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Medicare in Rhode Island

October 6, 2016

Reaching the age of 65 might allow an individual to receive health insurance coverage under Medicare. Rhode Island Medicare beneficiaries have more than one coverage option: they may receive coverage under Original Medicare, Part A (hospital insurance) and Part B (medical insurance) with or without a Medicare Supplement plan, and they may enroll in Medicare plans offered by Medicare-approved private insurance companies. Under the Medicare Advantage (Medicare Part C) program, Rhode Island Medicare beneficiaries may receive their health benefits from a Medicare Advantage plan, or if they choose to have their health and prescription drug coverage from a single plan, a Medicare Advantage Prescription Drug Plan. For beneficiaries who desire to stay with Original Medicare, prescription drug coverage may be added by enrolling in a stand-alone Medicare Part D Prescription Drug Plan.

Original Medicare for Rhode Island beneficiaries

Original Medicare consists of two parts: Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). To be eligible for Original Medicare, you must be

  • Age 65 or older, and
  • A U.S. citizen or legal permanent resident of five continuous years or more; or
  • Disabled and receiving disability benefits, or have certain health conditions such as end-stage renal disease (ESRD), or have amyotrophic lateral sclerosis (ALS or Lou Gehrig’s disease). Disabled individuals can get Medicare regardless of age, after they’ve collected disability benefits for 24 continuous months from the Social Security Administration (SSA) or the Railroad Retirement Board.

In Rhode Island, like in the rest of the United States, you’re eligible to enroll in Original Medicare three months before you turn 65 and no later than four months after that date. This is the seven-month Medicare Initial Enrollment Period.

In Rhode Island and throughout the US, you can also enroll in Medicare during the General Enrollment Period, which runs from January 1 to March 31 each year. However, if you miss your Initial Enrollment Period and enroll in Medicare at a later date, you will probably have to pay a late-enrollment penalty.

Most people do not pay a premium for Medicare Part A. There are some exceptions, most notably if you (or your spouse) haven’t worked in the United States the requisite minimum 10 years to be eligible for Social Security and Medicare benefits. In that case, you may have to pay a premium.

Medicare Part A beneficiaries in Rhode Island, as in all states, receive health benefits for health-care services that include:

  • Hospital care
  • Skilled nursing facility care
  • Nursing home care (non-Custodial)
  • Hospice care
  • Home health services

Medicare Part B provides medical insurance. Typically you pay a Part B monthly premium for this insurance, which includes coverage for such medical services and supplies as:

  • Physicians’ care, including preventive services
  • Outpatient treatment
  • Ambulance services
  • Durable medical equipment
  • Mental health (inpatient, outpatient, or partial hospitalization)
  • Laboratory and Radiology services
  • Limited outpatient prescription drugs, such as those administered by a health-care provider

Medicare plan options in Rhode Island

Medicare Advantage is an alternative way to receive Medicare benefits. Offered by private insurance companies contracted with Medicare rather than administered by the federal government, Medicare Advantage plans offer at least the same benefits as Medicare Part A and Part B (except for hospice care, which remains covered by Part A),  Many Medicare Advantage plans in Rhode Island offer additional benefits, like dental care, routine vision, and hearing coverage.

You  also may sign up for Medicare Advantage Prescription Drug plans, which combine health and prescription drug coverage into one private plan. But always remember that whether you enroll in a Medicare Advantage plan or a Medicare Advantage Prescription Drug plan, you remain enrolled in Original Medicare and continue paying the Medicare Part B premium to retain your health insurance coverage.

As a Rhode Island Medicare beneficiary, if you decide to stay with Original Medicare (Part A and Part B), you may also sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medicare Supplement plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles.  Medicare Supplement plans sold today don’t cover prescription drugs, and you can’t use them with Medicare Advantage plans. Medicare Supplement plans are offered by private insurance companies.

If you decide to receive your health coverage through Original Medicare, you may still obtain Medicare prescription drug coverage by enrolling in a stand-alone Medicare Part D Prescription Drug Plan.  Stand-alone Medicare Part D Prescription Drug Plans are offered by private insurance companies approved by Medicare and designed to work alongside your Medicare Part A and/or Part B coverage. The cost of Medicare Part D Prescription Drug Plans in Rhode Island vary, but most generally require payment of a monthly premium, annual deductible, and copayment or coinsurance.

Rhode Island residents have different Medicare Advantage plan offerings depending on the county in which they live. A resident of Providence in Providence County will have access to different Medicare plan offerings than a resident of Warwick in Kent County. Considering the variety Medicare plans available in Rhode Island, it’s always a good idea to customize your search for plans based on your personal health and prescription needs and the county in which you live.

For more information about private Medicare insurance for Rhode Island beneficiaries, please see:

Rhode Island resources for Medicare beneficiaries

There are a number of resources designed to help Rhode Island Medicare beneficiaries with Medicare-related issues and concerns. Here are some of the resources that may be helpful to you:

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