The ABCs of Surviving Medicare Open Enrollment 

Published in RINewsToday on October 20, 2025

It’s that time. The Medicare Open Enrollment period began last week and runs until December 7th. During this period, Rhode Island’s 243,000 Medicare beneficiaries (data from late 2024 to early 2025) are encouraged to explore their Medicare options, carefully review, compare options, and make necessary changes to their existing Medicare plan for the following year.

During the Medicare Open Enrollment period, you can join a new Medicare Advantage plan or Part D prescription drug plan, switch from Original Medicare to Medicare Advantage, or switch from Medicare Advantage to Original Medicare (with or without a Part D plan).

You can make as many changes as you want during this period. The last change you ultimately make will take effect on January 1, 2026.

Medicare Options

According to Healthinsurance.org, an independent website that provides consumer information and education on health insurance options, here’s a snapshot of Medicare plans chosen by Rhode Island beneficiaries.

As of September 2024, 144,610 Rhode Islanders were enrolled in Medicare Advantage plans. These plans, offered by private health insurance companies, are alternatives to Original Medicare. Medicare Advantage plans cover all the healthcare benefits that Original Medicare covers (e.g., hospital services and outpatient/medical/physician services), but the out-of-pocket costs can differ significantly, as Advantage plans set their own co-pays, co-insurance, and deductibles (within parameters defined by CMS).

Approximately 115,000 to 120,000 Rhode Islanders are enrolled in Original Medicare, representing about 49-51% of the state’s Medicare beneficiaries. Original Medicare, covering individuals aged 65 and older as well as certain younger people with disabilities, is a “fee-for-service” plan composed of two main parts: Part A for hospital insurance (covering inpatient hospital care, skilled nursing care, hospice care, and some home health services) and Part B for medical insurance (covering doctor visits, preventive care, and durable medical equipment). These two parts cover a wide range of medically necessary services, with beneficiaries paying a portion of costs, such as coinsurance and deductibles.

Medicare Part D is an optional prescription drug benefit offered by private insurance companies approved by Medicare. This benefit helps cover the cost of outpatient prescription medications. Approximately 83% of the total 243,377 beneficiaries in September 2024 have some form of prescription drug coverage through a Medicare Part D plan.

Finally, according to the U.S. Centers for Medicare & Medicaid Services, as of 2024, more than 50,000 Medicare beneficiaries in Rhode Island had Medigap policies. These policies are standardized supplemental insurance plans sold by private companies to cover the “gaps” in Original Medicare (Part A and Part B), including deductibles, co-payments, and co-insurance.

Taking a Close Look at Your Current Coverage

Even if you’re satisfied with your current coverage, the state’s Office for Healthy Aging recommends that Medicare beneficiaries closely review and compare their Medicare options to ensure their needs are met in the upcoming year. “Medicare beneficiaries will receive a lot of mail during Medicare Open Enrollment so it is very important to pay attention to any changes in the plan’s costs, including premiums, deductibles, and cost-sharing amounts. Make sure your providers and pharmacies are still in the plan’s network.”

All Medicare beneficiaries (or those approaching Medicare eligibility) can receive free, unbiased counseling from State Health Insurance Assistance Program (SHIP) counselors. These services are voluntary and meant to help people understand the complexity of plans and make informed choices. SHIP counseling is an offered resource, not a condition of having Medicare or enrolling in a plan.

What to Bring to Your SHIP Appointment

You can enroll in Medicare plans or manage your coverage without using OHA or SHIP partners’ counseling.  There is a risk of not choosing the best plan to meet your medical needs, missing savings or subsidies, and increasing stress or confusion in making the right choice.

After making an appointment, a SHIP counselor will request the beneficiary bring their Medicare card, current plan(s) cards, and a list of prescriptions and doctors to the meeting.

The OHA and its nine partners (see box below) are provided with training, certifications, and resources through the federal SHIP grant ensuring they stay up to date on what every Medicare Advantage, Traditional Medicare, and Medicare Part D plan offers.

Every October, OHA and its SHIP partners meet with presenters from Rhode Island’s Medicare Advantage plans to become aware of updates on all the 2026 plan changes.

Changes in 2026

According to AARP, expect some significant changes in 2026. The first Medicare-negotiated drug prices will go into effect for drugs like Eliquis, Jardiance, Xarelto, Januvia, Farxiga, Entresto, Enbrel, Imbruvica, Stelara, and NovoLog/Fiasp. Additionally, according to CMS, savings are expected to lower enrollees’ out-of-pocket spending by an estimated $1.5 billion next year. Finally, the new cap on annual out-of-pocket expenses for Part D drugs will increase to $2,100.

You can call 1-800-MEDICARE to make changes by phone. You can also use Medicare’s Plan Finder tool to compare plans at www.medicare.gov/plan-compare to compare options and enroll in some plans online. Alternatively, you can contact plans directly to enroll.

Find a Medicare plan

However, the Office of Healthy Aging cautions, “Unfortunately, we are still waiting for CMS to release some of the 2026 cost and premium changes, and due to the government shutdown, this may be further delayed.”

A Final Note… Beware of Scams and Fraud

Open Enrollment is also prime time for scams. Scammers who claim to represent Medicare may call asking for your Medicare number, Social Security number, or bank information, especially before you enroll. Medicare will never call, email, or text out of the blue to ask for personal information or payment. If you’re unsure, hang up and call 1-800-MEDICARE to verify.

To schedule an appointment with a State Health Insurance Assistance Program (SHIP) Counselor please contact one of the below agencies.

PARTNER AGENCYLOCATIONPHONE NUMBER
Aging Well84 Social St, Woonsocket, RI 02895401-766-3734
Johnston Senior Center1291 Hartford Ave, Johnston, RI 02919401-944-3343
Westbay Community Action Agency487 Jefferson Blvd, Warwick, RI 02886401-921-5237
South Kingstown Senior Center25 St Dominic Rd, Wakefield, RI 02879401-789-0268
Westerly Senior Center39 State St, Westerly, RI 02891401-596-2404
The Aging & Disability Resource Center (ADRC)50 Valley St, Providence, RI 02909401-462-4444
East Bay Community Action Agency100 Bullocks Point Ave, East Providence, RI 02915401-435-7876
Leon Mathieu Senior Center420 Main St, Pawtucket, RI 02860401-728-7582
Progreso Latino626 Broad St, Central Falls, RI 02863401-728-5920
Edward King House35 King St, Newport, RI 02840401-846-7426

Source:  OHA, Oct. 2025

Path to an “age-friendlier” budget

Published in RINewsToday on June 5, 2023

After a 47:10 minute meeting on Friday night, the House Finance Committee approved a $14 billion budget for the 2024 fiscal year that commits funding toward addressing the housing crisis (top priority), supports business development and makes education funding more equitable while limiting the use of one-time revenue to one-time expenditures. 

The passed budget reflects the May revenue estimate that was $61.2 million lower than projected last November. 

On June 2, 2023, the budget passed on a partisan vote of 13-3, sending the budget bill (2023-H 5200A) to the full House of Representatives, which is slated to take it up June 9 at 2:30 p.m. Changes could be made.

Hammering Out a Compromised Budget 

At a news conference held on Friday at 3:30 p.m. before the vote, House Speaker K. Joseph Shekarchi  (D-Dist. 23, Warwick) compared the politics of hammering out the state budget proposal to Democratic and GOP leadership making a deal to avoid a national default earlier this week.  “Nobody, including me and everyone else here, got everything they wanted,” he said, noting that the state budget required “compromise.”  

“Our goal with this budget is to support Rhode Islanders’ needs while responsibly preparing for our future. Our top priority, of course, is addressing our housing crisis, and we have worked hard, in collaboration with Governor McKee and our colleagues in the Senate, to identify the most effective ways we can direct the funding we have toward solutions that will help create more affordable housing access. This budget also strengthens our efforts to provide educational opportunities in K-12 and higher education and supports businesses, working Rhode Islanders, retirees and those struggling to meet their families’ basic needs,” said Shekarchi, in a statement announcing the House Finance Committee’s passage of the budget.

“At the same time, we are being realistic. Given the end of the federal funding related to the pandemic, we need to plan not only for next year, but for the following years, when we are not going to have the level of revenue we’ve been fortunate enough to have for the past few years. We are spending our remaining federal COVID funding and our available revenue on one-time investments rather than creating long-term commitments that we can’t sustain,” he said.  

Adds Marvin L. Abney (D-Dist. 73, Newport, Middletown), chairman of the House Finance Committee: “This budget was carefully crafted so that our residents, particularly our most vulnerable, retain the supports and assistance that they and their families need, so that our businesses have the ability and opportunity to grow, and so that Rhode Island is situated to withstand a very possible financial downtown that will affect both our state and national economies.  Responsible, compassionate and thoughtful decisions were made to create a budget that will benefit all Rhode Islanders and this budget positions the state to be as competitive as possible into the future.”

Taking a Look at Aging Programs and Services 

“I am extremely pleased the budget passed by the House Finance Committee contains important funding that will benefit seniors as well as older adults with disabilities,” says Maureen Maigret, chair of the Aging in Community Subcommittee of Rhode Island’s Long-Term Care Coordinating Council and policy consultant and board member of the Senior Agenda Coalition of RI. “The Office of Healthy Aging (OHA) will receive an additional $250,000 in general revenue for the Aging and Disability Resource Center (ADRC). The ADRC provides counseling about services and benefits and assistance with the application process.  Advocating to strengthen the ADRC (called the POINT) was a high priority for the Senior Agenda Coalition of RI and the Aging in Community Subcommittee of the Long Term Care Coordinating Council,” says Maigret.

According to Maigret, this is the first time that ADRC will receive state funds. To date, it has operated with limited federal dollars and too many persons are not aware of the program. The state funding can be matched by federal Medicaid funds. “ADRC services are critically important for older adults, persons with disabilities and family caregivers, as they attempt to find appropriate services and navigate a sometimes-fragmented system of care, says Maigret.

Maigret says that the budget also adds funds to support two new staff positions for OHA’s protective services unit to deal with increasing reports of elder abuse and exploitation. OHA’s Adult Protective Services received over 6,000 calls last year. The additional funding for these positions will ensure that reports are investigated in a timely manner and protect older adults at risk of abuse and neglect. 

Other notable additions to the budget include an increase in the Personal Needs Allowance (PNA) for nursing home residents on Medicaid to $75/month (from $50.) This amount had not been adjusted since 1999, says Maigret noting that the additional funding will help thousands of nursing home residents pay for such items as haircuts, clothing and, telephone service.

“The House Finance Committee also added $250,000 to increase funding for the Livable Home Modification grant program to $0.8 million,” says Maigret, noting that the program helps pay for costs of support home modifications and accessibility enhancements to allow individuals to remain in community settings. And of course, the funds dedicated to addressing housing affordability although not specific to the older population will benefit them,” adds Maigret. “Overall, these budget additions and the additional funds for community senior services and Meals on Wheels proposed by the Governor demonstrate a continued commitment on the part of our state leaders to address the needs of our growing older population,” she says.

The budget didn’t reinstate the retiree Cost of Living Adjustments (COLAs) eliminated in 2011.  “Once again, retired state workers, teachers, and municipal retirees who are part of the state retirement system have been shown how little they are valued by state legislators”, comments Susan Sweet, a former state associate director of elderly affairs and an advocate for low-income elders. “Although there were many bills in to restore the COLA or at least provide a token payment to these retirees, it appears that no funds at all are being directed towards that purpose.  This is a great disappointment to so many folks who faithfully performed their duties and were stripped of their promised pensions. No wonder that teachers and government workers are reluctant to spend their career lives in the public sector” she states.

Is Proposed House Budget “Age Friendly” ?

Maigret believes that the state has taken some positive steps toward becoming “age friendly” especially if we think of age-friendly with an intergenerational lens. Items that address children and youth such as expanded tuition assistance of Rhode Island colleges are important.  “However, we still have a long way to go in many of the domains for age friendliness,” she notes, “especially in the area of economic security for older adults as many live with income less than $25,000 relying mostly on fixed incomes.” 

Maigret calls on the Rhode Island General Assembly to fund mini-grants to communities to incentivize them to “look at their comprehensive plans with age-friendly lens.” 

Here is the link to the bill to establish the budget:

Here is the link to the entire budget and every article (as well as how it compares to the budget as submitted by the Governor in January):  https://www.rilegislature.gov/Budget/SitePages/FY24.aspx.

Here is a link to a press release which contains a summary of the highlights of the budget:

To watch the House Finance Committee meeting, go to https://ritv.devosvideo.com/show?video=defebab838c1&apg=52ab780b.