As of February 1, 2026, Rhode Island moved former SLMB-eligible residents into QMB, giving them fuller cost-sharing protection and Medicare balance-billing prohibitions.
In This Guide
- Key Takeaways
- Original Medicare: Parts A and B
- Medicare Advantage in Rhode Island (Part C)
- Medicare Part D: Prescription Drugs
- Medigap in Rhode Island
- Help Paying for Medicare in Rhode Island
- Medicare Enrollment Periods
- Free Medicare Help: RI SHIP
- Frequently Asked Questions
About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or RI SHIP at 1-888-884-8721.
Original Medicare: Parts A and B
Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are identical in Rhode Island and every other state.
Part A (Hospital Insurance)
Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.
| Cost | Amount |
|---|---|
| Monthly premium | $0 for most people (40+ quarters of work history) |
| Hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61-90 | $434 per day |
| Lifetime reserve days | $868 per day |
| SNF coinsurance, days 21-100 | $217 per day |
The hospital deductible rose $60 from 2025. A benefit period starts the day you're admitted and ends 60 days after you leave. Get readmitted after that, and the deductible applies again.
Part B (Medical Insurance)
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It doesn't cover routine dental, vision, or hearing.
- Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)
- Annual deductible: $283
- After the deductible: you pay 20% of the Medicare-approved amount for most services
Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage and you'll owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.
Medicare Advantage in Rhode Island (Part C)
Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.
Rhode Island is a small state with most of its population concentrated in and around Providence. The Medicare Advantage market reflects that geography: plan availability tends to be centered on the Providence metro, with the same carriers offering coverage across much of the state. Plan options, networks, and prices change every year and differ by county, so compare what's actually available at your address before you decide.
How These Plans Work
- You keep paying your Part B premium ($202.90) on top of any plan premium. CMS estimates the average Medicare Advantage premium at about $14 a month for 2026, and many plans charge $0 extra.
- Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll.
- Plans usually require prior authorization for certain services, which Original Medicare generally does not.
- Every plan caps your annual in-network out-of-pocket spending (federally limited to $9,250 in 2026; many plans set it lower). Original Medicare has no such cap.
Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. RI SHIP counselors can walk through the results with you at no charge.
Medicare Part D: Prescription Drugs
Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.
The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone. Part D now moves through three phases:
- Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
- Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
- Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.
That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with drug-spending growth. Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy. People who qualify for Extra Help often pay much less, sometimes nothing.
Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.
Medigap in Rhode Island
Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.
Rhode Island uses the federally standardized plans, labeled A through N, regulated by the Rhode Island Office of the Health Insurance Commissioner (OHIC). Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the most popular choice for newly eligible beneficiaries: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.
Your strongest window is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any Medigap plan at the standard rate regardless of your health. Outside it, Rhode Island insurers may use medical underwriting, meaning they can review your health history, charge you more, or decline your application.
Rhode Island does not have a birthday rule. If you missed your Medigap Open Enrollment Period and don't qualify for a special guaranteed-issue right, you'll likely need to pass medical underwriting to switch plans. RI SHIP counselors can help you identify whether any guaranteed-issue rights apply to your situation.
Medigap or Medicare Advantage?
You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.
Help Paying for Medicare in Rhode Island
If you're on a fixed income, two programs can cut your Medicare costs sharply.
Medicare Savings Programs: Rhode Island's 2026 Change
Rhode Island administers its Medicare Savings Programs through the Rhode Island EOHHS Medicaid program. As of February 1, 2026, the state made a significant change: Rhode Island eliminated the separate SLMB enrollment category. People who would have qualified for SLMB, meaning income between 100% and 120% of the Federal Poverty Level, are now automatically enrolled in QMB instead.
This matters because QMB provides substantially more protection than SLMB. SLMB paid only the Part B premium. QMB pays both Part A and Part B premiums plus all Medicare deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing. The practical result: Rhode Islanders who previously would have received only Part B premium help now get full cost-sharing protection automatically, without needing to know the difference between the two programs.
| Program | Individual | Couple | What it pays |
|---|---|---|---|
| QMB (includes former SLMB tier, eff. 2/1/2026) | Up to about $1,616 | Up to about $2,184 | Part A and B premiums, deductibles, coinsurance |
| QI | Up to about $1,816 | Up to about $2,455 | Part B premium |
For all programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple. Apply through Rhode Island EOHHS or get help from RI SHIP at 1-888-884-8721. Enrolling in any of these programs automatically qualifies you for Extra Help with Part D.
Extra Help for Part D
Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources. Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.
- Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple
- Resource limits: $16,590 for an individual, $33,100 for a married couple
- If you qualify for QMB or QI, you're enrolled in Extra Help automatically
Apply through Social Security at ssa.gov or call 1-800-772-1213. An RI SHIP counselor can help with the application at no charge.
Medicare Enrollment Periods
Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Rhode Island as everywhere else.
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment | 7 months around your 65th birthday | Sign up for Parts A, B, and D; pick MA or Medigap |
| Annual Open Enrollment | Oct 15 - Dec 7 | Switch MA plans, move between MA and Original Medicare, change Part D |
| MA Open Enrollment | Jan 1 - Mar 31 | Switch MA plans or drop MA for Original Medicare (if already in MA) |
| General Enrollment | Jan 1 - Mar 31 | Sign up for Part B if you missed your initial window |
| Medigap Open Enrollment | 6 months from age 65 + Part B | Buy any Medigap plan at the standard rate, no health screening |
Changes you make during Annual Open Enrollment take effect the following January 1. If you're already getting Social Security before 65, you're enrolled in Parts A and B automatically; if not, you sign up yourself through the Social Security Administration.
If you're working past 65 with employer coverage and plan to delay Part B, you get an 8-month Special Enrollment Period once that coverage ends. COBRA and retiree coverage don't count for this purpose. Miss that window and you'll wait for the General Enrollment Period and may owe a permanent late penalty.
Free Medicare Help: RI SHIP
You don't have to figure this out alone, and you don't have to pay a broker. Rhode Island runs RI SHIP through the Rhode Island Office of Healthy Aging, within the Executive Office of Health and Human Services (EOHHS). RI SHIP gives free, unbiased Medicare counseling and helps people with limited income apply for the Medicare Savings Program and Extra Help.
A RI SHIP counselor can help you:
- Understand your Medicare options and what each part covers
- Compare Medicare Advantage, Part D, and Medigap plans side by side
- Apply for the Medicare Savings Program and Extra Help
- Sort out billing problems, denials, and appeals
Call 1-888-884-8721 to reach a counselor.
Frequently Asked Questions
Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D premiums vary by plan, and many Medicare Advantage plans charge no extra premium. Your total depends on the plan you pick and the care you use.
As of February 1, 2026, Rhode Island eliminated the separate SLMB enrollment category. People who qualify at 100-120% of the Federal Poverty Level are now automatically enrolled in QMB instead of SLMB. QMB pays Part A and B premiums plus all deductibles and coinsurance, and bars providers from balance-billing. Previously, SLMB enrollees at the same income level received only Part B premium help. The change means more Rhode Islanders now get full cost-sharing protection without needing to know the difference between the two programs.
No. Rhode Island follows the standard federal Medigap rules. Your main protected window is the six-month Medigap Open Enrollment Period that starts when you turn 65 and enroll in Part B. Outside that window, insurers may use medical underwriting.
The Rhode Island Office of Healthy Aging, part of EOHHS, runs RI SHIP, the state's federally funded Medicare counseling program. Counselors give free, unbiased help with Medicare coverage choices, plan comparisons, and applications for the Medicare Savings Program and Extra Help. Call 1-888-884-8721.
Learn More
- Medicare: The National Guide
- Original Medicare vs. Medicare Advantage
- How Medigap Works
- Medicare Part D Drug Coverage
- Medicare Savings Programs
- Medicare Enrollment Periods
Find personalized help with Medicare in Rhode Island at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.