All the U.S. citizen of 65 years age living in the U.S. for continuous five years are eligible for Medicare plans if they or their spouse have worked enough to become eligible for Social Security or Railroad Retirement benefits or if they have paid Medicare payroll taxes. Individuals of 65 years already receiving Social Security or Railroad Retirement benefits are automatically enrolled in Original Medicare. Residents of Rhode Island looking for Medicare coverage have two ways to obtain it. They can either enroll in Original Medicare that include Part A and Part B or they can opt for Medicare Advantage plan, which is all in one alternative to Original Medicare.
Original Medicare in Rhode Island
Original Medicare comprising of Part A and Part B is the federal health-care program planned for seniors who are 65 years of age or older. This plan can also be availed by certain younger disabled individuals, or people with end-stage renal disease or Lou Gehrig’s disease. Medicare Part A coverage includes inpatient hospital care, skilled nursing home facility, home health along with hospice care. Medicare Part B is optional insurance plan, which is designed to complement Part A coverage and includes outpatient hospital services, physician services, laboratory and x-rays, home health, durable medical equipment, ambulance along with some other services. Just like any other states, residents of Rhode Island are also eligible to enroll in Original Medicare three months before they turn 65 and no later than four months after their birthday. This seven-month duration is termed as Medicare Initial Enrollment Period. Residents of Rhode Island can get Medicare Part A without paying any premium, if they have worked for at least 10 years and have paid their Medicare taxes. Residents who have not paid their Medicare taxes or work for ten years may owe a premium for their Part A coverage. However, majority of the Medicare beneficiaries have to pay a premium for Part B coverage, along with any copayments, deductibles, and coinsurance that may come with Medicare Part A and Part B coverage.
Medicare Part C or Advantage Plans in Rhode Island
In Rhode Island just like any other states, Medicare Advantage plans are widely available that offer an alternative way to get Medicare benefits. Quite a significant percentage of Medicare beneficiaries are enrolled in private Medicare Advantage plans. There are five counties in Rhode Island and in four counties 19 Medicare Advantage plans are available and in fifth county there are 18 Medicare Advantage plans. Medicare Advantage plans, offered by Medicare approved private insurance companies, cover all hospital and medical benefits that are covered through Original Medicare except the hospice care. Some Medicare Advantage plans also include additional benefits like routine dental, hearing, vision and prescription drug coverage. In order to qualify for a Medicare Advantage plan, individuals should be enrolled in Medicare Part A and Part B plan and they must be living in the plan’s service area. Individuals can sign up for a Medicare Advantage plan when they first become eligible for Medicare, or during the Annual Election Period that runs from October 15 to December 7. Residents of Rhode Island do have a lot of options in the year 2020, as there are some really best and popular Medicare Advantage plans which they can choose as per their requirements. Some of the popular Medicare Advantage plans available in Rhode Island are:
- Preferred Provider Organization Plans
- Health Maintenance Organization Plans
- Private Fee-for-Service Plans
- Special Needs Plans
Medicare Advantage Prescription Drug plans in Rhode Island
Since, Original Medicare plans do not provide coverage for prescription medication so people enrolled in this plan can obtain this coverage through Medicare Advantage Prescription Drug plans. Rhode Island residents who wish to have the convenience of health and prescription medication benefits in a single plan can enroll for Medicare Advantage Prescription Drug plan.
Medicare Part D Coverage in Rhode Island
Prescription drug coverage is a vital part of health plan and therefore individuals having Original Medicare or Medicare Advantage plan can avail prescription drug coverage through Medicare Part D plan. Medicare Part D is a prescription drug plan offered by private insurance carriers offering prescription drug coverage, which is not included under Medicare Part B and Medicare Advantage Plan. Like any other states of the country, residents of Rhode Island too are eligible to enroll in Medicare Part D if they Medicare Part A and/or Part B and they live in the service area of the Part D plan having prescription drug coverage. Medicare Part D plans are used along with the Original Medicare to provide exclusive coverage for prescription drugs. Since, Medicare Part D plans are sold by private insurance companies, so every Part D plan differs in terms of premiums, deductibles, copayments as well as drug formulary. However, before enrolling in a Part D plan, individuals are advised to check the plan formulary to make sure that the drugs used by them are included in the plan’s formulary. Plan’s formulary is a list of prescription drugs that are covered by the plan.
Medicare Supplement Plans or Medigap Plans in Rhode Island
Original Medicare plans come with substantial out-of-pocket costs, as there is no cap on this costs, therefore many Medicare enrollees opt to have Medicare Supplement or Medigap plans to supplement their Original Medicare. The Medigap plans cover some or all of the out-of-pocket costs such as coinsurance and deductibles, which otherwise beneficiaries would have to pay on their own. Medigap plans are standardized plans designed under federal rules, which allow beneficiaries six month time frame on turning 65 years of age and enroll in Original Medicare. During this time frame, coverage is guaranteed issue for Medigap plans. However, federal rules do not guarantee access to a Medigap plan to beneficiaries who are under 65 and eligible for Medicare due to disability. In Rhode island there are ten standardized Medigap plans available, where each plan is labeled with a letter offering a different level of coverage. However, medicare Supplement plans of the same type offers the same benefits irrespective of the insurance company offering the plan. Residents of Rhode Island like any other states need to be enrolled in Medicare Part A and Part B in order to become eligible and enroll for Medigap insurance plan.