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. 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.

If you live in Rhode Island and are at least 65 years old, you can make use of Medicare as your insurance policy for inpatient and outpatient care. Enrolling into Medicare will automatically get you Medicare Part A if you’re approved. Medicare Part A is free to everyone with 10 years of work history or 40 quarters of work history, and it includes inpatient services, some outpatient services, hospice care and nursing home care. For even more coverage you can opt for Medicare Part B for additional outpatient coverage, more coverage for medical procedures and additional coverage for better medical equipment to use at home.

Outside of the basic Medicare Parts A and B, you can go with Medicare Part C for additional coverage. It requires you to have A and B first, but offers different coverage options that aren’t included in the basic plans like vision and dental. Medicare Part C is also known as Medicare Advantage and is private. And Medicare Part D also requires you to have Parts A and B. Medicare Part D is the prescription drug plan that will help pay for most prescription costs that aren’t covered under Parts A and B.

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
  • Offered 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.

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 in 2022 Medicare Part B Costs in 2022
  • Part A is premium-free for most
  • Part A deductible is $1,556 per benefit period
  • Inpatient hospital stay days 61-90 is $389
  • The standard Part B premium is $170.10
  • The annual deductible for Part B is $233
  • 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.

It’s common for Rhode Island seniors to need additional medical coverage on top of Original Medicare. That’s because the cost of quality healthcare in Rhode Island is going up annually and is out of reach of some seniors now. As quality healthcare becomes more expensive, seniors with Medicare get increasingly larger bills that they are expected to cover out-of-pocket.

To prevent massive out-of-pocket costs from being an issue, people are utilizing supplemental health insurance. This kind of insurance is designed to help pay some of the extra leftover costs and to make getting quality healthcare more attainable for everyone.

Even with Medicare Parts A and B it’s common to have to pay for some inpatient care and most outpatient care. The right supplemental insurance helps fill your Medicare coverage gaps, reducing the costs that you’re going to have to pay overall. These types of plans will pick up some and sometimes all of the remaining tab after Medicare pays for some of the medical costs, leaving you with a much more affordable bill.

When shopping for an additional insurance policy to fill the gaps of your Medicare Parts A and B policies, you have two options to consider; Medigap (Medicare Supplement) or Medicare Advantage. Both of these plans are well-known for being reliable and offering excellent coverage. But they do work very differently from one another.

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:

Why Do Rhode Island Residents Choose Medicare Advantage?

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.

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
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