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.

Medicare Advantage Plans in Rhode Island

Compare ratings of insurance companies offering Medicare Advantage Plans in Rhode Island:

Insurance company Medicare rating A.M. Best rating BBB rating NCQA rating J.D. Power ranking
Aetna 4 stars A A+ 2.5 to 4.5 stars Fifth out of 10
Blue Cross Blue Shield 4 to 4.5 stars A+ A+ Not rated Sixth out of 10
Cigna 4 stars A- Not rated 2.5 to 4.5 stars Seventh out of 10
Highmark 4.5 stars A A- 2.5 to 4.5 stars Second out of 10
UnitedHealthcare 3.5 stars A- A- 4 stars Fourth out of 10

What You Should Know About Medicare Advantage Plans in Rhode Island

  • In 2022, there are 33 Medicare Advantage plans available in Rhode Island, compared to 26 plans in 2021.
  • 100% of Medicare beneficiaries have access to a zero premium Medicare Advantage plan in 2022.
  • The average Medicare Advantage monthly premium in 2022 is $25.46, a slight decrease from 2021.
  • Through the CMS Innovation Center’s Value-Based Insurance Design (VBID) Model, 2 plans will offer Medicare Advantage enrollees eliminated Part D cost-sharing; rewards and incentives programs related to healthy behaviors; and customized, innovative benefits that address social determinants of health, such as food insecurity and social isolation, for certain underserved and/or chronically ill enrollees.

Is Medicare Advantage Right for You?

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.
  • Note:
  • You can’t have both a Medicare Advantage Plan and a Medicare Supplement Plan.
  • You must be enrolled in Medicare Parts A and B to join a Medicare Advantage Plan.

What’s covered with a Medicare Advantage Plan?

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:
  • Doctor’s visits
  • Ambulance services
  • Emergency and urgent care
  • Durable medical equipment (DME)
  • Mental health care
  • Prescription drugs that you cannot self-administer
  • X-rays
  • Laboratory tests
Preventive services, such as:
  • Vaccinations
  • Cancer screenings
  • Diabetes screenings
  • Depression screenings
Additional benefits (depending on your plan), such as:
  • Routine vision exams with allowance for glasses
  • Routine dental exams
  • Hearing exams with allowance for hearing aids
  • Fitness and wellness programs and discounts
  • Transportation to medically necessary care
  • Over-the-counter (OTC) drugs

How to Compare Medicare Advantage Plans in Rhode Island

With 33 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:

  • Monthly premium: This is how much you pay for coverage monthly, regardless of the care you receive. You may need to pay your plan’s premium in addition to the Medicare Part B premium, although some plans have $0 premiums or help pay for your Part B premium.
  • Plan network: You may need to use doctors and providers who are within a plan’s network. Before choosing a Medicare Advantage Plan, think about the doctors and facilities (including pharmacies) you prefer to use, then check if the plan offers coverage at those locations. Some plans may provide out-of-network coverage, but this usually comes at a higher cost.
  • Deductible: Your deductible is the amount you must pay before your insurance plan starts helping cover the costs. Medicare Advantage Plans set their deductibles, and these may change only once per year on January 1.
  • Copayments and coinsurance: Copayments or coinsurance are how much you pay for each service or doctor’s visit, such as $20 per doctor visit. Each Medicare Advantage Plan sets its copayment or coinsurance amount that can differ from what you would pay through Original Medicare.
  • Out-of-pocket maximum: Each Medicare Advantage Plan sets a yearly limit on the maximum amount you’d be responsible for paying for services covered by Medicare. Once you reach this limit, you won’t have to pay anything for the services you receive covered by Part A and Part B in that year.
  • Additional coverage: Most Medicare Advantage Plans also provide prescription drug coverage and often include additional benefits that Original Medicare won’t cover, such as vision, dental, and hearing. Plans may provide even more benefits, like discounted gym membership or transportation to doctor’s visits. Medicare Advantage Plans can also tailor their benefits to the specific needs of particular chronically ill beneficiaries.

About Medicare Advantage Plans in Rhode Island

There are 33 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
33
  • Local HMO
  • Regional PPO
  • Sierra Health PPO
  • United Healthcare HMO
  • United Healthcare PPO

Types of Medicare Advantage Plans in Rhode Island

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.

Types of Medicare Advantage Plans
HMOs HMOs typically require that you receive all services from in network providers:
  • You must have a primary care physician (PCP), referrals for specialists, and prior authorizations for treatments and some prescriptions.
  • Drug coverage usually is included. You aren’t able to purchase standalone drug coverage.
  • Lower costs if you stay in network.
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.
  • You don’t need to choose a primary care doctor or referrals for specialists.
  • Drug coverage is usually included.
  • You aren’t able to purchase stand-alone drug coverage.
  • Higher premium and out-of-network costs.
PFFS Plans PFFS plans don’t require a primary care physician or referrals for specialists:
  • You can go to any Medicare-approved health care provider or facility that accepts the plan’s payment terms and agrees to treat you.
  • May include drug coverage, or you can purchase a standalone drug plan.
  • Higher cost if you choose a provider that doesn’t agree to the plan’s terms.
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 need a PCP and referrals to specialists.
  • Drug coverage is always included.
  • If you’re eligible, you can join an SNP at any time.

Enrollment and Eligibility for Medicare Advantage Plans in Rhode Island

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:

  • You’ve received Social Security Disability Insurance or Railroad Board Disability Annuity for 24 months
  • You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease
  • You have End-Stage Renal Disease

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.

  • Your IEP begins three months before the month you turn 65 and extends for three months after the month you turn 65. During this period, you can enroll in a Medicare Advantage Plan. If you join before the month you turn 65, your coverage will begin the first day of the month you turn 65. If you enroll in the three months after turning 65, your coverage will begin the first day of the month after you enroll.
  • If you miss your IEP, you can sign up for Medicare during the General Enrollment Period from January 1 to March 31.
  • After you enroll in Medicare, you can enroll in or make changes to your Medicare Advantage Plan coverage during the Medicare OEP from October 15 and December 7 of each year. During this time, you can change from Original Medicare to Medicare Advantage, switch to a different Medicare Advantage Plan, or change from Medicare Advantage back to Original Medicare.

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.

Medicare Enrollment Periods
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

Rhode Island Medicare Advantage Plans With Prescription Drug Coverage

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.

Getting Help with Medicare Advantage Plans

Rhode Island-wide Medicare Advantage Resources
Resource Contact How they help
AARP Rhode Island Phone: 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 Phone: 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 Phone: 401-462-9520

email: [email protected]

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  Phone: 800-745-6575 This site is a guide to the Medicaid plan types currently available in Rhode Island
Rhode Island Office of Healthy Aging Phone: 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
Rhode Island-wide Medicare Advantage Resources
Resource Contact How they help
Age Well Phone; 800-642-5119 Age Well provides access to healthy meals, in-home care and community resources
Area Agency on Aging for Northeastern Rhode Island Phone: 800-642-5119

email: [email protected]

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 Phone: 800-642-5119

email: [email protected]

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 Phone: 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 Phone: 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 Phone: 401-468-4325

email: [email protected]

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. Phone: 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 Phone: 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 Kensington Senior Services Phone: 401-789-0268

email: [email protected]

South Kensington Senior Services provides supportive services, engaging activities and a sense of community for older adults
TriCounty Community Action | Seniors and Disabled Adults Phone: 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 Phone: 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 Phone: 401-732-4660

email:

[email protected]

Westbay Community Action is a charitable organization serving the people of Kent County, helping with food, utilities, health, safety, and education
Federal Medicare Advantage Resources
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 Phone: 800-633-4227 The homepage for the main Medicare website for the U.S
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Insurance and health care consultant

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.

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