Medicare Advantage Plans in Rhode Island

Medicare Advantage plans in Rhode Island are an alternative way for beneficiaries to get Medicare health insurance. Medicare Advantage plans, also known as Medicare Part C, are bundled plans that include Medicare Part A and Medicare Part B benefits, plus Medicare Part D (prescription drug coverage) all in one plan. Most Part C insurance plans also have extra benefits not included in Original Medicare.

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Top-rated Medicare Advantage Providers in Rhode Island

  • Blue Cross: The Rhode Island Blue Cross company has enrolled 69 percent of the Medicare Part C plan market. The company offers HMO and HMO-POS plans that have also earned high star ratings.
  • PACE of Rhode Island: This small, regional Medicare insurance company has a small share of enrollment.
  • Humana: Humana may not be active in Rhode Island for Medicare Advantage plans.
  • Other Popular companies to look for are Aetna and Cigna.

Popular Medicare Advantage Plan Types in Rhode Island

Best health plans for network freedom: Medicare Advantage PPO plans

  • PPOs generally have a more comprehensive network of healthcare providers for their Medicare beneficiaries.
  • Enrollees in PPOs don't need referrals from primary care physicians to see specialists.
  • Premiums commonly vary from $0 to $100.00 per month.

Best plans for low out-of-pocket costs: Medicare Advantage HMO plans

  • HMOs typically have $0 monthly premiums.
  • HMOs use network providers and require referrals.

Best plans for low-income or chronic health conditions: Medicare Advantage D-SNP

  • D-SNPs, or Dual Eligible Special Needs Plans, cover people with low income or chronic health issues such as end-stage renal disease.
  • Dual eligible beneficiaries have both Medicare and Medicaid health care coverage. D-SNPs help cover expenses like copayments, coinsurance, premiums, and deductibles.

Medicare Enrollment Facts:

  • The number of people with Medicare Advantage coverage in Rhode Island in 2021 is 78,424.
  • People enrolled in Local HMO plans are 72,097
  • People enrolled in Local PPOs are 4,970
  • People enrolled in Regional PPOs: are 1,357
  • The percentage of the total Medicare population enrolled in Medicare Advantage in Rhode Island is 37 percent.
  • The number of people enrolled in Medicare Advantage nationwide: More than 26 million.
  • The percentage of Medicare beneficiaries enrolled in Medicare Advantage nationwide is 42 percent.

How much does Medicare Advantage in Rhode Island cost?

In Rhode Island, many HMO plans have $0 monthly premiums. Some service areas also have PPOs with zero premiums, although they are not as common.

Rhode Island is number one in the rankings of best states for Medicare Advantage Prescription Drug plans (MAPDs) in the United States. MAPDs in Rhode Island have an average premium of $42.50 per month and an average annual deductible of $60.63.

How much do Advantage Plans cost in Rhode Island?

PPO Plan $0.00 to $42.50

HMO Plan $0.00

When can I enroll in a Medicare Advantage plan?

1. During your Initial Enrollment Period

When you turn 65:

  • If you receive Social Security retirement benefits when you turn 65, the SSA automatically enrolls you in Medicare Part A and Part B. You can switch from Original Medicare to Medicare Advantage during this enrollment period.

The seven-month Initial Enrollment Period starts three months before the month of your 65th birthday. It includes the entire month of your birth date and ends three months after that.

If you are younger than 65:

  • And you have been receiving Social Security disability benefits for 24 months.
  • You have end-stage renal disease or ALS.

Your benefits begin immediately after diagnosis of ESRD or ALS. Your Initial Enrollment Period starts three months before the 25th month of receiving disability benefits. It includes that entire month, and it ends three months after that.

2. During the Open Enrollment Period or Annual Election Period

Beneficiaries can sign up for a new Medicare Advantage plan, switch to a different one, return to Original Medicare Part A and Part B, or enroll in a stand-alone Medicare Part D plan.

The Open Enrollment runs from October 15 to December 7 every year. Changes made to Medicare coverage during this period start on January 1.

3. During the Medicare Advantage Open Enrollment Period

Beneficiaries can leave Medicare Advantage plans and return to Original Medicare Part A and Part B or sign up for a different Medicare Advantage plan from January 1 to March 31. Changes take effect on the first day of the month following.

4. During Special Enrollment Periods

If you qualify for special enrollment, you can enroll in a Medicare Advantage plan or a Medicare Part D plan or alter your current health care plan by upgrading or adding new coverage options.

You may be eligible for a special enrollment period if:

  • You move from one service area to another.
  • You return to the US after living abroad.
  • You move into or out of a skilled nursing or long-term care facility.
  • You are released from prison.
  • You are no longer eligible for Medicaid services.
  • You are dual eligible for both Medicare benefits and Medicaid Services.
  • You lose your Medicare Advantage coverage because the provider has ended the plan.
  • You wish to switch your coverage from Original Medicare Part A and Part B plus Medigap to a Medicare Advantage plan.

5. During the five-star Special Enrollment Period

Medicare Advantage enrollees can switch to a plan with a five-star rating if one is available.

6. During the Special Enrollment Period for Medicare "Extra Help" programs

Beneficiaries who are in an Extra Help program or have Medicaid can make changes to their coverage during one of the following periods:

  • January – March
  • April – June
  • July – September

"Extra Help" is an income-based program that helps those eligible pay their monthly premiums, annual deductibles, and copayments for Medicare Part D.

Medicare Advantage Highlights:

Here are some more details about Medicare Advantage in Rhode Island:

  • All Medicare Advantage insurance plan providers are required by law to cover, at minimum, the same benefits as Original Medicare Part A and Part B.
  • The private insurance company you choose as your MA provider is responsible for your claims, customer service, and administration.
  • You pay a monthly premium to the provider for your Part C plan.
  • Enrollees must also pay their monthly Part B premium for Medicare Advantage eligibility.
  • Require enrollees to use network providers for health care services.
  • Many Medicare Advantage plans include a Part D plan's additional coverage and Medicare benefits.
  • Most plans in Rhode Island include extra benefits like vision, dental and hearing care, wellness club memberships, transportation services, and meal delivery.

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation's top-rated Medicare Advantage carriers. Call us today, or request a quote online to learn more about plan options.

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