Once you’ve enrolled in Original Medicare, you can choose to stay on Original Medicare or switch to Medicare Advantage. If you stay on Original Medicare, you also have the option to add a Medicare Supplement (also called Medigap) and/or Part D (prescription drug) plan to enhance your coverage. Which path is best depends on your unique health and financial status. That’s why we recommend working with an independent Medicare advisor to understand your options and make the best Medicare choices.

3. Get the best value from Medicare

Once you’ve enrolled in the best Medicare insurance coverage for your needs, there are three additional things you should do to get the best value from Medicare.

Use your coverage, including your preventive care services and any extra benefits that come with your plan.
Lean on our Chapter Member Advocates who can help you with things like finding lower prices for your prescriptions, claiming plan benefits that may come with your plan, and answering questions about billing and claims.
Review your Medicare coverage and shop around each year during the Medicare Open Enrollment Period (October 15 - December 7).

Rhode Island Medicare Advantage Plans

There are 28 Medicare Advantage plans in Rhode Island, but exact plan pricing and availability varies by county. For example, Kent County has 28 Medicare Advantage plans available and Washington County has 23. To hear about specific plans available to you, give us a call at (888) 604-0055 or schedule a free consultation with a licensed Rhode Island state Medicare Advisor.

Medicare Advantage plans replace Original Medicare and must legally provide at least the same level of coverage. Most of them also provide Part D coverage and various extra benefits. Some of the popular extra benefits include:

Dental, vision, and hearing care
Transportation services
Meal services
Flex spending cards
Fitness perks

Medicare Advantage plans are popular because they provide additional coverage and benefits and most of them have a zero-dollar or very low premium. While Medicare Advantage plan enrollees are still responsible for their Original Medicare premiums, more coverage for no (or a low) additional cost sounds great. So, what’s the catch? Many people complain about Medicare Advantage plans having:

Network limitations that prevent them from seeing their preferred doctors
Preauthorization requirements that limit their access to quick and affordable care
High out-of-pocket costs in comparison to Original Medicare + Medigap

Rhode Island Medicare Supplement Plans

Original Medicare doesn’t pay for about 20% of costs. It also doesn’t have an out-of-pocket limit. This means that if you need an expensive surgery, you could be on the hook for thousands of dollars, with no upward limit. Many Medicare beneficiaries enroll in Medicare Advantage plans, which still have standard out-of-pocket costs like deductibles and cost-sharing, but also come with out-of-pocket maximums that prevent you from owing a catastrophic amount. Many other Medicare beneficiaries choose to stay on Original Medicare and add a Medicare Supplement (also known as Medigap) plan to their coverage to significantly reduce their out-of-pocket spending.

There are ten types of Medigap plans available in Rhode Island, and each is labeled by a letter A through N. Plans of the same type (e.g., every Medigap Plan A) is identical in coverage, even if the pricing or insurance carrier is different. Each of these plans pays for a different combination of your Medicare out-of-pocket costs, including Part A and B deductibles and coinsurance. In addition to reducing your out-of-pocket costs, these plans also don’t:

Limit which doctors you can see. You can see any doctor who accepts Medicare.
Require prior authorizations for Medicare-covered services.

The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period, which occurs for six months following your Part B effective date. This is one of a handful of guaranteed issue periods, during which insurance carriers cannot ask you questions about your health history or deny you coverage. Outside of guaranteed issue periods, insurance companies can ask about your health history. They can also charge you more or deny you coverage due to your health history.

Rhode Island Part D Plans

Original Medicare does not cover prescriptions, which is why we have Medicare Part D. You can get Part D coverage through a Medicare Advantage plan that includes it or through a stand-alone Part D plan. There are 24 stand-alone Part D plans available in Rhode Island, with an average monthly premium of $41.56.

We recommend that everyone gets prescription coverage when they first enroll in Medicare, even if they don’t need it. This will ensure you don’t owe the Part D enrollment penalty if you do need prescription coverage later in life.

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Rhode Island Medicare Advisors or give us a call at (888) 604-0055.

Get help paying for Medicare in Rhode Island

There are three government programs that offer financial assistance for Medicare beneficiaries who have low incomes and resources.

Rhode Island Medicaid

Medicaid is a joint state and federal program that each state operates individually. If you’re on Medicare and have a low income, you may be eligible for Medicare Premium Assistance through a Medicare Premium Payment Program (may also be called Medicare Savings Program).

Rhode Island has three types of Medicare Premium Payment Programs.

Qualified Medicare Beneficiary (QMB)

To be eligible for the QMB program, your income must be lower than 100% of the Federal Poverty Level (FPL) and meet the resource requirement, which changes each year. If you are eligible, Medicaid will pay for your Part A & B premiums, deductibles, and coinsurance.

Specified Low-Income Medicare Beneficiary (SLMB)

To be eligible for the SLMB program, your income must be higher than 100% FPL and lower than 120% FPL. You must also meet the resource requirement, which changes each year. If you’re eligible, Medicaid will pay for your Part B.

Qualified Individual (QI)

To be eligible for the SLMB program, your income must be higher than 120% FPL and lower than 135% FPL. You must also meet the resource requirement, which changes each year. If you’re eligible, Medicaid will pay for your Part B premium.

To apply for any Medicare Premium Payment Programs, call or visit your local DHS office. You can also get help applying from one of our licensed Medicare advisors by calling (888) 604-0055.

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with Medicare Part D, including premiums, deductibles, and coinsurance/copayments. Extra Help is also sometimes called the Part D Low Income Subsidy (or LIS).

You automatically qualify for Extra Help if you:

Receive full Medicaid coverage from Rhode Island
Rhode Island pays your Part B premium
Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed Rhode Island Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

You are 65 and older, blind, or have a disability
You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.

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