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Medicare Plan Options in Rhode Island

A considerable number of senior citizens in the US rely on government-backed programs to receive proper healthcare and have their back, especially during difficult times. According to several surveys, approximately 16 million adults in the US are currently going through medical debt and owe more than $10,000.

Medical debt isn’t limited to a certain group of people but equally affects people across all demographics. People suffering from chronic ailments or disabilities are more vulnerable to facing excessive medical expenses and often end up bankrupt due to the rising healthcare costs.

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Even after a lifetime of meticulous financial planning and saving diligently, people are still vulnerable to financial strains, and nearly 1 in 3 US families usually opt out of seeking a doctor because of the exorbitant medical expenses.

This is why the government initiated the Medicare health insurance program, to finally give people a chance to get medical treatments without the fear of being indebted and finally have a comfortable retirement.

This reliable healthcare plan offers comprehensive coverage for a wide range of medical expenses for millions of US citizens nationwide. You will automatically become enrolled in Medicare when you reach the age of 65. Other people who qualify for Medicare must have been diagnosed with amyotrophic lateral sclerosis, had renal failure, or have been receiving disability benefits from the Railroad Retirement Board or Social Security. With a well-rounded health insurance program, you never have to worry about paying out-of-pocket expenses at the time of a medical emergency ever again.

But finding a robust healthcare policy that provides all the benefits necessary for your situation is not that simple. You require an expert’s insight to guide to through the overwhelming process of finding a reliable healthcare policy and take you step-by-step through the lengthy process of signing up for Medicare.

This is why at Integrity Now Insurance Brokers, our Medicare insurance agents are here to assist you and help you find the most comprehensive health insurance plans at competitive rates. Our Medicare insurance agents are annually accredited by the AHIP and are well-versed in the complexities and dynamics of the insurance industry. With our extensive experiences and access to top-rated Medicare insurance agencies in Rhode Island, we assure you that you are in safe hands.

We partner with the most reliable Medicare insurance agencies that we carefully select after studying their proven track record and efficient healthcare policies. Get in touch with our independent Medicare insurance brokers by giving us a call, and we will provide you with all the details that you require.


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A Quick Guide on Medicare Options Available in Rhode Island

Every person who is enrolling themselves in the Medicare program must choose between one of the two different ways to receive benefits from Medicare.

Original Medicare

The Original Medicare, also known as the traditional Medicare, is a popular fee-for-service program that is offered through the federal government. This healthcare plan covers acute care medical treatments and consists of two parts; Part A and Part B.

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Managed by the Centers for Medicare & Medicaid Services (CMS), the Original Medicare does not provide prescription drug coverage, and you will have to separately purchase Part D plans which specifically include coverage for drugs.

Medicare Part A offers coverage for services like inpatient hospital care, skilled nursing facilities (excluding custodial or long-term care), inpatient care in a religious non-medical healthcare institution, psychiatric care, home health care, and hospice care.

The Part B plan covers physician services, laboratory tests, medical equipment, blood work, mental health care, diagnostic X-rays, outpatient hospital services, and physical, occupational, and speech therapy.

Medicare has recently started to cover any medical treatment costs for people who have been diagnosed with a cognitive impairment like Alzheimer’s disease and other forms of dementia. These healthcare options enable patients to go through clinical trials, get medical and non-medical treatments, and have other additional benefits to living a higher quality of life.

These benefits involve evaluation of cognition and function, measurement of neuropsychiatric symptoms, medication, identifying caregivers and caregiver needs, assessing care directives, and providing referrals to community services for the beneficiary and their caregiver.

The Original Medicare Part A and Part B only provide 80% coverage of the overall medical expenses. This is why many people in Rhode Island like to opt for a secondary healthcare option like Medigap to get coverage for whatever isn’t covered in the Original Medicare.

Medicare Advantage – Part C

The Medicare Advantage plan is an all-in-one solution for people who are looking to combine all of their Medicare benefits into one single policy. This conglomeration of Medicare benefits includes all the benefits of Part A, Part B, and Part D. This plan also offers coverage for additional benefits like dental, hearing, vision, gym memberships, and other health and fitness programs.

When opting for Medicare Advantage, you will have to choose in-network doctors and healthcare providers for lower costs. These plans have lower out-of-pocket costs like coinsurances, copayments, and deductibles compared to the Original Medicare and most plans include comprehensive prescription drug coverage.

Rhode Island’s Medicare Advantage program offers four different types of plans.

Health and Maintenance Organization (HMO)

The HMO is a collective of medical healthcare providers who provide beneficiaries with coverage for various medical treatments by in-network hospitals and physicians that work on their terms and conditions.

HMOs mandate their subscribers to only choose from in-network healthcare providers to get their Medicare benefits.

  • Primary care provider (PCP) and specialty referral are required
  • Most policies include prescription medication coverage
  • Higher premiums and charges apply when opting for an out-of-network healthcare provider.

Preferred Provider Organization

The PPO includes a network of recommended providers that Medicare beneficiaries can choose from without paying any extra premiums.

  • PCP and a specialist’s referral are not required
  • Drug coverage is included in most policies
  • No extra charges or premiums apply for in-network healthcare providers

Private Fee-for-Service (PFFS)

This healthcare program is offered by State-licensed organizations that work under the terms and conditions of Medicare & Medicaid Services

  • No PCP or a specialist’s referral is required
  • Drug coverage is included in most policies but can also be purchased separately
  • Beneficiaries have to pay higher premiums when opting for out-of-network providers

Special Needs Plan (SNP)

The SNP health insurance limits its membership to people who have been diagnosed with specific chronic conditions and characteristics. They offer tailored benefits, drug formularies, and provider choices that are specifically designed to meet the special needs of these people.

To qualify for this plan, you need to be enrolled in Medicare Part A or Part B plans or have a chronic condition like cancer, cardiovascular diseases, dementia, diabetes mellitus, autoimmune disorders, HIV/AIDS, or a neurological disorder.

  • PCP and a specialist’s referral required
  • Plans include drug coverage


Medicare Part D

If your base health insurance plan does not provide drug coverage, you have the option to sign up for a separate drug plan called Medicare Part D. Like other health insurance plans; this program also charges a monthly premium, an annual deductible, and other out-of-pocket expenses.

All drug plans vary in terms of premiums, the pharmacies you can use, and the formulary. It’s important to choose a drug plan that includes all the prescription medication that you require.

The costs of Part D vary depending on the plan you opt for.

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Part D Deductible

A lot of the Part D policies have an annual deductible. The maximum deductible in 2022 for Part D enrollees is $480.

Initial Coverage Limit

Medicare beneficiaries will be responsible for 25% of the cost-sharing, and 75% will be covered by the plan.

Coverage Gap

Medicare Part D coverage gap begins after your drug plan has paid for a certain amount of prescription drugs. In 2022, this limit is $4,430. This amount almost changes every year, and you will be expected to pay 25% of the plan’s cost for any brand-name drugs listed in your plan’s formulary.


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An elderly woman sitting and using the computer.

Medigap – Supplemental Healthcare

Medigap or Medicare Supplement plans are a secondary healthcare program that is funded by private insurance agencies to help cover the gaps in the Original Medicare plans.

Each policy in this program is labeled from A to N. To qualify for Medigap:

  • The individual must be 65 years old or older
  • If younger, they must have been diagnosed with amyotrophic lateral sclerosis (ALS)
  • Have been receiving disability benefits from Social Security or the Railroad Retirement Board
  • Have been diagnosed with end-stage renal disease(ESRD)

Medigap provides all the basic benefits of Original Medicare, including coverage for Medicare Part A and Part B coinsurances, hospice care copayments and coinsurances, Medicare preventive care deductibles, and the first three pints of blood.

Other additional benefits include skilled nursing facility care deductibles, Part B excess charges, out-of-pocket yearly limit, and foreign travel emergency coverage.

Medigap insurers set their premiums in three ways.

Issue Age Rating

This approach for calculating premiums depends on the enrollee’s age and is less costly for younger subscribers. The overall costs are never affected due to the person’s age.

Attained-Age Rating

In this method, the premiums are cheaper for younger individuals. Many insurers tend to use this approach unless mandated to do otherwise.

Community Rating

Eight states in the US have mandated this approach, and premiums are unaffected by the enrollee’s age.

When signing up for a health insurance plan, many senior citizens tend to feel intimidated by the lengthy process of signing up for Medicare. There are various options to choose from, and finding one that meets all of your needs and requirements can be very difficult. This is why our Medicare insurance agents are here to help you find sturdy healthcare policies at the most reasonable rates.

With our deep knowledge and extensive experience in the insurance industry, we can help you streamline the well-rounded insurance plans that will provide you with ample coverage.

To learn more about the different Medicare options available in Rhode Island, don’t forget to go through our resources and learn the step-by-step process of signing up for Medicare.

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Comparing Medicare Plans in Rhode Island

Here are some factors you should consider before signing up for Medicare.

Provider Network

If you’re trying to prevent any extra medical expenses, try to opt for in-network healthcare providers rather than out-of-network ones. Medicare plans do not include higher charges and premiums for in-network hospitals and physicians, and this can save you from a huge financial burden.

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Amount of Coverage Required

Do your research and find plans that include healthcare benefits best suited to your situation.

Medicare Advantage and Medigap plans typically offer coverage for additional benefits like dental, vision, hearing, and other targeted treatments that aren’t a part of the Original Medicare.

Check Plan Ratings

You can compare different plan ratings by going through the Part C and Part D performance data annually released by the Center for Medicare & Medicaid Services (CMS).

Deductibles, Copayments, and Coinsurances

These are the maximum payments you will be expected to make if you adhere to the in and out-of-network coverage guidelines.

To compare the pricing on different plans in Rhode Island, you can use our plan finder tool.

Drug Coverage

Prescription medication is costly, and it’s best to invest in a healthcare plan that offers adequate coverage for prescription medications.

Make sure to check if the drugs you are regularly prescribed are mentioned in your plan’s formulary. If not, you can ask your physician for any alternate or generic versions of the drug that is enlisted in the formulary.


Extra Benefits

Most Medicare Advantage plans provide additional benefits to their beneficiaries that the Original Medicare does not cover.

Try to note down any benefits that are crucial for your health. You might require vision benefits, hearing benefits, dental services, etc. Medicare Advantage plans often provide tailored benefits to meet the specific needs of individuals with chronic illnesses.

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Medicare insurance agent talking to a client

Why Partner with Medicare Insurance Agents at Integrity Now Insurance Agents?

Our team of Medicare Insurance agents is a certified team of highly qualified insurance agents who have years of experience in providing comprehensive health insurance plans to senior citizens and youth with disabilities all over the US.

With our assistance, countless of our clients in Rhode Island have received efficient healthcare coverage plans provided by premium Medicare insurance providers at the most competitive rates. We assure you that your health is our priority. With our AHIP-certified insurance agents, you never have to worry about excessive medical treatment bills again.

Let’s schedule a call today and book a one-on-one consultation with our reliable Medicare insurance agents, and we will help you compare quotes and walk you through the intimidating process of signing up for Medicare.

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