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Medicare Benefits in Rhode Island – Coverage and Benefits

Rhode Island seniors 65 and over are eligible to enroll in Medicare and receive health coverage from the federal government at a reduced cost (when compared to similar private insurance options). At its core, the basic Medicare Plan consists of coverages which provide for hospital services and outpatient treatment. These are covered by Parts A and B of Original Medicare (respectively). But, unfortunately, this coverage isn’t 100% comprehensive – but we’ll talk about that in a minute.

First, let’s start with basic Medicare costs and fees. Medicare was originally proposed in order to alleviate the financial burden of expensive health care costs for a segment of the population living on a fixed retirement income. As such, it is designed to be as low-cost as possible. Part B requires premiums and deductibles from every beneficiary, and you can get exact numbers and details from this website. Part A, on the other hand, might be free for any senior citizen with a long enough work history of 10 years or more (40 quarters, cumulative). However, if your employment history is shorter than that, there are upfront costs which you will be required to pay.

Medicare Part A (Hospital Coverage)

  • Inpatient care in hospitals
  • Skilled nursing facility care
  • Hospice care
  • Home health care
Medicare Part B (Medical Insurance)

  • Services from doctors and health providers
  • Outpatient care
  • Home health care
  • Durable medical equipment
  • Some preventive services
Medicare Part C (Medicare Advantage)

  • Includes all benefits and services covered under Part A and Part B
  • Usually includes Medicare prescription drug coverage (Part D) as part of the plan
  • Run by Medicare-approved private insurance companies
  • May include extra benefits and services for an extra cost
Medicare Part D (Drug Coverage)

  • Helps cover the cost of prescription drugs
  • Run by Medicare-approved private insurance companies
  • May help lower your prescription drug costs and help protect against higher costs in the future

A Wide Variety of Medicare Plans in Rhode Island

Medicare comes in a variety of forms beyond Traditional Medicare (Parts A and B). In Rhode Island, there are 188,502 beneficiaries enjoying Medicare coverage in some form. The largest segment, which includes 86,711 beneficiaries, is made up of people who supplement their Original Medicare through an employer benefit program (or might not supplement it at all). For those who do supplement their Medicare personally, 36% of beneficiaries (67,860 seniors) do so through a Medicare Advantage plan. And additional 18% (34,180 people) do so with a Medigap policy. Next, we’ll explain how both Medigap and Medicare Advantage work, and why these policies are so popular with seniors.

Anyone currently looking for a Medicare supplement must first make sure they are currently enrolled in the federal Medicare program. You can click that link if you are unsure, or if you need to check your enrollment status.

Why is Medicare Supplement Insurance Necessary?

Well, the truth is that it isn’t absolutely necessary for the recently retired, or any senior who is still in relatively good health. And there is no legal requirement that you supplement your Traditional Medicare by purchasing additional coverage. But if you have chronic health conditions, or if you are well into your golden years, not supplementing your basic Medicare benefits could leave you vulnerable to many of these out-of-pocket expenses:

Medicare Part A Costs Medicare Part B Costs
  • $1,184 (as of 2014) Part A Annual Deductible for access to Basic Hospital Services
  • $296/day for an Inpatient hospital Stay between 61-90 days long
  • $147 Annual Deductible (as of 2014) for basic Part B Medical Coverage
  • 80/20 Coinsurance costs for all Medicare coverage; Medicare pays 80%, you pay 20% Out-of-Pocket

Supplementing Traditional Medicare is a low-cost way of hedging your best on your health. You could save a little money now by not buying a supplement policy, but you risk falling through the “gaps” in Medicare coverage and taking on thousands in unexpected medical bills later. Or, you could purchase an affordable supplement now, and enjoy the protection it provides.

Why Do Rhode Island Residents Choose Medigap?

There are several reasons why seniors in Rhode Island may prefer a Medigap policy over alternative plans such as Medicare Advantage. For one, these policies are designed with Medicare – and the very specific coverage gaps it is known for – in mind. That way, you get exactly as much coverage as you need at the most affordable cost possible. Also, unlike Advantage, you get to keep your government Medicare – you don’t have to transfer all of your health care coverage to a private company. There are ten plans in total, and each one offers identical benefits no matter where you live. However, costs will vary depending on your exact location and the available providers.

Take a look at the available coverage packages:

Top Medicare Supplement Plans in the Area

Type Starting From Part A Deductible Part B Deductible Excess Nursing Travel
F $122 $0 $0 100% Covered 100% Covered 100% Covered Request Info
C $122 $0 $0 Not Covered 100% Covered 100% Covered Request Info
G $118 $0 $147 100% Covered 100% Covered 100% Covered Request Info
B $102 $0 $147 Not Covered Not Covered Not Covered Request Info
N $76 $0 $147 Not Covered 100% Covered 100% Covered Request Info
D $118 $0 $147 Not Covered 100% Covered 100% Covered Request Info
A $67 $1 $147 Not Covered Not Covered Not Covered Request Info
L $67 $304 $147 Not Covered 75% Covered Not Covered Request Info
K $43 $608 $147 Not Covered 50% Covered Not Covered Request Info
M $107 $608 $147 Not Covered 100% Covered 100% Covered Request Info

What are the Pros and Cons of a Medicare Advantage Plan?

Medicare Advantage, also known as “Medicare Part C” or “Medicare Replacement” is Traditional Medicare, technically, but at the same time it is also not Traditional Medicare. Although this seems confusing, it’s actually quite simple: an Advantage plan replaces your Original Medicare plan with a policy that is equal to (or better than) your base Medicare benefits. And the “better than” part of that explanation can often include extras like dental or vision – for a price, of course. Many seniors also appreciate the simplicity of having one single entity (in this case, a private insurance company) handling their policy.

But there are drawbacks as well. Keep in mind that by switching, you’re essentially absolving your government of any responsibility for your healthcare, and instead handing that responsibility over to a private company. Additionally, there are certain regions of the country in which the provider networks are extremely limited in order to keep costs affordable for seniors. Therefore, you have to confront the possibility of switching doctors in order to accept an Advantage plan.

If you choose Medicare Advantage, you will be restricted to only receiving medical care from your plan’s HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization).

Top HMO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$0 BlueCHiP for Medicare Core (HMO) Health Only $0.00 $0
$0 AARP MedicareComplete (HMO) Health and Drug $0.00 $0
$0 AARP MedicareComplete Essential (HMO) Health Only $0.00 $0

Top PPO Plans in the Area

Cost Plan Name Coverage Type Premium Deductible Rating
$360 AARP MedicareComplete Choice (Regional PPO) Health and Drug $30.00 $0

Comparing Medicare Advantage and Medigap Policies

Even though these policies are designed to combat the common problem of Medicare coverage gaps, they couldn’t be more different. Below are some questions and answers which explain their major differences:

Questions Medicare Advantage Medicare Supplement
How are the plans funded? Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company. Your monthly premium takes care of the majority of your expenses.
Do I continue paying for Part B? Yes Yes
What does it cost me? Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly. While each plan does require a monthly premium, many of them are affordably priced.
What does the plan cover? Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be. All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.
Can I budget my health care expenses? It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket. Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.
Can my plan be cancelled? Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage. No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.
Are pre-approvals or pre-certifications required? Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care. No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.
Can I use any doctor or hospital? Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time. Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.
Can drug, vision, or dental coverage be included in the policy? Yes. No. These forms of coverage must be purchased separately.
Who is this plan type generally best suited for? If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you. If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.

Additional Medicare Resources in Rhode Island

For your convenience, we’ve collected the most relevant Medicare-related contact information and included it in the directory located on this page. As informative as we strive to be in this article, we know it’s impossible to answer all of the very important questions you currently have about your Medicare needs. So please feel free to get in touch with qualified experts who can.

Useful Contacts

Choose at least one topic area you are interested in: Select All

Help with my Medicare options & issues
Other insurance programs
Complaints about my care or services
General health & health conditions
Claims & billing
Health care facilities & services in your area

Important Medicare Terms

  • HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
  • Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
  • Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
  • Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.

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