Rhode Island seniors 65 and over are eligible to enroll in Medicare and receive health coverage from the federal government at a reduced cost (when compared to similar private insurance options). At its core, the basic Medicare Plan consists of coverages which provide for hospital services and outpatient treatment. These are covered by Parts A and B of Original Medicare (respectively). But, unfortunately, this coverage isn’t 100% comprehensive – but we’ll talk about that in a minute.
First, let’s start with basic Medicare costs and fees. Medicare was originally proposed in order to alleviate the financial burden of expensive health care costs for a segment of the population living on a fixed retirement income. As such, it is designed to be as low-cost as possible. Part B requires premiums and deductibles from every beneficiary, and you can get exact numbers and details from this website. Part A, on the other hand, might be free for any senior citizen with a long enough work history of 10 years or more (40 quarters, cumulative). However, if your employment history is shorter than that, there are upfront costs which you will be required to pay.
If you live in Rhode Island and are at least 65 years old, you can make use of Medicare as your insurance policy for inpatient and outpatient care. Enrolling into Medicare will automatically get you Medicare Part A if you’re approved. Medicare Part A is free to everyone with 10 years of work history or 40 quarters of work history, and it includes inpatient services, some outpatient services, hospice care and nursing home care. For even more coverage you can opt for Medicare Part B for additional outpatient coverage, more coverage for medical procedures and additional coverage for better medical equipment to use at home.
Outside of the basic Medicare Parts A and B, you can go with Medicare Part C for additional coverage. It requires you to have A and B first, but offers different coverage options that aren’t included in the basic plans like vision and dental. Medicare Part C is also known as Medicare Advantage and is private. And Medicare Part D also requires you to have Parts A and B. Medicare Part D is the prescription drug plan that will help pay for most prescription costs that aren’t covered under Parts A and B.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
A Wide Variety of Medicare Plans in Rhode Island
Medicare comes in a variety of forms beyond Traditional Medicare (Parts A and B). In Rhode Island, there are 188,502 beneficiaries enjoying Medicare coverage in some form. The largest segment, which includes 86,711 beneficiaries, is made up of people who supplement their Original Medicare through an employer benefit program (or might not supplement it at all). For those who do supplement their Medicare personally, 36% of beneficiaries (67,860 seniors) do so through a Medicare Advantage plan. And additional 18% (34,180 people) do so with a Medigap policy. Next, we’ll explain how both Medigap and Medicare Advantage work, and why these policies are so popular with seniors.
Anyone currently looking for a Medicare supplement must first make sure they are currently enrolled in the federal Medicare program. You can click that link if you are unsure, or if you need to check your enrollment status.
Why is Medicare Supplement Insurance Necessary?
Well, the truth is that it isn’t absolutely necessary for the recently retired, or any senior who is still in relatively good health. And there is no legal requirement that you supplement your Traditional Medicare by purchasing additional coverage. But if you have chronic health conditions, or if you are well into your golden years, not supplementing your basic Medicare benefits could leave you vulnerable to many of these out-of-pocket expenses:
|Medicare Part A Costs||Medicare Part B Costs|
Supplementing Traditional Medicare is a low-cost way of hedging your best on your health. You could save a little money now by not buying a supplement policy, but you risk falling through the “gaps” in Medicare coverage and taking on thousands in unexpected medical bills later. Or, you could purchase an affordable supplement now, and enjoy the protection it provides.
It’s common for Rhode Island seniors to need additional medical coverage on top of Original Medicare. That’s because the cost of quality healthcare in Rhode Island is going up annually and is out of reach of some seniors now. As quality healthcare becomes more expensive, seniors with Medicare get increasingly larger bills that they are expected to cover out-of-pocket.
To prevent massive out-of-pocket costs from being an issue, people are utilizing supplemental health insurance. This kind of insurance is designed to help pay some of the extra leftover costs and to make getting quality healthcare more attainable for everyone.
Even with Medicare Parts A and B it’s common to have to pay for some inpatient care and most outpatient care. The right supplemental insurance helps fill your Medicare coverage gaps, reducing the costs that you’re going to have to pay overall. These types of plans will pick up some and sometimes all of the remaining tab after Medicare pays for some of the medical costs, leaving you with a much more affordable bill.
When shopping for an additional insurance policy to fill the gaps of your Medicare Parts A and B policies, you have two options to consider; Medigap (Medicare Supplement) or Medicare Advantage. Both of these plans are well-known for being reliable and offering excellent coverage. But they do work very differently from one another.
Why Do Rhode Island Residents Choose Medigap?
There are several reasons why seniors in Rhode Island may prefer a Medigap policy over alternative plans such as Medicare Advantage. For one, these policies are designed with Medicare – and the very specific coverage gaps it is known for – in mind. That way, you get exactly as much coverage as you need at the most affordable cost possible. Also, unlike Advantage, you get to keep your government Medicare – you don’t have to transfer all of your health care coverage to a private company. There are ten plans in total, and each one offers identical benefits no matter where you live. However, costs will vary depending on your exact location and the available providers.
Take a look at the available coverage packages:
Top Medicare Supplement Plans in the Area
|Type||Starting From||Part A Deductible||Part B Deductible||Excess||Nursing||Travel|
|F||$122||$0||$0||100% Covered||100% Covered||100% Covered||Request Info|
|C||$122||$0||$0||Not Covered||100% Covered||100% Covered||Request Info|
|G||$118||$0||$147||100% Covered||100% Covered||100% Covered||Request Info|
|B||$102||$0||$147||Not Covered||Not Covered||Not Covered||Request Info|
|N||$76||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|D||$118||$0||$147||Not Covered||100% Covered||100% Covered||Request Info|
|A||$67||$1||$147||Not Covered||Not Covered||Not Covered||Request Info|
|L||$67||$304||$147||Not Covered||75% Covered||Not Covered||Request Info|
|K||$43||$608||$147||Not Covered||50% Covered||Not Covered||Request Info|
|M||$107||$608||$147||Not Covered||100% Covered||100% Covered||Request Info|
What are the Pros and Cons of a Medicare Advantage Plan?
Medicare Advantage, also known as “Medicare Part C” or “Medicare Replacement” is Traditional Medicare, technically, but at the same time it is also not Traditional Medicare. Although this seems confusing, it’s actually quite simple: an Advantage plan replaces your Original Medicare plan with a policy that is equal to (or better than) your base Medicare benefits. And the “better than” part of that explanation can often include extras like dental or vision – for a price, of course. Many seniors also appreciate the simplicity of having one single entity (in this case, a private insurance company) handling their policy.
But there are drawbacks as well. Keep in mind that by switching, you’re essentially absolving your government of any responsibility for your healthcare, and instead handing that responsibility over to a private company. Additionally, there are certain regions of the country in which the provider networks are extremely limited in order to keep costs affordable for seniors. Therefore, you have to confront the possibility of switching doctors in order to accept an Advantage plan.
If you choose Medicare Advantage, you will be restricted to only receiving medical care from your plan’s HMO (Health Maintenance Organization) or PPO (Preferred Provider Organization).
Comparing Medicare Advantage and Medigap Policies
Even though Medicare Advantage and Medicare Supplement plans are both offered by private insurance companies, there are some key differences between these two policies that really set them apart. Each plan covers medical costs differently, they bill customers differently, the policies offer different types of coverage and they are regulated differently as well. Learning the differences can help you decide which plan is right for you and which you should avoid when you stop and think about your needs.
If you opt for a Medicare Supplement policy, you’ll have a plan that pays some of your health costs after Medicare pays its portion of your covered benefits, and finally you are responsible for a monthly premium and possibly some out-of -pocket expenses.
With a Medicare Advantage policy, you get premium and co-pay costs that are estimated based on insurance costs in your area of Rhode Island. You will have some out-of-pocket expenses with the policy as well. Medicare Advantage picks up the whole healthcare cost initially, and you help pay for those costs along with Medicare. Your healthcare costs are adjusted depending on how much care you need as well. When you need a higher amount of care, you’ll spend more on your policy and your out-of-pocket costs as well.
The next big area that the plans differ is with what sort of coverage they offer you. A Medigap policy only covers the items that are covered by Medicare Part A and Part B. The policy just pays more money toward those same items that Medicare is already covering, so you’re responsible for paying less of those costs yourself.
Medicare Advantage is more complex because it covers more items. The policy gives you Medicare Part A and Part B coverage but can also covers additional items. If you choose a policy carefully, you could get one with dental or vision coverage as well.
The final major difference between the two policy types is how they are regulated. Medigap policies are heavily regulated. They are categorized by letter designations and if you get a Medigap Plan F policy in New Jersey, it will have the same coverage as a Medigap Plan F policy in Rhode Island. You can compare costs and opt for an option that’s more affordable because of this.
Medicare Advantage policies aren’t regulated nearly as closely. Instead of every policy being held to the same standards, you will get all sorts of different policies with different insurance companies. That’s why it’s important to look closely at all the details of your insurance policy to make sure that you aren’t spending more money than you should be for the coverage that you are getting from your policy.
These main differences are what separate the two supplement insurance policies for Medicare. Of course, there are other differences as well, and we detail most of them in our table below. It’s not rare to still have questions about Medicare Advantage or Medigap, so contact our support team today to find out more about these policies and to get help choosing the perfect policy for your needs.
|Questions||Medicare Advantage||Medicare Supplement|
|How does this policy cover medical expenses for me?||A Medicare Advantage policy covers all of your expenses initially, then it gets money from Medicare and charges you a series of premiums, co-pays and added costs to help make sure you cover the proper amount for your policy.||Medigap covers some of the out-of-pocket costs of services that Medicare pays for partially. Different policies cover different amounts, but they will limit your out-of-pocket costs nicely.|
|Am I required to pay for Part B insurance still?||Yes||Yes|
|What do I have to pay for this policy?||You’ll pay an adjusted premium each month as well as a range of co-pays and added costs depending on your specific situation and amount of healthcare needs.||With Medigap you will pay a set monthly premium and any remaining costs that aren’t covered by your policy. If you choose a comprehensive Medigap policy. you may not have any remaining costs beyond your premium.|
|What does this plan cover in terms of healthcare services?||An Advantage plan offers all the same coverage of Medicare Part A and Medicare Part B and extras. Different policies come with different extras, and you can get coverage features like dental insurance or vision insurance by choosing the right policy, but pay attention to the cost of the option.||Medigap or Medicare Supplement covers Medicare Part A and Medicare Part B items and that’s it. You can’t add additional coverage onto the policy, but you can get a larger amount of your remaining cost covered with these policies.|
|Is budgeting for healthcare costs easy with this plan?||No, budgeting can be difficult with an Advantage plan. That’s because these plans are complex. Your medical costs will change depending on your healthcare needs, and you’ll have trouble budgeting properly.||Your out-of-pocket costs will change depending on your healtchare needs but it’s easier to budget with than Medicare Advantage. And if you have a comprehensive plan you just pay the monthly premium and that’s it.|
|Am I guaranteed to get this policy?||No, you don’t have a guarantee that you can keep the plan. It can be cancelled at any point.||Yes, a Medicare Supplement plan guarantees that you will have the policy for as long as you need it as long as you make your payments and the company remains in business.|
|Do I need to be approved to get this policy?||Yes, you do. There is usually an approval process for you to go through.||No, you don’t. If you have been approved for Medicare already you can get a Medigap policy with no questions asked.|
|Do I have to work with a doctor or hospital network with this policy?||Sadly, you do with Advantage policies. Each policy has its own list of in-network healthcare providers. You are expected to use these providers if you want the insurance coverage.||Nope, you are free to pick and choose any location that takes Medicare.|
|Which policy is the right one for me to choose?||Advantage is perfect if you have low medical needs and you live in an urban location with plenty of healthcare options to choose from.||Medicare Supplement or Medigap is best if you live in a rural location or if you have a high number of healthcare costs that you are currently paying.|
Additional Medicare Resources in Rhode Island
For your convenience, we’ve collected the most relevant Medicare-related contact information and included it in the directory located on this page. As informative as we strive to be in this article, we know it’s impossible to answer all of the very important questions you currently have about your Medicare needs. So please feel free to get in touch with qualified experts who can.
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Important Medicare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.