If you’ve recently qualified for Medicare, you might be confused about the many parts and plan options, and what each option covers and how it benefits you. Understanding Medicare in Rhode Island can be difficult — we want to make it easier for you to choose a plan. Use our complete guide to Medicare in the Ocean State before you choose a supplemental or Medicare Advantage plan.
The Best Medicare in Rhode Island
- Best Overall in RI: Blue Cross & Blue Shield of Rhode Island
- Most Affordable in RI: Aetna
- Best for Special Needs Plans: UnitedHealthcare
- Best for $0 Copays: Lasso
What is Medicare?
Medicare is a type of federal health insurance coverage. Unlike private health insurance, most parts of Medicare are regulated and administered by the federal government of the United States. You may qualify for Medicare if you’re over the age of 65, if you’re younger with a disability or if you have a severe kidney disorder requiring a transplant or dialysis.
Let’s take a closer look at what each part of Medicare covers, how you can get it and who regulates it.
Original Medicare
Original Medicare, sometimes referred to as traditional Medicare, consists of Part A and Part B. It's the most enrolled and recognized of the federally administered healthcare programs — most people who have Medicare have Original Medicare A and B. Let’s take a look at what both parts of Original Medicare cover.
Part A
Often regarded as in-patient or hospital insurance, Part A coverage covers expenses from hospital care. If you’re involved in a car accident, for example, and must have emergency surgery, Medicare Part A covers your bill. Your Part A coverage may also include the cost of stays at skilled nursing facilities, hospice care (terminally ill persons) or health care at home.
Part B
Medicare Part B covers outpatient care costs that you receive outside of a hospital or hospice setting. Part B covers things like physician services, outpatient hospital expenses, mental health care, medical devices, ambulance, home health, laboratory and diagnostics services. In Rhode Island, Part B may be optional. Consider getting a Part B plan to complement the coverage offered in Part A.
Medicare Parts A and B are controlled and administered fully by the federal government. However, private companies are allowed to offer supplementary or replacement Medicare plans. Let’s take a look at what’s covered under Medicare Parts C and D.
Part C
Sometimes called Medicare Advantage, Medicare Part C is offered by private health insurance companies. Most Medicare Part C plans include Parts A and B coverage, as well as coverage for outpatient prescription drugs.
Medicare Part C allows you to benefit from a host of medical services such as medical support, lab and diagnostics, skilled nursing facility care, in-patient hospital care, dental, home health care, among other medical services. Though this subsect of Medicare is offered by private insurers, plans are regulated by Medicare. When you have a Medicare Advantage plan, you must adhere to all of the plan's rules. For example, you may need to use physicians and hospitals in the plan's network.
Part D
Popularly regarded as Medicare Prescription Drug Coverage, Medicare Part D covers prescription drugs you need outside of a hospital setting. If you need drugs administered within a hospital setting (like anesthetic before a surgery) Medicare Part A covers your care costs. If you want coverage for drugs you take at home (like antidepressants or medication to control your cholesterol) you’ll need a Part D plan. In Rhode Island, you can sign up for an independent Part D plan or you can buy a Medicare Advantage plan that includes Part D coverage.
No matter which type of Medicare you choose, your plan won’t cover 100% of your medical care costs. If you want additional protection, you might want to consider buying a Medicare supplemental plan. These plans are often referred to as “Medigap” plans because they’re intended to fill the “gaps” in Original Medicare.
Legalities of Medicare in Rhode Island
The Rhode Island Department of Health and Human Services oversees Medicare. The Social Security Administration handles the enrollment of qualified beneficiaries into the Medicare program. The Rhode Island State Department of Health Insurance in connection with Medicare approves the list of insurance providers allowed to sell Medicare Advantage plans, Medicare Part D plans and Medigap policies.
If you have concerns regarding the Medicare RI program, your best bet is to contact Medicare directly. If you have an issue with Medicare Parts C and D, you should reach out to the insurance company. For questions regarding insurance resolution or Medicare fraud, contact the Office of the Health Insurance Commissioner.
Types of Medicare Advantage Plans
With the various deductibles, coinsurance, copays and monthly payment charges, Medicare expenses can add up fast. One of the ways a Medicare Advantage plan helps to reduce cost is via Medicare provider networks. Let’s take a look at the different types of Medicare Part C plans you might see when you shop.
HMO
Also known as a health maintenance organization, HMO plans require you to see health providers, medical practitioners and hospitals within your designated plan network. The only exception is in an emergency, when you can see any emergency room in the country. HMO plans are usually much more affordable than other types of Part C coverage, but give you the least amount of freedom to use your benefits.
PPO
Unlike the HMO plans, the preferred provider organization (PPO) does not place restrictions on any healthcare provider or doctor you can see. You can see any doctor, specialist or other type of healthcare provider you’d like. PPO plans give you more freedom to use your plan as a patient, but you’ll almost always pay more when compared to HMO alternatives.
How to Sign Up for Medicare in RI
To qualify for Medicare, you must be a U.S. citizen or have attained permanent residency status for at least 5 years.
If you’ve been receiving retirement benefits through the Social Security Administration or Railroad Retirement Board (RRB), you will automatically be enrolled in the Original Medicare plan. This usually occurs 3 months before you reach 65 years of age. You may also be registered automatically if you are younger than 65 but receive Social Security disability benefits or disability benefits from the RRB for more than 24 months.
If you have end-stage renal disease, you may qualify for Medicare assistance but will need to enroll manually. You can join manually by visiting your local Social Security office to register for Medicare or register online. You can also register by calling 800-772-1213.
Not signing up for your Medicare Part B during your eligibility period may lead to a late registration fee. You may also experience a higher charge up to 10% on your monthly Part B every year for the period you were eligible but didn't register.
If you want to sign up for Medicare Part C or D, you’ll need to enroll with a licensed private insurance company offering these plans. Begin by comparing companies offering plans in your area and follow their individual enrollment process.
Average Cost of Medicare Advantage Plans in RI
Let’s take a look at what you might pay for a few different Medicare Advantage options in Rhode Island.
| Plan Name | Company | Plan Type | Health Care Deductibles | Drug Deductibles |
|---|---|---|---|---|
| BlueCHiP for Medicare Value | Blue Cross & Blue Shield of Rhode Island | HMO-POS | $0 | $0 |
| AARP Medicare Advantage Plan 1 (HMO-POS) | UnitedHealthcare | HMO-POS | $0 | $150 |
| Aetna Medicare Explorer Plan (PPO) | Aetna Medicare | PPO | $0 | $0 |
| BlueCHiP for Medicare Standard with Drugs (HMO) | Blue Cross & Blue Shield of Rhode Island | HMO | $0 | $100 |
| HealthMate for Medicare (PPO) | Blue Cross & Blue Shield of Rhode Island | PPO | $0 | $0 |
Best Medicare Insurance Providers in Rhode Island
Think that a Medicare Part C plan is the right choice for you? Now that you understand how Medicare works, let’s take a look at some of the best Medicare Advantage options in Rhode Island.
- Wide network of doctors, hospitals and specialists across the U.S.
1. Best Overall in RI: Blue Cross & Blue Shield of Rhode Island
Blue Cross & Blue Shield is one of the highest-rated Medicare Part C plan providers in Rhode Island — with an average score of 4 out of 5 stars on Medicare.gov, its plan choices are hard to beat. All Blue Cross plans in Rhode Island are HMOs with several options for you to balance your care costs and coverage. You can also choose the Blue Cross & Blue Shield Advantage Plan, which offers vision, hearing and other benefits not included in Original Medicare. If you’re looking for a single health plan option be sure to get a quote from Blue Cross Blue Shield.
- Member support
2. Most Affordable in RI: Aetna
With a $0 copay for primary doctor visits and PPO plans with no annual premium charge, Aetna offers some of the most affordable Medicare plans in Rhode Island. Aetna Medicare Explorer Premier Plan offers policyholders several benefits such as dental care, worldwide emergency support, fitness benefits, and others. Its PPO coverage also means that you can keep seeing the doctors and specialists you trust. With affordable PPO coverage and low plan premiums, Aetna is our top choice for Medicare Part C coverage that doesn’t break the bank.
- Same day coverage available
3. Best for Special Needs Plans: UnitedHealthcare
A Medicare Special Needs Plan (SNP) is a special type of health insurance coverage that customizes your insurance benefits to suit specific health issues. UnitedHealthcare offers a series of SNP options that you can use to better personalize your healthcare to your needs. The UnitedHealth Nursing Home Plan 1 & 2 offers nursing home care in a facility or at home. Each of the plans comes with several benefits such as dental, OTC drugs, vision, telehealth and much more. With a 4.5 rating on Medicare.gov, UnitedHealthcare is one of the most popular options for Rhode Islanders.
- Best for MSA
4. Best for $0 Copays: Lasso
If you’re living on a limited income as a senior, copays can create a serious dent in your budget. Lasso Healthcare offers a series of plans in Rhode Island with $0 copays. Many of its plan options include $0 copays for everything from preventive care visits to prosthetics fittings after you meet your deductible. Lasso also offers Medical Savings Account (MSA) options, and all of its plans include $0 monthly premiums.
Which Medicare Plan Is Right For You?
Finding the right Medicare Advantage plan can be difficult. Be sure to leave yourself with plenty of time to compare and collect quotes. The best way to ensure that you’re not overpaying for your medical care costs is to get at least a few quotes from competing companies and different plans. Begin by getting a quote from some of our favorite insurance providers today — and get on the path to complete coverage.
Frequently Asked Questions
What are the different parts of Medicare?
Medicare has 4 parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C is provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Is Medicare free?
Because there are 4 parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient medical services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.
About Sarah Horvath
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