Know your options for Medicare Advantage Plans in Rhode Island and find out how to enroll.
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Medicare beneficiaries have two options for how to receive their Medicare coverage: through Original Medicare or a Medicare Advantage Plan. Original Medicare includes Medicare Part A hospital insurance and Part B medical insurance. Medicare Advantage Plans bundle both Part A and Part B into a single plan making them an all-in-one alternative to Original Medicare. Many MA Plans also provide Part D prescription drug coverage and may offer more ancillary benefits such hearing, dental, vision and wellness benefits.
Medicare Advantage Plans are offered by private, Medicare-approved insurance companies that set their own rates and the extra benefit offerings, so each MA plan is different. You should compare your options carefully before choosing a plan. This article will guide you through everything you need to know about Medicare Advantage Plans in Rhode Island.
You have choices in Medicare coverage. While you can opt to stick with Original Medicare, a Medicare Advantage Plan – also known as Part C – may be a better alternative for you.
|Original Medicare||Medicare Advantage Plans|
|Original Medicare covers your Part A hospital insurance and Part B medical insurance.||Medicare Advantage Plans combine Part A, Part B, and additional benefits.|
|You can add Part D prescription drug coverage.||Prescription drug coverage is usually included.|
|You’re able to use any medical provider in the U.S. that accepts Medicare.||You’ll usually need to use doctors in your plan’s network.|
|You can buy supplemental coverage to manage out-of-pocket costs, including your coinsurance.||Your Medicare Advantage Plan may have lower out-of-pocket costs than Original Medicare.|
|Vision, hearing, dental, and other benefits aren’t covered.||Your plan may offer additional benefits, including vision, hearing, and dental.|
Medicare Advantage Plans cover benefits from Original Medicare Part A (hospital insurance), Part B (medical insurance), usually Part D (prescription drug coverage), and sometimes additional benefits that Original Medicare doesn’t cover. Each Medicare Advantage Plan insurer sets the rules about how you receive and pay for these benefits.
|Hospital and skilled nursing facility inpatient care||Home health care||Prescription drug coverage (if included in your plan)|
|Medically necessary outpatient services, such as:
||Preventive services, such as:
||Additional benefits (depending on your plan), such as:
With 39 Medicare Advantage Plans available in Rhode Island, you likely have several options in your area. To help you choose the best plan for you, consider what is most important to you before selecting a plan. There are several factors to keep in mind:
There are 39 Medicare Advantage Plans offered in Rhode Island. These plans include local HMO and regional PPO plans.
|Number of Medicare Advantage Plans available||Medicare Advantage Plan types available||Medicare Advantage Plans rated 3.5 or higher by NCQA|
In Rhode Island, the most common Medicare Advantage plans available are HMOs or PPOs, although there are also a few SNPs and regional PFFS plans available. Seniors eligible for Medicare may choose from plans provided by multiple private insurers, although the choices available vary by county.
|HMOs||HMOs typically require that you receive all services from in network providers:
|PPOs||PPOs include a preferred network of providers, but you have the option of choosing doctors or hospitals from outside of the network for a higher cost.
|PFFS Plans||PFFS plans don’t require a primary care physician or referrals for specialists:
|SNPs||SNPs are only for people with specific conditions and characteristics, and include care coordination and targeted benefits tailored to meet your specific needs:
You’re eligible for Medicare when you turn 65 or if you’re younger and have a qualifying disability. A qualifying disability means at least one of the following applies:
When you become eligible for Medicare, you are also eligible for Medicare Advantage Plans. There are specific times of the year when you can enroll for the first time in a Medicare Advantage Plan: during your Initial Enrollment Period and the Open Enrollment Period.
Medicare Advantage Open Enrollment occurs between January 1 and March 31 of each year. This period is only for beneficiaries already in a Medicare Advantage Plan, and you can change plans or switch to Original Medicare. You cannot switch from Original Medicare to Medicare Advantage during Medicare Advantage Open Enrollment.
There are exceptions to these enrollment periods called Special Enrollment Periods. Certain events or circumstances may make you eligible to change your Medicare Advantage Plan outside of the open enrollment periods, such as if you move outside of your existing plan’s service area or to a location with new plan options you didn’t have before. If you think you may qualify for a Special Enrollment Period, call 1-800-MEDICARE and explain your situation.
|Enrollment period||When it happens||Medicare plans you can choose||What you can do|
|Initial Enrollment Period||Three months before you turn 65, the month you turn 65, and three months after||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Sign up for Medicare Part A and Part B. Complete your Part B enrollment to avoid a late enrollment penalty.|
|General Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan. If you enroll in Medicare during this period, your MAP enrollment is April through June.||Sign up for Medicare if you missed your IEP|
|Open Enrollment Period||October 15 – December 7||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Join, switch, or drop a plan|
|Medicare Advantage Open Enrollment Period||January 1 – March 31||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||If you’re enrolled in a Medicare Advantage Plan, you can change your plan or switch to Original Medicare|
|Special Enrollment Period||When you have a qualifying event||Medicare Part A, Part B, Part D, Medigap, or Medicare Advantage Plan||Make changes to your plan|
Most Medicare Advantage HMO and PPO plans and all SNP plans provide prescription drug coverage like you would get from Medicare Part D. Some PFFS plans may provide prescription drug coverage, but not all do. Evaluate a plan’s prescription drug coverage when deciding which Rhode Island Medicare Advantage Plan to use.
Prescription drug coverage may vary by cost, coverage, and convenience among Medicare Advantage Plans. Your monthly premium may include a premium for the drug coverage in the plan. There is usually a copayment or coinsurance amount that you have to pay for each prescription after you reach your annual deductible.
Some plans use different cost tiers with different costs for different drugs. For instance, you may pay less for generic drugs than brand-name drugs or less for brand-name drugs within different tiers. If your plan uses tiers, the formulary will list all covered drugs and their tiers. Verify your preferred or local pharmacies are included in the plan’s network.
|Resource||Contact||How they help|
|AARP Rhode Island||(888) 687-2277||AARP is a nonprofit, nonpartisan organization that empowers people to choose how they live as they age|
|Rhode Island Executive Office of Health and Human Services | Medicare-Medicaid Plan||(401) 462-5274||EOHHS contracts with Neighborhood Health Plan of Rhode Island to administer Rhode Island’s Medicare-Medicaid Plan (MMP) which is designed to coordinate both Medicare and Medicaid benefits into one, integrated delivery system for eligible members|
|Rhode Island Insurance Department||(401) 462-9520
|The Mission of the Rhode Island Department of Business Regulation is to assist, educate, and protect the public through the implementation and enforcement of state laws mandating regulation and licensing of designated businesses, professions, occupations, and other specific activities while recognizing the need to foster a sound business environment|
|Rhode Island Medicaid||(800) 745-6575||This site is a guide to the Medicaid plan types currently available in Rhode Island|
|Rhode Island Office of Healthy Aging||(401) 462-3000||The Rhode Island Office of Healthy Aging partners with organizations throughout Rhode Island to connect you with information and resources that help you age strong|
|Resource||Contact||How they help|
|Age Well||(800) 642-5119||Age Well provides access to healthy meals, in-home care and community resources|
|Area Agency on Aging for Northeastern Rhode Island||(800) 642-5119
|The Northeast Kingdom Council on Aging
is an organization which delivers quality programs and services to older adults, people with disabilities, and family caregivers
|Central Rhode Island Council on Aging||(800) 642-5119
|CVCOA serves adults 60 and older living in Central Vermont, their caregivers, partners and families without discrimination and regardless of income|
|Child & Family Services of Newport County | Elders||(401) 849‑2300||Child & Family provides important services and programs to thousands of children, teens, families and elders throughout Rhode Island each year|
|City of Province Senior Services||(401) 680-5000||The Department of Senior Services enhances the quality of life for senior residents in Providence and creates awareness that seniors are a valuable asset to the community|
|City of Warwick Police Department Elderly Affairs||(401) 468-4325
|In the State of Rhode Island, every Police Department is mandated to designate a Senior Police Advocate, who serves as a liaison to the Division of Elderly Affairs on matters of elder abuse, neglect, and self-neglect – Officer Gavin McVeigh is currently serving in this role|
|Council on Aging for Southeastern Rhode Island, Inc.||(802) 885-2669||Council on Aging for Southeastern Rhode Island, Inc. provides a comprehensive and coordinated system of information and referral, home-based assistance, case management, nutrition services, and volunteer supports|
|East Bay Community Action Program | Senior Services||(401) 437-1000||The Senior Services provides seniors with options and resources to help them remain in their community as well as avoid falls, hospitalizations and nursing home placement|
|South Kingston Senior Services||(401) 789-0268
|South Kensington Senior Services provides supportive services, engaging activities and a sense of community for older adults|
|TriCounty Community Action | Seniors and Disabled Adults||(401) 349-5670||Tri-County’s Senior and Disabled Adult Case Managers are available to assist with a multitude of services including, healthcare and medical assistance, home health aides, home modifications, elder abuse and self- neglect prevention, and when necessary, nursing home referrals|
|United Way of Rhode Island||(401) 444-0600||United Way of Rhode Island’s mission is uniting our community and resources to build racial equity and opportunities for all Rhode Islanders|
|Westbay Community Action Program | Senior Information and Safety Programs||(401) 732-4660
|Westbay Community Action is a charitable organization serving the people of Kent County, helping with food, utilities, health, safety, and education|
|Resource||Contact||How they help|
|CMS Medicare Managed Care Appeals & Grievances||N/A||Provided by the CMS, this page provides information related to dealing with Medicare managed care plan grievances and appeals|
|CMS Medicare Managed Care Eligibility and Enrollment||N/A||Provided by the Centers for Medicare & Medicaid Services (CMS), this page offers information for contacting MAP organizations plus other health plans and related aspects to Medicare health plan enrollment|
|CMS Medicare Prescription Drug Eligibility and Enrollment||N/A||Provided by the CMS, this page details prescription drug eligibility and enrollment as it relates to MAP|
|Medicare.gov||(800) 633-4227||The homepage for the main Medicare website for the U.S|
Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.
Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.
Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.