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Rhode Island Medicare Advantage Plans

Last Updated on

October 6, 2016

If you are a Medicare beneficiary residing in Rhode Island, you may be interested in learning more about your Medicare options.

Learn about Medicare Advantage in Rhode Island

Medicare beneficiaries in Rhode Island can sign up for Medicare Advantage plans as an alternative way of receiving their Original Medicare coverage. Offered by private insurance companies contracted with Medicare, Medicare Advantage plans cover hospitalization and medical benefits offered by Medicare Part A and Part B respectively, with the exception of hospice care, which remains covered by Part A.  Many Medicare Advantage plans in Rhode Island offer additional benefits such as prescription drug coverage, and routine vision, hearing, and/or dental coverage, which are benefits not available under Original Medicare.

To sign up for a Medicare Advantage plan, you must first be enrolled in Original Medicare, Part A and Part B, and you have to live within the Medicare Advantage plan’s service area.

You can get a Medicare Advantage plan during your Initial Coverage Election Period (ICEP). The Initial Coverage Election Period is usually the same as your Initial Enrollment Period under Original Medicare, which begins three months before the month you turn 65, includes your birthday month, and ends three months after that month.

If you didn’t enroll in a Medicare Advantage plan when you were first eligible, or if you want to switch Medicare Advantage plans or make certain other coverage changes, you can take advantage of the Medicare Advantage and Prescription Drug Plan Annual Election Period, which runs from October 15 to December 7 each year. Your new coverage goes into effect on January 1 of the following year.

In certain situations, you may be allowed to switch Medicare Advantage plans in Rhode Island (as in other states) during a Special Election Period. Those situations include, but are not limited to: moving to a new address where your existing plan isn’t available; losing your current coverage, or experiencing changes in your current plan that affect your health benefits. Special Election Periods vary depending on personal circumstances that might affect your ability to receive Medicare benefits to which you are entitled.

If you’re enrolled in a Medicare Advantage plan in Rhode Island and want to switch back to Original Medicare, Part A and Part B, you may do so during the annual Medicare Advantage Disenrollment Period, which runs from January 1 to February 14. During this period, you can also add a stand-alone Medicare Part D Prescription Drug Plan.

If you decide to enroll in a Medicare Advantage plan in Rhode Island, you have to keep Medicare Part A and Part B, and you have to continue paying your Medicare Part B premium.

Types of Medicare Advantage plans in Rhode Island

You will probably want to familiarize yourself with the various types of Medicare Advantage plans available in Rhode Island so that you can make an informed decision about this alternative way to receive your Medicare benefits. The main types of Medicare Advantage plans are described below.

  • A Health Maintenance Organization (HMO) plan is a type of Medicare Advantage plan that generally requires you to visit doctors, health-care providers, and hospitals included in your plan’s network to receive benefits from the plan except in the instances of emergency care or medically necessary care that is authorized by the plan and not available within the plan’s network. Note that you may have to get a referral from your primary doctor or health provider to receive coverage for certain health services.
  • An HMO Point-of-Service plan is more flexible than a standard HMO plan, allowing you to go out of network in certain circumstances for a number of covered health services, but generally at a higher out-of-pocket cost.
  • A Preferred Provider Organization (PPO)* plan offers even greater flexibility, allowing you to select doctors, health care providers, and hospitals outside your plan’s network, but again at a higher out-of-pocket cost.
  • A Private Fee-for-Service (PFFS) plan reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits, and also determines your share of each expense. Any provider you use must agree to accept the plan’s terms and conditions on a case-by-case scenario and agree to treat you. The PFFS plan may offer a partial or full network of providers, and sometimes does not involve any networks at all. It is important to check with the provider to see if they accept the plan because not all providers accept it.
  • A Medical Savings Account (MSA) plan combines a high deductible with a savings account into which Medicare contributes money that you can use to pay for your health-care expenses.
  • A Medicare Special Needs Plan (SNP) is for people with health needs, offering coverage tailored to suit their specific situations. There are Medicare SNPs for people with chronic conditions (such as congestive heart failure and diabetes), those living in institutions (like nursing homes), and people who qualify for both Medicare and Medicaid.
  • A Medicare Advantage Prescription Drug (MAPD) plan combines health and prescription drug coverage into a single insurance plan.

Comparing Medicare Advantage plans available in Rhode Island

With the number of options available in Rhode Island, you may find it useful to compare the Medicare Advantage plans available in your area.

The availability and costs of Medicare Advantage plans generally vary depending on where you live, the insurance company offering the plan, and specific plan details. You may find that some Medicare Advantage plans offer premiums as low as $0.  Be sure you consider other costs as well, such as copayments and deductibles, and that you continue paying your Medicare Part B premium no matter which Medicare Advantage plan you choose.

Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B.  Consider whether a Medicare Advantage Prescription Drug plan would be a good choice to meet your medical and prescription drug coverage needs. If a Medicare Advantage plan offers other extra benefits, such as preventive vision or dental care, consider whether these benefits are important to your coverage needs.

The Medicare Advantage plans available in Rhode Island may include networks of participating providers. If so, your using the doctors, hospitals and other health-care providers who participate in the plan’s network has a significant impact on your ability to receive the full benefits of the Medicare Advantage plan and limit your out-of-pocket expenses.  If you currently have doctors and other health-care providers you want to retain, check to see if they participate in the Medicare Advantage plan you are considering before you make your final decision.

To start comparing Medicare Advantage plans in Rhode Island, enter your zip code above for a customized list of plans available in your area.

For more information about Medicare in Rhode Island, please refer to the following articles:

* Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.