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, so check the CMS fact sheet or medicare.gov for the current year's figures.3 To reach a person, call 1-800-MEDICARE (1-800-633-4227), staffed 24 hours a day, 7 days a week except some federal holidays; TTY users call 1-877-486-2048.7 RI SHIP counselors (1-888-884-8721) can also walk you through what applies to you.1

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 once you have not received inpatient hospital care or skilled care in a skilled nursing facility for 60 days in a row. That clock can run while you are still in a facility, so someone who drops from skilled to custodial care can begin a new benefit period without leaving. Get care again 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.3,8

• 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 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, unless you qualify for a Special Enrollment Period or a Medicare Savings Program. Having creditable drug coverage is a Part D term and does not excuse a late Part B enrollment.9

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.10

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. Some plans go further and help pay all or part of your Part B premium.3,10
• Plans run on networks (HMO or PPO). Confirm your doctors and hospitals are in-network before you enroll; emergency care, out-of-area urgent care, and temporary out-of-area dialysis are covered in or out of network.10
• Plans usually require prior authorization for certain services, which Original Medicare generally does not.10
• 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 on its own. CMS's sentence adds the condition: no yearly limit on what you pay out of pocket unless you have supplemental coverage, like Medigap, Medicaid, employer, retiree, or union coverage. What each covers varies by policy.10

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).11
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 Medicare Supplement (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 with Original Medicare, and a Medigap policy can't pay a Medicare Advantage plan's copays, coinsurance, deductibles, or premiums.10

Rhode Island uses the federally standardized plans, labeled A-D, F, G, and K-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, 2020.12 Plan G is the letter that stands in for Plan F if you are newly eligible: 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.13,3

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 insurance company can't refuse to sell you any of the Medigap policies it offers and can't charge you more because you have health problems.13 Outside it, and outside Rhode Island's annual fall right described below, you may have to pay more for a policy, and an insurance company is allowed to deny you a policy if you don't meet its medical underwriting requirements.14

A "birthday rule" is the annual window California, Maryland, Idaho and about a dozen other states give existing Medigap policyholders to switch plans without underwriting. Rhode Island is not one of those states.5 Its annual right runs on the fall calendar instead. Under R.I. Gen. Laws § 27-18.2-3(h), each year during the Medicare Annual Enrollment Period, which Rhode Island's Office of the Health Insurance Commissioner (OHIC) says currently runs October 15 to December 7, you have a guaranteed-issue right to any Medigap policy an insurer currently makes available in Rhode Island, for coverage starting January 1 of the following year.6 To qualify, you must be enrolled in a Medigap policy or a Medicare Advantage plan, and you must have been covered by Medigap or Medicare Advantage since your Medicare Initial Enrollment Period with no gap longer than 90 days. The insurer can't condition the policy on your health or medical care and can't perform individual medical underwriting.6 If you're under 65 and in a Medicare Advantage plan or Medigap Plan A because of a disability, the annual right is to Medigap Plan A policies. OHIC reports that the rule took effect October 15, 2025, for plans beginning in 2026.6 Our Rhode Island Medicare Supplement guide walks through it in detail. If you don't meet those conditions, missed your Medigap Open Enrollment Period, and don't qualify for a federal special guaranteed-issue right, an insurance company is allowed to deny you a policy if you don't meet its medical underwriting requirements.14 Ask RI SHIP or OHIC what options apply to you.1

Medigap or Medicare Advantage?

You can't use both at once. A Medigap policy can't pay your Medicare Advantage copayments, coinsurance, deductibles, or premiums, and while you're in an Advantage plan it's illegal for anyone to sell you a Medigap policy unless you're switching back to Original Medicare.10 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. The lock isn't permanent. If you join an Advantage plan for the first time and go back to Original Medicare within 12 months, federal law gives you a trial right to buy a Medigap policy and a separate drug plan.10 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 the federal standard alone would.

Medicare Savings Programs: Rhode Island's 2026 Change

Medicare Savings Programs are state-run and administered through Medicaid.2 Rhode Island runs them under the name Medicare Premium Payment (MPP): the Rhode Island Executive Office of Health and Human Services (EOHHS) publishes the program, and applications are filed through the Department of Human Services (DHS).2 As of February 1, 2026, the state made a significant change: people who would have qualified for SLMB (Specified Low-Income Medicare Beneficiary) now qualify for QMB (Qualified Medicare Beneficiary) instead and are automatically enrolled in the QMB group. EOHHS also notes that SLMB and QDWI still exist because federal law requires them, and that people who qualify for QDWI can get Medicaid through Rhode Island's Sherlock and Ticket to Work programs.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 above the federal floors: the 2026 federal cutoffs are $1,350 individual and $1,824 couple for QMB, and $1,816 and $2,455 for QI. No Rhode Island source publishes the poverty-level percentage behind the state's own figures, so compare the dollar amounts rather than any percentage you see quoted elsewhere.2 For both programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple, exactly the federal standard, because Rhode Island has not eliminated its asset test.2 Enrolling in either program automatically qualifies you for Extra Help with Part D; QDWI, the separate savings program for working people with disabilities who lost premium-free Part A, does not.2

None of these printed limits is a hard cutoff to screen yourself against. States can effectively raise both the income and the resource limits by disregarding certain income and resources, which is why Rhode Island's income figures already sit above the federal floors, so apply and let the state do the counting. QI comes with one condition QMB does not: its funds are limited and eligibility is first come, first served, so apply early in the year.2 QI is also the one tier you must reapply for every year; qualifying once does not carry you into the next.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.15 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, in the 48 contiguous states and DC (Alaska and Hawaii run higher)15
• Resource limits: $16,590 for an individual, $33,100 for a married couple, rising to $18,090 and $36,100 if you tell Social Security you expect to use some of your resources for burial expenses15
• If you qualify for QMB or QI, you're enrolled in Extra Help automatically2

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.15

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.16

Changes you make during Annual Open Enrollment take effect the following January 1.16 In Rhode Island, the same fall window is when people who meet the state's continuous-coverage conditions can buy a Medigap policy without medical underwriting (see the Medigap section above).6 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).16

If you're working past 65 with employer coverage and plan to delay Part B, you get an 8-month Special Enrollment Period counted from the month that job or its coverage ends, whichever comes first. COBRA and retiree coverage don't count for this purpose, and if you're self-employed or your plan isn't available to everyone at the company, ask your insurer whether it counts as employer group health plan coverage before you delay; if it doesn't, sign up at 65. Miss that window and you'll wait for the General Enrollment Period and may owe a permanent late penalty. This Special Enrollment Period does not apply if you're eligible for Medicare based on End-Stage Renal Disease (ESRD).17

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. RI SHIP is hosted and staffed by the Rhode Island Office of Healthy Aging (OHA). RI SHIP helps people find the right Medicare coverage at the right cost, and helps people with limited income apply for Medicaid, 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.