Rhode Island Medicare Supplement Plans (Medigap)
Rhode Island Medicare Supplement Plans are referred to as Medigap. These plans are provided through private insurance companies. They help cover some of the otherwise out-of-pocket expenses, referred to as gaps, which remain after Medicare benefits.
The federal Medicare program is a health insurance program for persons 65 years or older and persons with qualifying disabilities. However, the federal Medicare program was not designed to cover every medical expense encountered by beneficiaries, leaving many out-of-pocket expenses.
To help offset the remaining out-of-pocket expenses, private insurance companies now work with Original Medicare by offering beneficiaries additional coverage through Medigap plans.
Rhode Island Medicare Benefits
Rhode Island Medicare consists of four parts; A, B, C, and D. Also available are Rhode Island Medicare Supplement Plans that may be added to Part A and B Medicare to provide additional coverage.
- Part A and B are referred to as Original Medicare. Part A covers inpatient care and Part B covers outpatient care. Original Medicare is available to anyone who is eligible for Medicare in Rhode Island regardless of their location.
- Part C is referred to as Medicare Advantage. This option combines the coverage of Part A and Part B plans into a single plan. However, unlike Part A and Part B plans, Part C plan costs and details can vary by location and have many network restrictions.
- Part D provides prescription drug coverage to Medicare beneficiaries and may be added to Original Medicare or Medicare Advantage plans. Like Medicare Advantage, plan details and costs can vary by location.
- Rhode Island Medicare Supplement Plans are also referred to as Medigap plans. They provide additional coverage for Medicare beneficiaries enrolled in Original Medicare. Medigap plans aid beneficiaries in paying medical expenses that would otherwise be an out-of-pocket expense, such as; deductibles, copays, and coinsurance.
Health Benefits Covered by Medicare in Rhode Island
Rhode Island Medicare provides beneficiaries coverage for medical services that are deemed necessary by a doctor. Medicare covers 80% of the medical cost and beneficiaries are responsible for the remaining 20%.
However, if you’re enrolled in a Rhode Island Medicare Supplement Plan, it will provide coverage of the otherwise out-of-pocket expense of the 20% coinsurance.
Qualifying for Medigap in Rhode Island
In you live in Rhode Island, are 65 years or older, and are enrolled in Original Medicare, then you are eligible for a Rhode Island Medigap plan. For optimal coverage, Medicare beneficiaries should consider enrolling in Original Medicare with a Medigap Plan as well as a Medicare Prescription Drug Plan.
Rhode Island Medicare Benefits for the Disabled Under 65
Disabled persons under the age of 65 may qualify for Original Medicare if they have one of the following;
- End-Stage Renal Disease (ESRD)
- Amyotrophic Lateral Sclerosis (ASL)
- Received disability benefits from Social Security for more than 24 consecutive months
- Received certain disability benefits from Railroad Retirement Board (RRB) for more than 24 consecutive months
Enrolling in Rhode Island Medicare
There are several Rhode Island Medicare enrollment methods for 2018 that are available. You may visit your local Social Security Administration office to enroll in person, visit the Social Security website to enroll online, or call Social Security to enroll over the phone.
Automatic enrollment will be done for those who are 65 and receive retirement benefits through the Social Security Administration (SSA) or through the Railroad Retirement Board (RRB).
For those who are not automatically enrolled in Medicare, it is important to be aware that there are penalties for late enrollment that will be added to your monthly Medicare Part B premium.
The period in which to enroll to avoid a late penalty is during your personal Initial Enrollment Period (IEP). Which is a 7-month window around your 65th birthday, being; 3-months prior to, the month of, and 3-months following.
If you do not enroll during your Open Enrollment Period then your next opportunity to enroll in Medicare, with the financial penalties to be incurred, will be during the Open Enrollment Period (OEP) which is from October 5th through December 7th.
Medigap Premiums in Rhode Island
Rhode Island Medigap plans are sold by private insurance companies and are specially designed to supplement Medicare benefits.
Like traditional healthcare insurance, the cost and available coverage of these plans will vary from company-to-company. All consider factors such as; age, sex, and location.
For example, someone who lives in Warwick may not receive the same cost and coverage as someone in North Kingstown. This is simply due to their location of residence in Rhode Island.
One of the benefits to Medigap plans is that the government has insured that the plan is guaranteed renewable. They do this by the implementation of the Medicare Supplement rate guarantee, which is referred to as Medigap protection.
Rhode Island Medicare Supplement Plans
Rhode Island Medicare Supplement Plans are offered through private insurance companies. They’re identified with a letter, A through N, with the coverage under each letter plan being identical from company-to-company. The only difference being that of premium costs to the beneficiary.
The most popular Medicare Supplement Plans in Rhode Island are, Plan F, G, and N.
- Plan F is referred to as first-dollar coverage. It’s the most popular Medicare Supplement Plan in Rhode Island as it is the most comprehensive, but it is also the mosy expensive plan. It covers 100% of approved expenses that Original Medicare does not cover, resulting in minimal out-of-pocket expense for beneficiaries.
- Plan G is referred to as Medicare Part G and is nearly identical to Plan F with the difference being that Plan G requires beneficiaries to pay their Medicare Part B deductibles.
- Plan N is referred to as cost-sharing plan. It does not provide as much coverage as Plan F and G, but the monthly premiums are significantly lower than Plan F and G. Plan N covers some of the expenses not covered by Original Medicare but not all. Beneficiaries are responsible for paying their Medicare Part B deductible as well as co-pays of $20 for doctor’s visits and $50 for emergency room visits.
Rhode Island Medicare Advantage Plan
Rhode Island Medicare beneficiaries who choose to enroll in a Medicare Advantage Plan will no longer be eligible for Original Medicare, as the Advantage plan will take the place of Original Medicare as the beneficiary primary insurance coverage.
Choosing a Medicare Advantage Plan over Original Medicare will also result in the beneficiary’s ineligibility to add a Medicare Supplement Plan.
There are pros and cons to Medicare Advantage Plans and Medicare Supplement Plans. The key is finding a plan that best fits your individual health and financial needs.
Medicare Advantage Plans usually have lower monthly premiums than Medicare Supplement Plans. However, they only permit benefices to see in-network hospitals and doctors (HMO’s and PPO’s).
Medicare Supplement Plans, on the other hand, may have higher monthly premiums. But they don’t have a network which allows beneficiaries to go to any hospital and doctor of their choosing.
Operating without a network can alleviate much stress and surprise out-of-pocket costs when learning that a previous Medicare Advantage Plan in-network doctor is no longer. As Medicare Advantage Plan networks often change throughout the year.
Rhode Island Medicare Prescription Drug Plans
Rhode Island Medicare beneficiaries can add a Medicare Prescription Drug Plan (Part D) to their either their Original Medicare Plan (Part A and B) or their Medicare Advantage Plan (Part C) in order to have coverage for their prescription drugs.
There are four aspects to coverage under Medicare Part D; deductibles, initial coverage, coverage gap, and catastrophic coverage.
- Deductibles vary from beneficiary to beneficiary, with a maximum deductible of $405.00 in 2018.
- Initial Coverage pays 75% of prescription medications up to $3,750.00.
- Coverage Gap is referred to as Medicare donut hole and begins after the Initial Coverage up to $5,00.00. It covers 49% of generic prescription medications and 10% of brand-name prescription medications. With the manufacturer providing a 50% discount for a total price coverage for the beneficiary being 60%.
- Catastrophic Coverage begins after the Coverage Gap and will cover 95% of prescription medications.
Applying for Rhode Island Medicare Benefits in 2018
For those Rhode Islanders who are not automatically enrolled in Medicare, there are several convenient ways in which you can enroll and where you can request further information prior to enrolling. You can request quotes and apply through your local Social Security office online, over the phone, or in person.
To apply for Rhode Island Medicare Supplements, contact us by phone or complete our online compare rates form to see rates in your area.
Rhode Island Medicare Resources
- Senior Health Insurance Program (SHIP) offers free advice and counseling to Medicare beneficiaries. This program is funded by the Centers for Medicare and Medicaid (CMS).
- Senior Medicare Patrol (SMP) educates seniors about Medicare fraud, waste, and abuse.
- Pharmaceutical Assistance to the Elderly provides assistance to Medicare Part D beneficiaries who financially qualify that need assistance in paying for their prescription medications.
The Rhode Island Department of Human Resources also oversees the Rhode Island Medical Assistance Program, referred to as Medicaid.
- Medicaid offers financial assistance to Medicare beneficiaries who financially qualify that need assistance to pay their premiums and deductibles.
FAQs About Rhode Island Medicare
What Blue Cross Blue and Blue Shield Rhode Island Medicare Plans are there?
Blue Cross Blue and Blue Shield of Rhode Island is an HMO plan with a Medicare Contract. There are four plans;·
- BlueCHiP- which is a Medicare Advantage plan.
- Plan 65- which is a Original Medicare Supplement plan.
- MedicareRx– regional Part D prescription drug plan (PDP).
- Dental Options – which offer a supplemental dental option that may be a stand-alone plan or added to BlueCHiP, Plan 65, or Blue MedicareRx.
Does Medicare in Rhode Island pay for assisted living?
Medicare does not cover the costs of assisted living. However, it will cover skilled nursing care in an assisted living facility for up to 100 days following a hospital stay of at least 3 days.
What doctors accept Medicare in Rhode Island?
Doctors have three options when it comes to accepting Original Medicare, they can be; Participating, Non-Participating, or they can choose to Opt-Out.
In Rhode Island, due to the MOM Law, doctors cannot choose to be Non-Participating- they must choose to be fully-in or fully-out.
- Participating Providers (PAR) have accepted assignment which means they accept Medicare-approved amounts for medical services and thus cannot charge Medicare Part B excess charges to beneficiaries. Over 96% of doctors in the US are Participating Providers.
- Non-Participating Providers (non-PAR) are agreements with Medicare where a doctor can choose to accept assignment on a case-to-case basis. They may charge a Part B excess charge if they choose to not accept assignment. In Rhode Island this option is not available. This state has adopted the Medicare Overcharge Measure Law (MOM Law) which prohibits doctors from charging beneficiaries Medicare Part B excess charges. Thus, there are no Part B excess charges in Rhode Island per law.
- Opt-Out Providers have chosen to not accept Medicare. They’ve signed an affidavit stating they have opted-out of the Medicare program completely. Less than 1% of the nation’s doctors have chosen to opt-out.
Medicare Advantage plans, on the other hand, operate with a network in which beneficiaries can only see healthcare providers that are with-in that network.
Choosing the Best Rhode Island Medicare Options
When it comes to choosing the best Medicare plan option, beneficiaries should consider their individual financial and medical needs.
If you have a doctor you have been seeing for 20-years and are willing to pay higher monthly premiums to continuing seeing, then Original Medicare with an Additional Medicare Supplement Plan may be in your best interest.
But if you do not have a doctor preference and lower monthly premiums bare a higher weight than the doctor you see, a Medicare Advantage Plan could be the best option for you.
In any regard, the starting point to choosing the right Rhode Island Medicare plan for you is to gain the needed information to make that decision.
You can contact us by phone at the number above to speak with one of our agents, or you can complete our rate comparison form online and an agent will provide you with rates for the top Medical Supplement Insurance plans from companies in your area.