Medicare provides health insurance coverage for citizens over 65 years old, as well as workers with disabilities. The state government of Rhode Island offers various programs that assist Medicare beneficiaries in the state, even though Medicare itself is funded by the federal government.
Medicare beneficiaries can obtain Original Medicare from The Centers for Medicare & Medicaid Services (CMS) which runs the Medicare program in RI. Original Medicare is made up of Part A and Part B, which covers different sets of healthcare services. Medicare Part A is mainly for hospital services such as inpatient care. Medicare Part B offers medical insurance that covers outpatient care, preventive screenings, durable medical supplies, and other medically necessary treatments.
Beneficiaries will have to contend with the out-of-pocket costs of Medicare, such as deductibles, copays, and coinsurance. Premiums are not normally required for Medicare Part A. They are required for Medicare Part B, but workers who earn less than $85,000 a year only pay a Part B premium of $134 a month.
Those who wish for additional coverage beyond what is offered in Original Medicare may obtain Medicare supplemental plans from Medicare-approved carriers in Rhode Island. These will require an additional premium.
The extra coverage offered by the supplemental can be very different depending on the particular plan. Many of these plans offer coverage for prescription drugs, and these plans are part of Medicare Part D. Other plans can cover many other health care services that are not covered by Original Medicare. Some plans may even help cover the cost of out-of-pocket expenses.
A more comprehensive plan that contains the coverage of Original Medicare, as well as the coverage and benefits of supplemental plans, can be found with Medicare Advantage Plans, which are also known as Medicare Part C. The additional coverage will depend on the details for each specific plan.
These Medicare Advantage Plans may be purchased from private carriers, which all have Medicare approval.
A significant number of residents in Rhode Island may find it difficult to cover all the expenses involved in Medicare insurance. To help these Medicare beneficiaries, The Rhode Island state government offers various Medicare Savings Programs (MSPs) that provide several types of financial assistance. These programs also have limits for income and assets.
Those who are eligible for the Qualified Medicare Beneficiary (QMB) program will find that the program will pay for virtually all the expenses required for Medicare. The program will pay for the premiums for both Part A and Part B, as well as the deductibles, coinsurance, and copayments.
However, this program also has the most stringent income limits, as it requires that individuals who qualify cannot earn more than $1,032 a month. For married couples, the income limit is $1,392 a month.
The Specified Low-Income Medicare Beneficiary (SLMB) program covers the payment for the Part B premium which can cost at least $134 a month. To qualify, an individual’s monthly income cannot exceed $1,234. Married couples need to have a combined monthly income of less than $1,666.
The Qualified Individual (QI) program also pays for the Part B premium only, but the funding for this particular program is more limited. Applications are thus granted only on a “first come, first served” basis. To qualify, an individual must earn less than $1,386 a month. The combined monthly income of a married couple should be less than $1,872.
All these programs also come with a resource limit of $7,560 for individuals and $11,340 for married couples. The limit does not include the value of the home in which the beneficiary is living in, and one car isn’t considered as well. However, checking accounts, savings accounts, stocks, bonds, and uninhabited properties may be counted.
These programs also automatically make the qualified Medicare beneficiaries automatically qualified for the Extra Help Low-Income Subsidy for Medicare prescription drug coverage. The Extra Help can pay for 100% to 25% of Medicare Part D, depending on the income and resources of the beneficiary.
As mandated by federal law, the state has the Rhode Island Senior Health Insurance Program (SHIP) that offers free and objective counselling for Medicare beneficiaries in the state. Rhode Island residents can contact SHIP at 401-462-4000 and TTY 401-462-0740.