- In 2019, there were 14 Medicare Advantage Plans available in Rhode Island.
- 37% of the total Medicare population in Rhode Island was enrolled in Medicare Advantage Plans as of 2018.
- In 2018, Original Medicare spent an average of $9,261 per beneficiary in Rhode Island, which is 8% lower than the national average.
- Available Medicare Advantage Plans range from 21 to 22 across Rhode Island’s five counties.
Medicare Advantage Plans are offered by private insurance companies, so the premium depends on which insurer you choose. In addition to the monthly premium, you may have to pay an annual deductible and copays/coinsurance for each service. Some areas have more plans available than others, and your location also has an impact on your out-of-pocket costs. If you decide to enroll in Medicare Advantage, you’ll have several options related to covered services and plan restrictions.
Medicare Advantage Plans in Rhode Island
Types of Medicare Advantage Plans
Rhode Island has several Medicare Advantage Plans available, all of which have their own rules and restrictions. No matter which plan you choose, your insurance company must offer at least the same level of coverage you’d get if you enrolled in Original Medicare. Your options may include HMOs, PPOs, SNPs, and PFFS plans.
Health Maintenance Organizations (HMO)
If you’ve ever had employer-sponsored insurance, you may have heard of an HMO plan. HMOs require their members to get medical care from a network of participating providers. If you choose a provider who isn’t in the network, your HMO may not cover the service. You also have to choose a primary care provider and get referrals to see medical specialists, making an HMO the most restrictive type of Medicare Advantage Plan.
Preferred Provider Organizations (PPO)
PPOs also have networks of participating providers, but they’re not as restrictive as HMOs. If you go to an out-of-network provider, your PPO plan may cover a smaller percentage of the cost than if you’d chosen an in-network provider. Another benefit of choosing a PPO is that you don’t have to select a primary care provider or ask your PCP for referrals for specialist care. Therefore, PPO plans give you more flexibility in choosing doctors and hospitals.
Private Fee-for-Service Plans (PFFS)
In a PFFS plan, health care providers receive a fixed fee for each service provided. You don’t need to ask for specialist referrals or choose a primary care provider if you sign up for one of these plans. If you have a medical emergency, any hospital you visit or doctor you see must treat you; however, providers aren’t obligated to treat you in nonemergency situations if they haven’t agreed to the terms of your plan.
Special Needs Plans (SNP)
SNPs are designed to cover the doctors, hospitals, medications, and medical treatments used by people with certain medical problems. If you have diabetes, for example, the plan may provide a high level of coverage for insulin, oral medications, and services provided by an endocrinologist. In most cases, you must receive services from facilities and medical professionals in the SNP’s network. One exception is if you have a medical emergency that requires urgent care.
Enrollment eligibility for Medicare Advantage Plans in Rhode Island
You must meet the following eligibility requirements to enroll in Medicare Advantage:
- You must be at least 65 years old or have a disability that qualifies you for Medicare at a younger age.
- You must be enrolled in Original Medicare (Part A and Part B).
- You can’t have Medicare Supplement Insurance (Medigap).
You can only join Medicare Advantage or make changes to your plan at certain times:
- Initial enrollment. The first opportunity is your initial enrollment period (IEP), which begins three months before you turn 65 and ends four months later (seven months total). During the IEP, you can sign up for Medicare Advantage or Medicare Part D. You can also switch Medicare Advantage Plans if you became eligible for Medicare before you turned 65.
- Open enrollment. This annual period starts on October 15th and ends on December 7th. During open enrollment, you can join Medicare Advantage for the first time or switch from one Medicare Advantage Plan to another. As long as you enroll by December 7th, you’ll be covered by your new Medicare Advantage Plan on January 1st.
- Medicare Advantage open enrollment. This period runs from January 1st to March 31st. During MA open enrollment, you can switch from Medicare Advantage to Original Medicare. You can also switch Medicare Advantage Plans.
- If you don’t enroll during one of these periods, you may qualify for a special enrollment period. These periods are typically reserved for people who’ve lost their existing health coverage, become eligible for an SNP, or moved outside their previous plan’s service area.
Prescription drug coverage
Medicare Part D covers prescription medications. Unless you choose a PFFS plan that doesn’t cover prescriptions, you can’t sign up for both Medicare Part D and a Medicare Advantage Plan. If you do, you’ll be removed from Medicare Advantage and enrolled in Original Medicare. Even if you don’t take any daily medications when you first enroll in Medicare, you should look for a Medicare Advantage Plan with prescription coverage. Choosing a robust plan from the start can help you avoid unmanageable out-of-pocket costs later.
Medicare Advantage Resources in Rhode Island
With multiple insurance companies offering Medicare Advantage Plans in Rhode Island, it’s important to review your options carefully. If you’re not sure how to compare plans or calculate your expected out-of-pocket costs, several organizations are available to help. They include Rhode Island Senior Medicare Patrol, Rhode Island Point, and the Rhode Island Office of Healthy Aging. The Office of the Health Insurance Commissioner is also available to handle any complaints you have about your insurance company.
Rhode Island Senior Medicare Patrol
Rhode Island Senior Medicare Patrol offers educational programs and one-on-one counseling to help older adults and their loved ones learn how to identify Medicare fraud and stop it in its tracks. If you receive a summary notice or explanation of benefits that just doesn’t seem right, an SMP counselor will review it and let you know how to proceed. SMP counselors are also available to help you compare Original Medicare with Medicare Advantage.
Contact Information: Website | 401-462-0194
Rhode Island Point
Rhode Island Point is a 24-hour hotline staffed by specialists with in-depth knowledge of the state’s healthy aging resources. If you have questions about Medicare or aren’t sure if you should enroll in Original Medicare or Medicare Advantage, a trained specialist can assess your situation and offer unbiased advice. The Point program also offers information on utility assistance, long-term care, home health care, and hospice. Services are available to adults aged 55 and older and their caregivers.
Contact Information: Website | 401-462-4444
Rhode Island Office of the Health Insurance Commissioner
The Rhode Island Office of the Health Insurance Commissioner is charged with regulating insurance companies in Rhode Island. OHIC issues consumer alerts, accepts complaints, and protects consumers by working with other departments in the Insurance Division to amend existing insurance-related laws and introduce new ones. If you enroll in Medicare Advantage and have trouble with your insurance company, you can submit a complaint by filling out the online complaint form.
Contact Information: Website | 401-462-9520
Rhode Island Office of Healthy Aging
The Rhode Island Office of Healthy Aging promotes the interests of older adults and younger people with disabilities. Because so much Medicare information is now online, it’s important for people of all ages to staypeople of all ages need to stayfinancial exploitation. If someone tries to use your Medicare benefits or forces you to pay for their out-of-pocket Medicare expenses, you can file a report with RIOHA.
Contact Information: Website | 401-462-3000
Learn More From Our Sources
- Medicare | How Original Medicare works | Last accessed June 2021
- Medicare | Medicare Advantage Plans | Last accessed June 2021
- Medicare | Health Maintenance Organization (HMO) | Last accessed June 2021
- Medicare | Preferred Provider Organization (PPO) | Last accessed June 2021
- CMS.gov | Private Fee-for-Service Plans | Last accessed June 2021
- Medicare | Medicare Special Needs Plans | Last accessed June 2021
- Medicare | Medicare enrollment periods: when to sign up | Last accessed June 2021
- Medicare | Drug coverage (Part D) | Last accessed June 2021