The ABCs of Surviving Medicare Open Enrollment – Herb Weiss

by Herb Weiss, contributing writer, aging issues

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.

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.

Source:  OHA, Oct. 2025

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To read more articles by Herb Weiss, go to: https://rinewstoday.com/herb-weiss/