Medicare Plans in Rhode Island

What Rhode Island Medicare Plans Are Available?

Rhode Island Medicare programs can help eligible enrollees obtain coverage to help with health care costs ranging from physician visits to prescription medications. Choosing the best plan options depends on eligibility factors and cost. 

Medicare provides a few coverage options in the form of different parts from which consumers can choose. 

Part A: This is the original Medicare program and the one that focuses on hospital-related coverage. It also covers inpatient care delivered through other types of medical facilities, including surgical centers, skilled nursing care facilities and even hospice. This part of Medicare has no premium requirement for anyone who has paid into the payroll tax system via an employer. Part A is available for purchase if individuals also purchase Part B. 

Part B: This part of Medicare functions more like traditional insurance in that it has monthly premiums, which are largely based on income considerations. This portion covers preventative care, in-office physician visits and home health services. Enrollment in Part B is required as soon as individuals are eligible to avoid the penalty that may be levied every 12 months for late sign-ups. Exceptions to this penalty include those who had employer-sponsored healthcare through their job or via a spouse's policy and endured a sudden loss of coverage. 

Part C: Part C of the Medicare program is also known as the Medicare Advantage program. Delivered through a health maintenance organization (HMO) or preferred provider organization (PPO) model, Advantage plans are managed by private insurers. They must cover everything Parts A and B do but often cover extras that the original components do not, such as dental and vision coverage. Part C is an option instead of Parts A and B, not in addition to them. 

Part D: Medicare Part D is the prescription drug benefit component. It covers the cost of any prescribed medications for those enrolled in the Medicare program. It also has monthly premiums attached (based on income) as well as a specific enrollment period (with the same penalties and exceptions as those in Part B). 

Medigap: Medigap coverage helps Medicare recipients cover the costs of healthcare not addressed by the previous components of the plan. This includes co-pays for in-office visits, coinsurance costs and even some types of medical equipment. Medigap enrollees must already have Parts A and B. 

Roughly 236,000 residents are registered for Medicare in Rhode Island, half of which also have Advantage plans. There are 35 Advantage plans available to Rhode Island residents as of 2024 and 15 Medigap options. Of the Medigap programs, two are available to those enrolled in Medicare under the age of 65. 

Who Is Eligible for Rhode Island Medicare?

Those who are 65 and up and have paid into the payroll tax system are automatically eligible for Medicare. Eligibility outside of this age range includes those with disabilities or chronic conditions, as determined by the Social Security Administration. For those with automatic eligibility, enrollment occurs about 4 months before an individual's 65th birthday. 

How Do I Enroll in Medicare in Rhode Island?

To enroll in Medicare in Rhode Island, those not automatically signed up must do so in the 3 months prior to their 65th birthday, in that month or in the 3-month period following that month. Enrollment is an option after this time, but depending on the circumstances, a penalty may be levied to do so. 

Medicare also has specific enrollment periods. For instance, enrollment for those wanting to switch a Medicare Advantage plan takes place between January 1 and March 31. Coverage for this enrollment period starts on July 1. Fall enrollment takes place between October 15 and December 7. Coverage for this enrollment period starts on January 1. 

Special enrollment is available to those who have suddenly lost employer-sponsored coverage. 

Eligible individuals may visit the Social Security Administration website at www.SocialSecurity.gov to sign up. They can also call (800) 772-1213 Monday through Friday from 7 a.m.-7 p.m. Local Social Security offices can also assist with the signup process.