Medicare Advantage Plans in Rhode Island

Medicare Advantage plans are an alternative to Original Medicare, offered by Medicare-approved private insurance companies. These plans include Part A (hospital) and Part B (medical) benefits, and most also include Part D (prescription drug coverage). Many plans offer added benefits like routine dental, vision, hearing, and fitness programs.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, but some may qualify earlier due to disability, ALS, or ESRD.

Enrollment options include:

• Initial Enrollment: 3 months before and after your 65th birthday month
• General Enrollment: Jan 1 – Mar 31 (if enrolling in Part B)
• Special Enrollment Periods: Triggered by life changes like moving, losing coverage, or qualifying for Medicaid or a chronic condition plan

What Types of Medicare Advantage Plans Are Available in Rhode Island?

Rhode Island offers a wide range of MA plans:

• Health Maintenance Organizations (HMOs): Require in-network care and specialist referrals
• Preferred Provider Organizations (PPOs): Allow out-of-network care at higher cost, usually no referrals needed
• Private Fee-for-Service (PFFS) Plans: May use any provider who accepts plan terms; some have networks
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions like diabetes, cancer, or ESRD
  • I-SNPs: For individuals living in institutions or needing nursing care
  • Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid, offering enhanced benefits
• Medical Savings Accounts (MSAs): Combine a high-deductible MA plan with a medical savings account funded by the insurer

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. However:

• MSAs and some PFFS plans do not include drug coverage—you may purchase a standalone Part D plan if allowed
• HMOs and PPOs without drug coverage do not allow a separate Part D plan
• If you delay drug coverage without creditable insurance, a late enrollment penalty may apply

How Do You Choose a Medicare Advantage Plan?

Before enrolling, it’s important to understand Medicare Advantage costs. Key factors include:

• Premiums: Many plans offer $0 premiums, but you must still pay your Part B premium
• Deductibles, Coinsurance & Copays: Understand what you’ll pay for doctor visits, lab tests, and other services
• Out-of-Pocket Maximums: Protects you by capping annual medical costs
• Extra Benefits: Check for vision, hearing, dental, telehealth, transportation, fitness memberships, and meal delivery options

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during the following specific enrollment periods:

• Initial Enrollment: 3 months before and after your 65th birthday
• Annual Open Enrollment (Oct 15–Dec 7): Switch, drop, or enroll in an MA plan
• General Enrollment (Jan 1–Mar 31): Enroll in an MA plan if you started Medicare Part B during this time
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare
• Special Enrollment Periods: May apply if:
  • You move out of your plan’s area
  • You lose other insurance
  • Your plan is terminated
  • You qualify for Medicaid or a chronic condition SNP

What If You Want to Change Your Medicare Advantage Plan?

You can switch plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Understanding Medicare Advantage Star Ratings

The CMS star ratings system is how the Centers for Medicare & Medicaid Services (CMS) rates Medicare Advantage (MA) plans using a 5-star quality scale. These ratings help consumers compare the performance of different plans based on a standardized set of measures.

CMS Star Ratings Overview

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect data collected from Medicare Advantage (Part C) and Medicare Advantage Prescription Drug Plans (Part D).

What Are Medicare Resources in Rhode Island?

Rhode Island offers the following support programs:

• State Health Insurance Assistance Program (SHIP): Provides free Medicare counseling. Call 1-888-884-8721
• Rhode Island SMP Program: Educates beneficiaries on avoiding Medicare fraud
• Department of Business Regulation: File insurance complaints online
• Rhode Island Medicaid: Assists low-income residents. Apply online or call 1-855-697-4347

Learn about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, are standardized plans sold by private insurers to cover Original Medicare out-of-pocket costs.

• Must be enrolled in Medicare Parts A and B
• Best time to enroll is during the six-month Medigap Open Enrollment Period
• Plans do not include drug coverage—you’ll need a separate Part D plan
• There are 10 standardized plans. Medicare Supplement Plan G had the highest enrollment in 2023
• Plan F is no longer available to people newly eligible after 2020
• Medigap plans offer predictable costs and nationwide coverage with no referrals

Learn more about Medicare Supplement plans in Rhode Island.

Next Steps

If a Medicare Advantage plan in Rhode Island is right for you, compare options in your ZIP code. Evaluate premiums, out-of-pocket limits, provider networks, drug coverage, and extra benefits—then enroll during an eligible enrollment window.