Introduction to Medicare Part C in Rhode Island

There are many different Medicare supplement insurance plans for you to choose from, and Medicare Advantage is one of them. In case you are unfamiliar, Medicare supplement plans are designed to protect seniors like you from the potentially costly gaps which exist in your federal Medicare coverage. If you are new to Medicare Advantage, there is a lot to learn. We will help teach you the basics in this article.

Federal Regulations for Medicare Advantage

Another nickname for Medicare Advantage is “Medicare replacement”, and it’s an accurate one. When you sign up for Medicare Advantage, you are basically transferring the responsibility for paying out your Medicare claims to a private health insurance company. You can rest assured that these insurance policies are regulated by the federal government, ensuring that your coverage is at least as good (and in many cases, better) than Original Medicare.

Medicare Advantage Enrollment In Rhode Island

More than one-third of Rhode Island seniors who have enrolled in Medicare (37% to be exact) have decided to enroll in a Medicare Advantage plan. But of those, not everyone is enrolled in the exact same plan. Some Advantage plans are more popular than others, as you can see in the chart below:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Living in Rhode Island means that your monthly premium will probably vary when compared to a senior in Montana or New Mexico. Your personal circumstances, such as age, weight, and smoking habits, may also adjust your rate. Below are some estimated monthly premiums which might be available in your area:

Most Popular Medicare Advantage Plans in Rhode Island

If you’re familiar with how five star rating systems work, then our rating system will make shopping for your Medicare Advantage plan a breeze. Companies earn more stars if they are financially stable, receive high customer service ratings, and demonstrate a competent history of healthcare management for their clients. We also evaluate affordability when it comes to the services they offer. The more stars they have, the more likely you are to get the best possible care for your money.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

One of the most important things you need to research before you sign up for Medicare Advantage is the provider network you wish to join. A good start is to ask your current doctor what network(s) they belong to, so that you won’t have to worry about switching after you acquire coverage. Also, keep in mind that the doctors and hospitals in your network today might not be there in the future. You should have a plan in place just in case your insurance provider makes drastic changes to their network.

  • HMO Plans – A health management organization (HMO) consists of a smaller network of doctors, hospitals, and facilities you are allowed to get care from if you want your insurance company to help you pay for the care and reimburse your costs. Going out of network, in most cases, will result in you paying for your care 100% out-of-pocket unless it is an absolute emergency. When you sign up with an HMO, you choose a primary care doctor and then that physician will refer you to other caregivers as needed.
  • PPO Plans – With A PPO plan, your insurance provider will select a network of preferred care providers that they would like you to get your care from. But you are not limited to those doctors or facilities only. It will cost you more to go out-of-network, but your insurance company will still help you with some of those costs. PPO networks tend to be larger as well, and offer you a greater variety of healthcare options compared to more limited networks.
  • PFFS Plans – PFFS plans aren’t HMOs or PPOs – they fall somewhere in between. They give you the freedom of choice that a PPO plan does, but in order to get the care you want, your insurance company and your chosen care provider must agree to the same payment terms. Unfortunately, the likelihood that they will agree might be lower on some plans, making a PFFS plan almost as restrictive as an HMO. And your provider can change their mind about agreeing to the payment terms at any time, so even if they give you care tomorrow, you might not be able to make another appointment with them a few months from now and still have your costs covered by your insurance company.
  • Special Needs Plans – Special Needs Plans are reserved exclusively for people with expensive, chronic conditions. In order to keep costs down, you’re limited to a restricted network like that of an HMO and are severely financially penalized if you go out of network for anything other than emergency care. Some insurance companies may let you negotiate for out-of-network care at a more reasonable price – but this can be difficult and is usually unsuccessful.

Doctor/Providers List

  • HMO Plans – With a Medicare Advantage HMO plan, you will choose a primary care physician, get care from other providers if and only if they give you referrals, and you will do your best to stay in network (with the exception of emergencies) if you want to keep your costs affordable and shared between you and your insurance company. You also enjoy all the benefits you would get with Original Medicare, but they will be administered by a private insurance company and you may be able to purchase extra coverage.
  • PPO Plans – Medicare Advantage PPO plans are also extremely similar to their private health insurance counterparts. You can choose to stay in network for more affordable care, or you can exercise your freedom to go out-of-network – but your insurance company will cover fewer of your costs. Some seniors with more specific medical needs and the money to pay for them may feel like the premium price tag is worth it, though.
  • PFFS Plans – PFFS plans hinge on your health care providers and your insurance company agreeing to payment terms every single time you go to get care. Sometimes they will agree, sometimes they won’t. You aren’t limited to a specific network, so you can get care from wherever you want. But if the caregivers you choose won’t agree with your insurance company on payment terms, then you’ll have to shop around. But you’ll still get all of the health insurance benefits you can expect from a Medicare Advantage plan.
  • Special Needs Plans – SNP plans under Medicare Advantage are particularly fine-tuned to provide the most affordable and effective medical care for seniors with chronic medical conditions. End Stage Renal Disease (ESRD) is a good example of such a condition. Your network of approved care providers is limited, and your financial penalties for going out of network for care (unless it’s an emergency) will be considerable. You will also have to work harder to negotiate out-of-network care in advance with your insurance company if you feel no one in your network can give you what you need.

Do you already have a really great doctor and/or network of care providers that you don’t want to lose if you switch to Medicare Advantage? Depending on the plan you choose, this may be a real concern. That’s why you should take advantage of Medicare.gov’s Physician Search Tool to double-check and make sure the care you need will be available in your Medicare Advantage provider network.

Drug, Vision and Dental Coverage

Do you want extra coverage, such as vision care coverage, to be on the same insurance policy as your health insurance? Then you may want to look closer at Medicare Advantage. It’s easy to add this extra coverage to your policy if your provider offers it in your area. And it gives you the convenience of managing all of your health care needs under the same plan. Keep in mind it will increase your costs, and it may not be available from all Medicare Advantage providers. But for most seniors, it’s a very convenient option.

Dental care coverage is another optional benefit you may choose to purchase from your Medicare Advantage provider if they offer it. But it’s not your only option. If you’re still on the fence about Medicare Advantage, make sure to compare the costs of their dental plan with private health insurance dental plans in your area, since that is the alternative you will have to settle on if you decide to go with Medicare supplement insurance or stay on Original Medicare instead.

Enrollment Options & Best Time To Enroll

Enrolling in a Medicare Advantage plan within your Initial Enrollment Period is the best way to ensure that you get put through the easiest and most expedient approval process. Waiting past the IEP, trying to enroll outside of a Special Enrollment Period, and/or having a serious medical condition (such as End Stage Renal Disease) will make it difficult for you to get approved. If you are rejected, and still in need of affordable coverage, you should contact your local insurance agent. You may also want to contact your state department of insurance for more options. And finally, feel free to take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

When you’re trying to decide on a Medicare Advantage plan, the three most important things you need to consider are the reputation of the company, the affordability of the policy, and how well both of those things will cater to your future medical needs. If you don’t have all of these pieces, it’ll be hard to put the puzzle together and figure out whether or not a Medicare Advantage plan is right for you.

But that can take a lot of work if you try and do it all on your own. To make matters worse, your enrollment period window is lamentably short, so you don’t have a whole lot of time to decide. That’s where we come in. With our expertise, we can help you find the plan that’s right for you at a cost you can afford. All we need is a little bit of basic information to get you started.

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