Medicare in Rhode Island

Medicare is the federally run health insurance program for people aged 65 and older and individuals with specific disabilities. As of 2020, more than 235,000 people in Montana receive Medicare, representing almost 22% of the state’s total population. Of the state’s Medicare beneficiaries, it enrolled more than 189,000 in Original Medicare, and more than 46,000 people have Medicare Advantage. In 2019, Montana’s Medicare spend was in excess of $1.5 billion, up approximately $1 million compared with the previous year. On average, the state spent $8,387 per enrollee in 2019.

Original Medicare Part A covers expenses related to care inpatient care in a hospital, nursing home and skilled nursing facility care, hospice care and aspects of home health care. Part A Medicare coverage is free for those who paid, or whose spouse paid, Medicare taxes for a set period. Part B Medicare provides coverage for preventative services and other outpatient medical services and supplies.. As of 2022, the standard premium for Part B Medicare is $170.10.

There are also private plans that provide tailored coverage. Private health insurance companies offer Medicare Advantage plans, also known as Part C Medicare, which include the same benefits as Parts A and B, excluding hospice care. Such plans typically provide supplementary coverage for expenses such as prescription drugs and eye care. 

Part D provides coverage for prescription medications; it can add prescription drug coverage to Original Medicare, some Medicare Cost plans and some Medicare Advantage plans. There are also Medicare supplement plans, known as Medigap, provided by private health insurance companies to minimize costs incurred by Original Medicare policyholders. Those enrolled in Medicare Advantage plans do not need and can’t buy Medigap. 

This guide details Medicare in Montana, with an overview of Medicare plans available in the state and resources geared toward helping individuals understand their options to make informed decisions about health insurance.

Options for Medicare Coverage in Rhode Island

Medicare beneficiaries are generally very satisfied with their health insurance, but Original Medicare may not cover all the treatments, drugs, equipment and other health care needs of some seniors in Rhode Island. Thankfully, seniors have quite a few coverage options that can fill the gaps in their benefits, many of which are very low cost. 

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Part C is a health insurance option for Rhode Island seniors who prefer a private plan over Original Medicare. While private organizations operate these plans, they must adhere to Medicare guidelines, which require policies to cover the same benefits as Parts A and B. There are also a few Medicare Advantage Plans that include health care planning, cost-sharing, fitness club memberships and other incentive programs. The average monthly premium for a Medicare Advantage plan is $25.46, but some plans have a $0 premium.

Seniors who want to sign up for a Medicare Advantage plan can choose between four types of policies: Health maintenance organization, preferred provider organization, special needs plan and private fee-for-service. These plans have a wide range of costs and coverage options to accommodate the health care needs of all types of seniors. 

Who Should Consider Medicare Advantage

Seniors should consider a Medicare Advantage plan if they:

• Are generally healthy, so may benefit from lower premiums Prefer more options even if it costs a bit more
• Have special health needs that require unique coverage
• Will accept managed care
• Want limits on their out-of-pocket expenses

The Top 10 Medicare Advantage Plans in Rhode Island

The table below lists the 10 Medicare Advantage plans in Rhode Island with the highest enrollment numbers. Since providers usually offer more than one plan, the table lists the costs in a range. The information in this table is up to date as of April 2022.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Rhode Island

Medicare is a very large program that can be difficult for many seniors to understand and navigate. Seniors in Rhode Island can get the help they need to successfully benefit from Medicare by taking advantage of the following resources. These resources provide information, give one-on-one guidance and advocate for the rights of beneficiaries.