Medicare in Rhode Island
Key Takeaways
- U.S. citizens and permanent residents 65 and older who live in Rhode Island are eligible for Medicare. Medicare is a government-funded insurance option that offers coverage for medical services and inpatient hospital care.
- Original Medicare (Parts A and B) will cover most of your inpatient and outpatient services. However, you can add additional coverage and assistance, such as Medicare Part D and Medigap.
- Medicare Advantage Plans (Part C) in Rhode Island vary depending on the provider you choose. All Part C plans cover the same services as Original Medicare, but many also offer additional coverage like prescription drugs, dental, vision, and more.
From mansion tours in Newport to beach walks on Block Island, Rhode Island is full of beauty and charm. When you’re actively enjoying life on the East Coast, it’s important to have a health insurance plan that keeps you covered.
GoHealth licensed insurance agents in Rhode Island can help you find a Medicare plan to meet your needs.
How Do I Apply for Medicare in Rhode Island?
There are multiple ways to apply for Medicare Plans in Rhode Island, including online, over the phone, and in person.
- Visit the Social Security website and use their online application.
- Apply over the phone using the Social Security administration’s toll-free number at 1-800-772-1213 (TTY 1-800-325-0778).
- Apply in person at your nearest Social Security office during business hours.
- Call GoHealth to speak with a licensed insurance agent.
What Medicare coverage is right for my specific situation?
What Are the Parts of Medicare?
The parts of Medicare include Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, and Medigap”
- Medicare Part A is hospital insurance.
- Medicare Part B is medical insurance.
- Medicare Part C, also known as Medicare Advantage, substitutes Part A and Part B and most Part C plans include additional benefits like coverage for prescription drugs, vision, dental, etc.
- Medicare Part D helps cover prescription drugs.
- Medicare Supplement plans help cover the out-of-pocket costs of Part A and B.
What Are the Requirements to Qualify for Medicare?
All citizens or permanent residents aged 65 and older qualify for Medicare in Rhode Island. Individuals aged 50 and older who are the child or widow of a government worker may also qualify for Medicare. Also, people below the age of 65 can receive Medicare if they have a qualifying disability and have received Social Security or Railroad Retirement Board disability benefits for 24 months.
If you have been diagnosed with end-stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), you will be automatically signed up for Medicare from the first month you receive disability benefits. GoHealth licensed insurance agents are trained to help walk you through how to first enroll in Medicare.
Do I Qualify for Medicaid in RI?
Medicaid is a government-funded health insurance option that covers millions of low-income Americans. Many older adults receive both Medicaid & Medicare to help cover their healthcare needs. In Rhode Island, a Medicare-Medicaid Plan (MMP) coordinates Medicaid and Medicare coverage and benefits. You qualify for Medicaid in Rhode Island if you are low income and are 65 years or older, have a disability, or have a child under 18 years of age.
Find the Medicare Plan that works for you.
How Do you Qualify for Medicare if You Are Under 65?
You can qualify for Medicare before 65 if you receive benefits for a disability. People who have received Social Security or Railroad Retirement Board disability benefits for 24 months are eligible to apply for Medicare. Individuals with Amyotrophic Lateral Sclerosis (ALS) or End-Stage Renal Disease (ESRD) are automatically eligible for Medicare after the first month of their disability benefits.
How Much Does Medicare Cost?
Although Medicare may offer some low and zero-cost options for beneficiaries in Rhode Island, Medicare plans are never “free.” However, if you meet the criteria, some parts of Medicare may cost you nothing out-of-pocket.
Premiums for Medicare in RI can vary. For most people who enroll in Medicare, Part A and Part B have standard costs that depend on your income and whether or not you’ve paid enough tax into Medicare and Social Security. Here’s a breakdown:
- For most Americans who contribute to Medicare and Social Security for at least 10 years through payroll, you won’t pay a monthly premium for your Part A plan.
- The standard Part B premium for 2025 is $185. Still, this monthly premium can increase based on individual or joint incomes.
- Medicare Advantage (Part C), Part D, and Medicare Supplement plans can vary in cost and benefits from state to state.
If you do not enroll in Original Medicare when you are first eligible, you risk facing late enrollment penalties for Part A or Part B. The exception to this rule is when you are transitioning from a group health plan to Medicare. Once you enroll in Medicare, if you do not enroll in either Part D or another creditable drug coverage, you also risk a Part D permanent late enrollment penalty. As soon as you are eligible for Medicare, reach out to a GoHealth licensed insurance agent so that we can help you enroll on time.
Who Has the Best Medicare Advantage Program?
Many private insurance companies offer Medicare Advantage in Rhode Island, making it difficult to choose the right Medicare plan. However, it’s essential to understand that there is no single “best” Medicare Advantage plan. Instead, the best Medicare plan for you will be one that meets your healthcare and financial needs.
The Center for Medicare & Medicaid Services’ (CMS) five-star rating system can help you compare plans and providers in Rhode Island. GoHealth licensed insurance agents can also help you find a plan that meets all of your needs.
Find the Medicare Plan that works for you.
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 204,250 people are enrolled in Medicare Part A and B in Rhode Island. The total number of beneficiaries enrolled in Medicare Advantage increased from 105,022 to 111,572 year over year. Medicare Advantage participation in Rhode Island went from 52.61% to 54.63% year over year. If you’d like to dive deeper into how Medicare in Rhode Island breaks down across the state, we provide a glance at who is using Medicare and how.
204,250 Beneficiaries with Part A & Part B
111,572 Medicare Advantage Beneficiaries
54.63% Medicare Advantage Participation Rate
55.05% Female
44.95% Male
86.34% Non-Hispanic White
3.01% African American
5.22% Hispanic
5.42% Other/Unknown
15.56% Eligible for Medicaid
0.97 Average HCC Score
$9,928.77 Actual Per Capita Costs
18.32% Hospital Readmission Rate
25.61% % of Beneficiaries with an Emergency Department Visit
105,022 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
52.61% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Rhode Island Executive Office of Health and Human Services
https://eohhs.ri.gov/consumer/older-adults/resources
What should I know about the Rhode Island Executive Office of Health and Human Services?
Find resources on healthcare for elders, including Medicare enrollment services and financial help.
Rhode Island Department of Human Services
https://dhs.ri.gov/
What should I know about the Rhode Island Department of Human Services?
Check your eligibility for Medicaid and other healthcare and financial programs.
Rhode Island Office of Healthy Aging
https://oha.ri.gov/
What should I know about the Rhode Island Office of Healthy Aging?
Get information and resources on organizations in Rhode Island that help older adults thrive.
Rhode Island Aging & Disability Resource Center (ADRC)
https://www.oscil.org/
What should I know about the Rhode Island Aging & Disability Resource Center?
Find additional resources and one-on-one assistance for disability-related services.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in Rhode Island about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- Medicare. SSA.gov.
- Five-Star Quality Rating System. CMS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.