Medicare in Rhode Island: Who's Eligible, Costs, and More

If you’re approaching age 65 in Rhode Island, you probably have a lot on your mind. When will you retire? How will you fund your retirement? And how can you use Medicare to get the health coverage you need once you no longer work?

This guide is intended to help you answer the questions you have about Medicare in Rhode Island and how to take advantage of this important benefit from age 65 onward, or if you have a qualifying health condition. We’ll answer common questions here, and you can also contact us to get answers to your specific questions.

Who is Eligible for Medicare in RI?

Over one million people receive Medicare benefits in Rhode Island. The goal of Medicare is to provide health coverage for those who are no longer working and therefore are unlikely to have health insurance from an employer. To be eligible, you need to be 65 or older or have specific health conditions. There are over 1 million people enrolled in a Medicare Advantage plan in Rhode Island.

In order to sign up for Medicare, you need to be an American citizen or permanent resident who has lived in the United States for at least five years. 

Also, one of the following requirements must be met:

• You’re age 65 or older
• You’re under 65 but disabled and receiving disability benefits from Social Security or the Railroad Retirement Board
• You have end-stage renal disease (ESRD)
• You have Amyotrophic Lateral Sclerosis (ALS), also known as Lou Gehrig’s disease

Most people are automatically enrolled in Original Medicare during their initial enrollment period. If you want to add additional coverage or switch to a Medicare Advantage plan, you’ll need to do so yourself — it won’t happen automatically.

For example, you might want to add prescription drug coverage (Medicare Part D) or get a Medigap plan to help cover your out-of-pocket costs. You only have guaranteed acceptance to a Medigap plan during your initial enrollment period, so it’s important to act quickly. 

It pays to review your coverage to ensure you have the best plan for your needs, even if you’re automatically enrolled in Medicare.

How Much is Medicare in Rhode Island?

Each part of Medicare has separate costs. We’ll look at each one individually in this section so that you know what to expect.

Medicare Part A is inpatient hospital coverage. Most Americans don’t pay a premium for Medicare Part A, but there is an annual deductible of $1,556 in 2022. For inpatient hospital stays totaling up to 60 days, there is no coinsurance. However, for days 61-90 in a year, you’ll have coinsurance of $389 per day in 2022. After day 90 in a year, there is no Medicare coverage unless you use your lifetime days, and you only have 60 of those available throughout your life. For lifetime days, the coinsurance is $778 a day in 2022.

Medicare Part B is medical coverage that helps pay for doctor’s visits, medical equipment, preventive care, and more. Most Americans pay a monthly premium in 2022 of $170.10 for Part B, although if you have an especially high income or enroll late, you could pay more. There is an annual deductible of $233 before your coverage begins. After your deductible, you pay 20% of the Medicare-approved amount for care and Medicare pays the rest. Learn more about updated Medicare costs for 2022.

Together Medicare Parts A and B are Original Medicare. You can also add Medicare Part D if you want prescription drug coverage. These plans are sold by private insurance companies, so they will vary in monthly premiums, deductibles, and copayments. Be sure to compare drug plans carefully and ensure your prescriptions are included in the plan before you commit.

Another option is Medicare Advantage (or Medicare Part C). This coverage is a full replacement for Original Medicare and often includes prescription drug coverage and additional benefits not covered by Original Medicare. 

Medicare Advantage in Rhode Island is a great option if you’re interested in extra benefits and tend to stay in your local area. Medicare Advantage plans are offered by private insurance companies and include a limited medical provider network, similar to traditional health insurance. If you travel often, you might be better off with the national coverage offered by Original Medicare. 

Many Medicare Advantage plans are available for the same premium as Medicare Part B, but some cost extra every month. It’s important to carefully compare plans in your area so that you get the best medical network and benefits for your needs.

Learn More About Medicare in Rhode Island

The goal of this guide is to answer the most common questions about Medicare in Rhode Island, but it’s likely that you have some specific questions that aren’t covered here. Talking to a licensed insurance agent can help ensure you get the right coverage for your medical needs. Contact us to compare plans and learn more about your options today!