Are you turning 65 in 2021? Then it’s time to look into Medicare plans in Rhode Island, and there are many plans and coverage levels to consider.
Medicare Rhode Island is divided into several parts that cover a range of healthcare needs and budgets. Medicare plans in Rhode Island fall into one of the following parts.
Medicare Part A is the most basic healthcare coverage provided by the federal government. Many people will qualify for premium-free Part A coverage. If you’re eligible for Social Security benefits, you’ll automatically be enrolled in Part A when you turn age 65.
Part A covers:
- inpatient hospital care
- limited skilled nursing facility care
- limited, part-time home healthcare
- hospice care
Medicare Part B provides additional basic medical coverage on an outpatient bases. Together, Part A and Part B make up “original Medicare.”
Part B coverage includes:
- doctor’s appointments
- outpatient hospital care and emergency room visits
- medical equipment, such as wheelchairs or home oxygen
- preventive services, such as screenings
- mental health services
- lab tests
Medicare Advantage plans in Rhode Island, or Part C plans, are offered by private health insurance carriers. While these plans are approved by Medicare, they’re not run by the federal government. Part C benefits include:
- original Medicare coverage, including all hospital and medical coverage
- prescription drug coverage
- additional healthcare services that may include vision, dental, hearing, or wellness services
Prescription drug plans, or Medicare Part D plans, are also provided by private insurance carriers. These plans can be used to supplement your original Medicare Rhode Island coverage and reduce your out-of-pocket medication expenses.
Each drug plan has a list of prescription drugs they’ll cover. You will need to carefully read this list to see if your medications are covered by the plan.
Medicare supplement insurance (Medigap) plans in Rhode Island are available through private insurance carriers. They help cover some costs of your care like copays and coinsurance, since original Medicare does not have an out-of-pocket limit.
These plans are only available with original Medicare. You may not purchase both a Medicare Advantage plan and a Medigap plan.
While original Medicare is provided by the federal government and offers the same coverage across the country, Medicare Advantage plans are unique to each state and even each county.
You can search for Medicare Advantage plans in Rhode Island to find those that are offered in your county. These carriers offer Medicare Advantage plans in Rhode Island:
- Aetna Medicare
- Blue Cross & Blue Shield of Rhode Island
- Lasso Healthcare
The quality of Medicare Advantage plans can vary. Before enrolling in a Part C plan, do your research to make sure it’s the right fit for both your budget and your healthcare needs.
To be eligible for Medicare plans in Rhode Island, you must meet the following eligibility requirements:
- be age 65 or older
- be a permanent resident of Rhode Island or an American citizen
Those under age 65 may also qualify for Medicare Rhode Island coverage. If you have a permanent disability or certain chronic illnesses, you may be eligible for Medicare plans in Rhode Island.
You will have several opportunities to enroll in Medicare. However, your initial enrollment offers the best chance to avoid penalties and higher fees.
Enroll in Medicare as soon as you’re eligible. You’ll be able to enroll in Medicare Rhode Island during your initial enrollment period, which begins 3 months before your 65th birthday and ends 3 months after your birthday.
You may be automatically enrolled in original Medicare at this time if you receive retirement benefits. You can also choose to add Part D coverage to your plan.
General enrollment and open enrollment
Once this initial enrollment period has passed, you will have two times per year to reevaluate your healthcare needs. You can add Part D coverage to your plan, enroll in an Advantage plan, or even switch between Medicare Advantage plans in Rhode Island.
These other times to change your coverage include:
- general enrollment period: January 1 to March 31
- open enrollment period: October 15 to December 7
You may also quality for a special enrollment period if your circumstances disrupt your healthcare coverage.
Special circumstances include:
- moving outside the range of your healthcare plan
- moving into a nursing home
- leaving a job, and losing employer healthcare coverage
- becoming eligible for Medicare based on a disability or chronic illness
When deciding what Medicare Rhode Island coverage will meet your healthcare needs, you’ll need to consider budget, location, and coverage needs.
Here are some tips for assessing your needs before enrollment:
- If you are considering a Part C plan, check with your doctor first. Most Medicare Advantage plans in Rhode Island only provide coverage to certain in-network physicians.
- If you’re considering Part C or D Medicare plans in Rhode Island, make a complete list of the medications you regularly take. Read the list of covered drugs in each plan you’re considering, and rule out any plans that don’t pay for your medications.
- Check each plan’s coverage area using your zip code, and rule out any plans that don’t provide coverage in your county.
When looking for more specifics on Medicare plans in Rhode Island, you can contact Medicare or your state agencies directly to seek counseling or clarify coverage.
- Rhode Island Office of Healthy Aging: 888-884-8721. Get Medicare counseling with a SHIP counsellor, learn about the Medicare savings program, and see if you may be eligible for subsidized healthcare coverage.
- Point: 401-462-4444. You can access information, advice, and assistance applying in programs by calling Point.
- Executive Office of Health & Human Services, Elders: 401-462-5274.This office provides support, assists in long-term care placement, and handles the Medicare Premium Payment Program.
You should now have a short list of drug or Medicare Advantage plans in Rhode Island that you’re considering. These are your next steps to begin enrolling:
- Calculate when your initial enrollment period will begin, and plan to enroll in Medicare before your 65th birthday. Delaying enrollment will delay the plan start date, and you may have a gap in your coverage.
- Use the Medicare star ratings to pick a plan that’s been rated highly by other plan members.
- Contact one of the state agencies for help with the enrollment process for Medicare Rhode Island.
This article was updated on October 6, 2020 to 2021 Medicare information.
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