Medicare offers healthcare coverage to Rhode Island residents age 65 or older, or to those Rhode Island residents that suffer from certain medical disabilities. In 2015, 197,000 people are enrolled in Medicare in Rhode Island, accounting for 19% of the population in Rhode Island. In 2009 an average of $10,121 was spent per Medicare enrollee in Rhode Island, approximately 2.35% lower than the national average of $10,365. Between 2015 to 2030 the number of seniors in Rhode Island is expected to rise by an estimated 40.67% according to calculations based off of the 2000 Census. Thus, the number of Medicare beneficiaries in the state is also expected to grow.
Like other states, Rhode Island participates in a national network of Senior Health Insurance Programs (SHIP). Medicare beneficiaries and their caregivers can receive free, unbiased, and one-on-one health insurance counseling from SHIP. Another program available to residents is Senior Medicare Patrol (SMP) which aims to educate and also empower consumers on how to identify, avoid, and report instances of Medicare waste, fraud and/or abuse.
When you are eligible for Medicare you may sign up for Original Medicare (Part A & Part B), which cover hospital services and medical services, respectively, or you may enroll in a Medicare Advantage Plan (Medicare Part C). If you sign up for Original Medicare you also have the option to purchase a separate or stand alone prescription drug plan (Part D). Medicare Advantage and Medicare Part D insurance plans are sold by private insurance companies that have a contract with Medicare. Original Medicare offers its beneficiaries flexibility in choosing their providers and you are not limited to a network. However, there is no limit on out-of-pocket medical expenses and you must always pay 20% coinsurance for medical service costs. For most Medicare beneficiaries, Part A is already paid through paycheck deductions during their working years (or their spouse's) but most Medicare beneficiaries pay premiums for Part B unless they qualify for financial assistance. Medicare Advantage plans require you to stay in network but some plans will also cover out-of-network care at a higher cost. Many Medicare Advantage plans also include additional health benefits such as vision, dental, or hearing coverage and you have the option to purchase a Medicare Advantage plan with prescription drug coverage (MAPD) in almost all states.
Using CMS data HealthPocket found that:
- The average total monthly premium for a 2017 Medicare Advantage plan in Rhode Island is $59.67, 4.5% less than the national average of $62.48. 33.33% of 2017 Medicare Part C insurance plans in Rhode Island have a $0 monthly premium.
- The maximum possible annual drug deductible in any 2017 Medicare Advantage plan with a drug component is $290, but in Rhode Island the average annual drug deductible for Medicare Part C insurance plans with drug components is $119. 50% of 2017 Medicare Part C insurance plans with a drug component in Rhode Island have a $0 annual drug deductible.
- All 2017 Medicare Part C insurance plans without a drug component in Rhode Island have a $0 monthly premium.
- The average medical out-of-pocket limit for 2017 Medicare Part C insurance plans in Rhode Island is $4,300. 16.67% of 2017 Medicare Advantage plans in Rhode Island had a medical out-of-pocket limit of $3,400 or less.
To assist seniors in choosing Medicare plans, CMS assigns star ratings to Medicare Part C and Part D plans each year based on preventive care, chronic condition management, customer service, member satisfaction, and drug pricing. Ratings range from 1 star (a poor plan) to 5 stars (an excellent plan).
- The average overall CMS star rating assigned to Medicare Part C insurance plans in Rhode Island was 4.5 stars in 2017.
- Among Rhode Island's 2017 Medicare Advantage plans with CMS star ratings:
- 100% earned a score of 4 or 4.5 stars
Data on Medicare eligibility, enrollment, and spending by state from Kaiser Family Foundation