Medicare in Rhode Island: Plans and Coverage (2026)

Medicare in Rhode Island runs on federal rules, but the state adds free RI SHIP counseling and a 2026 change that enrolls former SLMB-eligible residents in the more generous QMB program.1,2

This guide covers Medicare in Rhode Island for 2026: what each part costs, which plan types are available, and how to get help paying. Because the state is compact and Providence-centered, plan choice is more uniform here than in larger states.

In This Guide

• Key Takeaways
• Medicare Parts A and B in Rhode Island
• Medicare Advantage Plans (Part C)
• Medicare Part D: Prescription Drugs
• Medigap Plans in Rhode Island
• Help Paying for Medicare
• 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.

What Do Medicare Parts A and B Cover in Rhode Island?

Original Medicare is run directly by the federal government and is one of the two ways to get your parts of Medicare. 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.3

The hospital deductible rose $60 from 2025, to $1,736 per benefit period.3 A benefit period starts the day you're admitted and ends 60 days after you leave. Get readmitted after that gap, 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.3

• Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)3
• Annual deductible: $2833
• After the deductible: you pay 20% of the Medicare-approved amount for most services3

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.5

How Do Medicare Advantage Plans (Part C) Work in Rhode Island?

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.6

Rhode Island is a small state with most of its population concentrated in and around Providence, so the Medicare Advantage market is more uniform than in larger states: 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 still 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.3,6
• 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.6
• 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.6

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.

What Does Medicare Part D Cover in 2026?

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.4 Part D now moves through three phases:

1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).7
2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.4

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.4 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.4 People who qualify for Extra Help often pay much less, sometimes nothing.

For a deeper look at how Part D works, see our guide to Medicare Part D drug coverage.

How Do Medigap Plans Work 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).1 Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020.8 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.8,3

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.8 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 or an annual guaranteed-issue window for switching Medigap plans.1 If you missed your Medigap Open Enrollment Period and don't qualify for a federal special guaranteed-issue right, you'll likely need to pass medical underwriting to change 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.

How Can You Get Help Paying for Medicare in Rhode Island?

If you're on a fixed income, two programs can cut your Medicare costs sharply. Rhode Island's 2026 change makes the more generous of them reach further than it does in most states.

Medicare Savings Programs: Rhode Island's 2026 Change

Rhode Island administers its Medicare Savings Programs through the Rhode Island Executive Office of Health and Human Services (EOHHS) Medicaid program. As of February 1, 2026, the state made a significant change: people who would have qualified for SLMB (Specified Low-Income Medicare Beneficiary), meaning income between roughly 100% and 120% of the Federal Poverty Level, now qualify for QMB (Qualified Medicare Beneficiary) instead and are automatically enrolled in the QMB group.2

This matters because QMB provides substantially more protection than SLMB did. 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.2 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.2

These Rhode Island income limits, published by EOHHS, run higher than the standard federal QMB and QI cutoffs because the state folded the SLMB band into QMB.2 For all programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple.2 Enrolling in any of these programs automatically qualifies you for Extra Help with Part D.2

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy (LIS), pays Part D premiums, deductibles, and copays for people with limited income and resources.9 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 couple9
• Resource limits: $16,590 for an individual, $33,100 for a married couple9
• 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.9

When Can You Enroll in Medicare?

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.10

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 (SSA).10

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.11

For a full breakdown of each period and the penalties to avoid, see our Medicare enrollment periods guide.

Where Can You Get Free Medicare Help in Rhode Island?

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.1

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

Key Rhode Island Medicare Contacts

Learn More

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.