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Rhode Island Medicare Advantage Plans | Your Essential Guide

Updated on July 30th, 2021

We aim to help you make informed healthcare decisions. While this post may contain links to lead generation forms, this won’t influence our writing. We follow strict editorial standards to give you the most accurate and unbiased information.

What You Need to Know

Medicare Advantage (MA) plans are a bundled alternative to Original Medicare. 

The Medicare Advantage penetration rate in Rhode Island is 44%. This means 44% of people eligible for Medicare are enrolled in an MA plan.

The average cost for an MA plan in Rhode Island is $25.03 per month, which is higher than the national average of $21.

What Are Medicare Advantage Plans in Rhode Island?

One of the most frustrating things about healthcare is out-of-pocket expenses. Even Original Medicare has significant out-of-pocket costs. Rhode Island Medicare Advantage plans help with those costs. 

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Also known as Medicare Part C, Medicare Advantage (MA) plans are a bundled alternative to Original Medicare. You receive your Medicare Part A and B benefits through the MA plan. Most plans also include Medicare Part D prescription benefits. In addition, these plans typically provide benefits that aren’t offered by Medicare, such as vision, hearing, and dental care.1

What Types of Medicare Advantage Plans Are Available?

Rhode Island residents have access to several types of MA plans. One of the most important differences between plans is whether they have a provider network and whether you’re required to visit providers in that network when you seek care. A provider network is a group of healthcare providers that have contracted with an insurance company. 

Here are the types of MA plans available in Rhode Island:

  • Health maintenance organization (HMO): An HMO has a provider network, and you must seek care from in-network providers unless it’s an emergency or you’re traveling. You usually need a referral to see a specialist. 
  • Preferred provider organization (PPO): A PPO also has a provider network. You can visit providers outside the network, but you pay more if you do. You typically don’t need a referral to see a specialist. 
  • Private fee-for-service (PFFS) plan: PFFS plans might have a provider network. You can go to any provider that accepts the terms and conditions of the plan. You can usually see a specialist without a referral. 
  • Special needs plans (SNPs): These plans are for people on Medicare who have specific healthcare needs. There are three types of SNPs:
    • Chronic condition special needs plan (C-SNP): This is for Medicare members with ongoing health conditions like diabetes, cancer, HIV/AIDS and end-stage renal disease (ESRD). 
    • Institutional special needs plan (I-SNP): This option is for Medicare beneficiaries who live in an institution like a nursing home or who need nursing care at home. 
    • Dual eligible special needs plan (D-SNP): This type of plan is for people who are eligible for both Medicare and Medicaid. 
  • Medical savings account (MSA) plan: This option combines a high-deductible MA plan with a medical savings account (MSA). The plan deposits money into your MSA, and you can use the funds to pay for your out-of-pocket Medicare costs. If your out-of-pocket costs exceed the amount in your MSA, you’re responsible for the difference until you reach your plan’s deductible. The MA plan will cover your Medicare-approved healthcare costs once you meet the deductible.2

Multiple Plan Options Available

Rhode Islanders eligible for Medicare have numerous types of Medicare Advantage plans to choose from, including HMOs, preferred provider organizations (PPOs), and several types of plans for those with special healthcare needs.

What Are Prescription Drug Options with Medicare Advantage Plans?

Most MA plans include Medicare Part D prescription drug coverage. If you enroll in an HMO or PPO that doesn’t include Medicare Part D coverage, you cannot buy a separate, standalone Part D plan. You can buy a separate Part D plan if you enroll in an MSA or certain PFFS plans. 

If you don’t buy a Part D plan or an MA plan with Part D coverage when you’re first eligible for Medicare, you may be required to pay a late enrollment penalty if you decide to enroll in a Part D plan at a later time.3

Prescription Drugs Are Usually Covered

Most Medicare Advantage plans include coverage of prescription drugs, but check with a plan to make sure before you sign up.

How Do You Choose a Medicare Advantage Plan?

Rhode Island residents should consider the following when choosing an MA plan:

  • Premiums: This is the amount you pay each month for a plan. Many plans have a $0 premium, but others cost more. Keep in mind that in most cases, you have to pay your Medicare Part B premium in addition to your MA plan premium. 
  • Other out-of-pocket expenses: These include:
    • Deductible: This is the amount you pay for Medicare-covered services before your plan starts paying.
    • Coinsurance: This is a percentage you pay for a covered service after you pay any deductibles. For example, you might pay 20% of the cost of an emergency room visit. 
    • Copayment: This is a set amount you pay for a covered service. You might pay $10 for a doctor’s visit, for example.4
    • Out-of-pocket maximum: This is the most you’ll pay out of pocket for Medicare-approved charges in one year.5
  • Plan benefits: MA plans typically provide other benefits, including:
    • Vision care: Eye exams and glasses are usually covered. 
    • Dental care: This typically covers cleanings and routine exams. More advanced dental work like dentures and bridges may also be covered. 
    • Telehealth: This allows you to consult with a healthcare provider from home via phone or videoconference. 
    • Other perks: Plans may provide fitness club membership, transportation to medical appointments or meal delivery in certain circumstances.6

When and How to Enroll in a Medicare Advantage Plan

You can only enroll in an MA plan at these specific times: 

  • Initial Enrollment Period: When you’re first eligible for Medicare, you have a seven-month enrollment period. It starts three months before your 65th birthday month and lasts for another three months afterward. 
  • Open Enrollment Period: Each year, from October 15 to December 7, you can join, switch or drop an MA plan during this period, also known as the Annual Election Period. Coverage starts January 1. 
  • Medicare Advantage Open Enrollment Period: From January 1 to March 31 each year, you can switch MA plans or drop your MA plan and return to Original Medicare. 
  • General Enrollment Period: If you have Medicare Part A and start Medicare Part B between January 1 and March 31, you can enroll in an MA plan during that time. Coverage may not start until July 1.
  • Special Enrollment Periods: You’re also able to make plan changes under certain circumstances. These include, but aren’t limited to:
    • Moving out of a plan’s service area
    • Losing coverage from an employer or union
    • Gaining coverage from an employer or union
    • Your plan losing its contract with Medicare
    • You have a chronic condition that would be better served by a chronic condition special needs plan (C-SNP)7

What Is Medicare Advantage Enrollment in Rhode Island?

The Medicare Advantage penetration rate in Rhode Island is 44%. This means 44% of people eligible for Medicare are enrolled in an MA plan. 

How Much Do Medicare Advantage Plans Cost in Rhode Island?

The average cost for an MA plan in Rhode Island is $25.03 per month, which is higher than the national average of $21.8

Providence residents, for example, can choose among 20 MA plans. Thirteen of these plans have a $0 premium. Four plans are less than $100 per month, and three are more than $100. The most expensive plan is $266 per month. 

How Do You Change Your Medicare Advantage Plan?

You can change your MA plan and enroll in a new one during the Open Enrollment Period from October 15 to December 7 each year or during Medicare Advantage Open Enrollment from January 1 to March 31.9

What Are Alternatives to Medicare Advantage Plans?

One alternative is the Program for All-Inclusive Care for the Elderly, or PACE. PACE is for adults ages 55 and older who have complex healthcare needs but want to remain at home instead of going into a nursing home. 

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Another alternative is Original Medicare or Medigap. You could choose Original Medicare with no other coverage, but you will have significant out-of-pocket costs. You could also purchase a Medicare Supplement plan, which helps to cover out-of-pocket costs. If you want prescription coverage, you would also need to purchase a Medicare Part D plan. For coverage comparable to an MA plan, you would need three separate types of coverage (Original Medicare, a Medicare Supplement Plan, and a Medicare Part D plan).10

What Are Medicare Resources in Rhode Island?

Rhode Island residents have access to several Medicare resources:

  • State Health Insurance Assistance Program (SHIP): SHIP provides free counseling on Medicare and related programs. Call SHIP at 1-888-884-8721.
  • Department of Business Regulation: If you have an issue with your MA plan, you can file a complaint with this department. 
  • Medicaid: This program provides free or low-cost healthcare to people with limited incomes and assets. Apply online

Next Steps

To find out if an MA plan is right for you, speak to a licensed professional or visit the Medicare Plan Finder. Consider the monthly premiums, out-of-pocket costs, and benefits, and choose a plan that meets your medical needs and your budget.



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