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Medicare in Rhode Island

Learn how to get started with Medicare in Rhode Island, and more

Reviewed by: Eboni Onayo, Licensed Insurance Agent. Written by: Eleesha Dominique.

Key Takeaways

  • Adults 65 and older who live in Rhode Island are eligible for Medicare. Medicare is a government-funded insurance option that offers coverage for medical services, prescription drugs, and more.

  • Original Medicare (Parts A and B) will cover most of your inpatient and outpatient services. However, you can always choose to add additional coverage and assistance, such as Medicare Part D and Medigap.

  • Medicare Advantage Plans (Part C) in Rhode Island vary depending on the provider you choose. All Part C plans cover the same services as Original Medicare, but many also offer additional coverage like prescription drugs, dental, vision, and more.

From mansion tours in Newport to beach walks on Block Island, Rhode Island is full of beauty and charm. When you’re actively enjoying life on the East Coast, it’s important to have a health insurance plan that keeps you covered.

Whether you’ve already got a set insurance plan in mind or need help choosing one, GoHealth licensed insurance agents in Rhode Island can help you find a Medicare plan to meet your needs.

How do I apply for Medicare in Rhode Island?

There are multiple ways to apply for Medicare Plans in Rhode Island, including online, over the phone, and in person. At GoHealth, we can help make the entire application process much easier.

  • Call GoHealth to speak with a licensed insurance agent.
  • Visit the Social Security website and use their online application.
  • Apply over the phone using the Social Security administration’s toll-free number at 1-800-772-1213 (TTY 1-800-325-0778).
  • Apply in person at your nearest Social Security office during business hours.

If you turn 65 and have been receiving Social Security disability benefits, you will be automatically enrolled into Original Medicare (Parts A and B). If not, you can apply to enroll in Medicare Part A & B during your 7-month Initial Enrollment Period. This period includes the three months before, the month of, and three months after your 65th birthday. Once you have enrolled in Parts A and B, Medicare Part C enrollment becomes available.

What are the different Medicare plans available?

The five parts of Medicare include Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, and Medigap. Enrolling in these Medicare plans can help cover most, if not all, of your medical needs.

Original Medicare (Parts A and B) cover both inpatient and outpatient services and mental health services. You can add Medicare Part D to help cover the cost of your prescription drugs. Medigap is another add-on that can help lower some of your out-of-pocket costs, such as copayments, coinsurance, and more.

What is the requirement to qualify for Medicare?

All citizens or permanent residents aged 65 and older qualify for Medicare in Rhode Island. [1] Individuals aged 50 and older who are the child or widow of a government worker may also qualify for Medicare. Also, people below the age of 65 can receive Medicare if they have a qualifying disability and have received Social Security or Railroad Retirement Board disability benefits.

Generally, you must receive disability benefits for 24 months to qualify for Part A and Part B. However, suppose you have been diagnosed with End-Stage Renal Disease (ESRD) or Amyotrophic Lateral Sclerosis (ALS). In that case, you will be automatically signed up for Medicare from the first month you receive disability benefits. GoHealth licensed insurance agents are trained to help walk you through how to first enroll in Medicare.

Do I qualify for Medicaid in RI?

Medicaid is a government-funded health insurance option that covers millions of low-income Americans. Many older adults receive both Medicaid & Medicare to help cover many of their healthcare needs. In Rhode Island, a Medicare-Medicaid Plan (MMP) coordinates Medicaid and Medicare coverage and benefits. You qualify for Medicaid in Rhode Island if you are low income and are 65 years or older, have a disability, or have a child under 18 years of age.

How do you qualify for Medicare if you are under 65?

You can qualify for Medicare before 65 if you receive benefits for a disability. People who have received Social Security or Railroad Retirement Board disability benefits for 24 months are eligible to apply for Medicare. Individuals with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD) are automatically eligible for Medicare after the first month of their disability benefits. If you are 50 years or older, and you meet the requirement of the Social Security Disability program, you may also qualify for Medicare if you are the child or widow of someone who worked in a Medicare-covered government position.

What Medicare plans are required at 65?

If you do not enroll in Original Medicare when you are first eligible, you risk facing late enrollment penalties for Part A or Part B. The exception to this rule is when you are transitioning from a group health plan to Medicare. Once you enroll in Medicare, if you do not enroll in either Part D or another creditable drug coverage, you also risk a Part D permanent late enrollment penalty. As soon as you are eligible for Medicare, reach out to a GoHealth licensed insurance agent so that we can help you enroll on time.

Is Medicare free at 65?

Although Medicare may offer some low and zero-cost options for beneficiaries in Rhode Island, Medicare plans are never “free” – however, if you meet the criteria, some parts of Medicare may cost you nothing out-of-pocket. You can qualify for premium-free Part A if you’re already receiving Social Security or Railroad Retirement Board disability benefits or if you’re eligible for disability benefits. You can also qualify for a premium-free plan if you previously had Medicare coverage through your place of employment. Since Medicare costs can vary based on income, low-income beneficiaries may also be eligible for lower out-of-pocket Medicare costs.

Who has the best Medicare Advantage program?

Many private insurance companies offer Medicare Advantage in Rhode Island, making it difficult to choose the right Medicare plan. However, it’s essential to understand that there is no single “best” Medicare Advantage plan. Instead, the best Medicare plan for you will be one that meets your healthcare and financial needs. The Center for Medicare & Medicaid Services’ (CMS) five-star rating system can help you compare plans and providers in Rhode Island. [2] If you need help comparing your options, GoHealth licensed insurance agents can also help you find a plan that meets all of your needs.

Medicare in Rhode Island by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 195,933 people are enrolled in Medicare in Rhode Island. The total number of beneficiaries enrolled in Medicare Advantage in Rhode Island is 101,847. The previous year, 96,929 enrolled in Medicare Advantage. Medicare Advantage participation in Rhode Island went from 50.40% to 51.98% year over year. If you’d like to dive deeper into how Medicare in Rhode Island breaks down across the state, we provide a glance at who is using Medicare, and how.

 

 

 

Outline of Rhode Island
195,933
Beneficiaries with Part A & Part B
101,847
Medicare Advantage Beneficiaries
51.98%
Medicare Advantage Participation Rate
55.12%
% Female
44.88%
% Male
0.97
Average HCC Score
$10,369.28
Actual Per Capita Costs
14.56%
% Eligible for Medicaid
30.44%
% of Beneficiaries with an Emergency Department Visit
18.99%
Hospital Readmission Rate
87.58%
% Non-Hispanic White
2.94%
% African American
4.63%
% Hispanic
4.85%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Rhode Island Medicare Resources & Contacts

Beneficiaries spend an average of $10,369.28 each year on Medicare in Rhode Island. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Rhode Island-based resources, like these, may be able to help:

Rhode Island Executive Office of Health and Human Services

1-855-840-4774 or 401-462-5274

https://www.eohhs.ri.gov/consumer/elders/resources

What should I know about the Rhode Island Executive Office of Health and Human Services?
Find resources on healthcare for elders, including Medicare enrollment services and financial help.

Rhode Island Department of Human Services

1-800-745-6575

http://www.dhs.ri.gov/

What should I know about the Rhode Island Department of Human Services?
Check your eligibility for Medicaid and other healthcare and financial programs.

Rhode Island Office of Healthy Aging

401-462-3000

https://oha.ri.gov/

What should I know about the Rhode Island Office of Healthy Aging?
Get information and resources on organizations in Rhode Island that help older adults thrive.

Rhode Island Aging & Disability Resource Center (ADRC)

401-738-1013

http://www.oscil.org/adrc.html

What should I know about the Rhode Island Aging & Disability Resource Center?
Find additional resources and one-on-one assistance for disability-related services.

Nationwide Resources

Speak with an insurance agent that is licensed in Rhode Island about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in RI, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

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