What You Need to Know
You must have Medicare Part A and B to buy a Medicare Supplement plan.
Medigap policies don’t include prescription drug coverage.
Three of the most popular Medigap policies are F, C, and N.
Medicare is a federal health insurance program that covers Rhode Islanders age 65 or older, plus younger people with certain health conditions. Original Medicare, or Medicare Part A (hospital care) and B (outpatient care), offers many benefits but covers only about 80% of medical expenses. You’ll have to pay out-of-pocket costs like deductibles, coinsurance and copayments with no cap on your annual expenses.
To pay the costs that Original Medicare doesn’t, you can buy a Medicare Supplement Insurance plan, also called Medigap, from private insurance companies. Medigap policies, named by letters, are offered as standardized benefit packages. For example, Plan C provides the same benefits across different insurers, though the price may differ.
Rhode Island is one of 17 states that don’t require insurers to offer Medigap policies for people under age 65 on Medicare. Only one insurer, Blue Shield of Rhode Island, offers such coverage today. But a proposed bill would require all Medigap insurers to offer policies to Medicare recipients regardless of health, disability status, or age, effective January 1, 2022.1
Rhode Island implemented a state-based individual mandate effective January 2020, with penalties for those who don’t have health insurance. Medicare and Medicaid meet the requirements of the mandate.2
Medigap policies are guaranteed renewable as long as you pay your premiums, which are in addition to your monthly Medicare Part B premium ($148.50 in 2021). They don’t include Medicare Part D prescription drug coverage. You’ll need to buy a separate Part D prescription drug plan.
When Can You Enroll in Medigap in Rhode Island?
Your first chance to enroll is during your one-time Medigap Open Enrollment Period. It’s also your best chance since your policy will have the lowest premium rate and your health won’t impact your eligibility. This six-month period starts when you turn 65 and you enroll in Medicare Part B. You can buy any Medigap policy offered in Rhode Island.
You can buy Medicare Supplement Insurance outside of your Open Enrollment Period at any time, but you’ll have to meet the insurer’s medical underwriting requirements. You could be rejected or pay more because of health issues.
You may have a guaranteed issue right in certain situations. For example, your employer group health coverage ends, or you’re leaving a Medicare Advantage plan for the first time during the 12-month trial.3
Guaranteed issue rights offer you the same protections as if you were in your Open Enrollment Period. An insurer can’t refuse your application, must cover your preexisting conditions, and can’t charge you more.4
You may also have access to a Special Enrollment Period, which gives you guaranteed issue rights for a short period. You might qualify if you move, your coverage changes or you lose your plan through no fault of your own.
When to Buy
The best time to buy a Medicare Supplement plan at the lowest price is during your Medigap Open Enrollment Period.
What Are the Most Popular Medicare Supplement Plans?
Plans F, C and N are the most popular Medigap policies in Rhode Island. In 2019, they represented 40%, 39%, and 11%, respectively, for a total of over 90% of all plans sold statewide.5
Plan F is the most popular because it provides the most benefits. It covers:6
- Medicare Part A coinsurance and hospital costs
- Medicare Part B coinsurance or copayment
- The first three pints of blood
- Medicare Part A hospice care coinsurance or copayment
- Skilled nursing facility care coinsurance
- Medicare Part A deductible
- Medicare Part B deductible
- Medicare Part B excess charges
- Foreign travel emergency costs, up to 80%
Plan F is one of only two plans covering excess charges from doctors who don’t accept Medicare assignment. They are allowed to charge up to 15% more than the Medicare-approved amount for those services. (Plan G also covers excess charges.)
Plan C covers everything Plan F covers except the Part B excess charges.
As of January 2020, Plans F and C are no longer available to people new to Medicare because they cover the Part B deductible. But if you had another Medigap policy before January 2020, you may be able to switch to one of those plans if you have a guaranteed issue right or meet the insurer’s underwriting requirements.
Plan N includes everything covered by Plan F except the Part B excess charges and Part B deductible. You may owe a copayment of up to $20 for some office visits and up to $50 for emergency room visits that don’t result in inpatient admissions.
Each letter plan offers the same coverage across companies, but insurers may charge different amounts for the same plan.
How Do You Choose a Medicare Supplement Plan?
A Medicare Supplement plan can cover some, most or all expenses not paid by Medicare, depending on the plan you choose. First, choose from among Plans A through N. Not all insurers offer all plans in Rhode Island, so use the Medicare Plan Finder to see the options in your area.
Compare the prices of two or three insurers who offer the plan you chose. If pricing is similar, you may also want to ask friends and family about their experience with different companies. It’s not easy to change Medicare Supplement providers, so you’ll likely be dealing with the company for many years.
Insurers use different methods to calculate your premium each year. With “attained age,” prices increase as you age. With “issue age,” the premium is based on your age when you buy and won’t increase (aside from inflation and other factors). With “community” or “no age” premiums, everyone pays the same regardless of age. 7
How Much Do Medigap Policies Cost in Rhode Island?
The pricing of Medicare Supplement plans in Rhode Island can be affected by factors such as your age, gender and whether you use tobacco.
A nonsmoking man living in Providence could buy Plan B for $119 to $335 a month at age 65, but it could cost $167 to $374 at age 75. A 66-year-old nonsmoking woman living in Cranston could buy Plan A for $67 to $313. A man would pay $78 to $348. And a 70-year-old woman in Newport could get Plan G for $118 to $337 as a nonsmoker but $130 to $371 as a smoker.8
What If You Want to Change Your Medigap Policy in Rhode Island?
You may decide to change your Medicare Supplement plan because:9
- You’re paying for benefits you don’t need.
- You want more benefits.
- You want to change insurance companies.
- You want a less expensive policy.
Unless you qualify for a Special Enrollment Period or a guaranteed issue right, you may face medical underwriting and possibly higher premiums.
To switch, find a new insurer or policy and apply. If your application is accepted, you can cancel your current policy. You have a 30-day “free look period” with a new policy. You may want to be sure you’re keeping the new policy before canceling the old one, even if it means paying double premiums for a month.
What Are Alternatives to Medicare Supplement in Rhode Island?
The combination of Original Medicare and Medigap can be replaced with a Medicare Advantage (MA) plan, or Medicare Part C. In MA plans, private insurers usually bundle Medicare Part D prescription drug plans with Medicare Part A and B benefits, along with other coverage such as vision, dental and hearing. MA plans generally restrict you to provider networks for coverage.
What Are Medicare Resources in Rhode Island?
Rhode Island offers several resources for you to learn more about Medicare coverage:
The Rhode Island State Health Insurance Assistance Program (SHIP) helps you find the best Medicare coverage, as well as subsidies for Medicaid, Medicare Savings Program and the Extra Help/Low Income program. Call (888) 884-8721 for this free service, or contact the Point for an office near you.
The Office of the Health Insurance Commissioner in Rhode Island is responsible for protecting the interests of consumers. Call (855) 747-3224 for help.
Rhode Island Medical Assistance or Medicaid helps if you are age 65 or older, have a disability and low income. Find the Medicaid services and support you need by calling (855) 697-4347.
If you’re about to enroll in Original Medicare and you’d like a Medicare Supplement plan, review your options and contact several insurance companies to compare prices for the plan you want.