Rhode Island Health Insurance

What You Need to Know

Rhode Island’s Open Enrollment Period starts on November 1 ands on January 31.

Rhode Island runs its own health insurance marketplace, HealthSource RI.

Only two companies offer individual and family health insurance plans in Rhode Island.

Rhode Island residents may number just one million,¹ but the Ocean State has the full range of health insurance options. If you live here, you can get coverage through your employer; through the state-based Health Insurance Marketplace; directly from an insurance company; or through government-assisted plans such as Medicare, Medicaid and the Children’s Health Insurance Program (CHIP).

Half of Rhode Island’s residents get their health coverage through their work. One in four receives it through Medicaid and one in seven through Medicare, although Affordable Care Act (ACA) plans cover fewer than one in every 20 residents.²

Rhode Island expanded Medicaid coverage in 2014 as a result of the ACA (also known as Obamacare). This change made it possible for residents who aren’t eligible for other Medicaid programs or Medicare and who earn 133% or less of the federal poverty level (FPL) to get health insurance.³ By December 2020, the expansion covered an additional 82,200 Rhode Islanders.⁴ 

Obamacare and the state’s Medicaid expansion together helped drop Rhode Island’s uninsured rate dramatically—from 12% in 2013 to just a little over 4% by 2019.⁵       

Here you’ll find an overview of Rhode Island’s health insurance landscape and get help navigating your options to choose a plan that’s right for you.

When Is the Open Enrollment Period in Rhode Island?

The Open Enrollment Period (OEP) in Rhode Island starts on November 1, 2021 and ends January 31, 2022.⁶ 

If you don’t sign up then, you won’t be able to apply for  ACA plans until next year’s OEP unless you have what’s called a “qualifying life event.” This is something that changes the size of your family or leaves you uninsured, such as getting married, having a baby or losing your job. Events like these open a short window of time called a Special Enrollment Period during which you can get insurance.⁷

Enrollment in Rhode Island’s ACA Marketplace started at 28,000 residents in 2014 and, with minor exceptions, settled in over 31,000 by 2021.⁸

How Do You Enroll in Rhode Island’s Health Insurance Marketplace?

Every Affordable Care Act plan is required to provide 10 “essential health benefits,” starting with coverage for preexisting conditions, inpatient hospital care and prescription drugs. 

Rhode Island runs its own health insurance marketplace. That means you can buy coverage and possibly qualify for subsidies through the  Health Insurance Marketplace (also called an “exchange”) at the HealthSource RI website. (Subsidies can help you pay your monthly premiums, if you qualify.) 

At HealthSource RI, you can compare affordable health plans, purchase coverage and apply for Medicaid and other subsidized coverage.⁹ 

Besides establishing its own state-based ACA exchange and expanding Medicaid, Rhode Island has virtually banned short-term health insurance policies that don’t comply with the ACA. The state also put in place a state-based individual mandate, which means that all Rhode Islanders must get and maintain health coverage. The mandate took effect in January 2020. If you didn’t have health insurance, penalties will appear on tax returns filed.¹⁰

To buy insurance through Rhode Island’s health insurance exchange, visit HealthSource RI, or call (855) 840-4774.

How Much Does Health Insurance Cost in Rhode Island?

Whether you buy an individual health insurance plan on the state Marketplace or outside it, you’ll see that policies are organized into “metal” levels of gold, silver and bronze. These refer to levels of cost-sharing, meaning how you and your insurance company will share the cost of your medical expenses. The more valuable the metal, the more coverage you get.

For 2022, the state approved a 2.1% increase on the average unsubsidized premium rates.¹¹

From 2018 to 2022, the average benchmark premium in Rhode Island went from $311 to $361 in five years. Here are the average monthly costs for a 40-year-old Rhode Island resident for bronze, silver and gold plans sold through the state’s Marketplace:¹² 

Average Premiums for Rhode Island Marketplace Plans (for a 40-year-old person)

Metal Level	2020	2021	2022
Lowest-Cost Bronze Plan	$219	$231	$240
Lowest-Cost Silver Plan	$314	$328	$341
Lowest-Cost Gold Plan	$325	$339	$349

The federal government uses a “benchmark” silver plan— the second-lowest-cost silver premium for a 40-year-old — to calculate subsidies. (Subsidies, if you qualify, help you pay your monthly premium.) ¹³ 

Which Companies Offer Individual Health Insurance Plans in Rhode Island?

In 2022, two health insurance companies sell individual policies to Rhode Islanders through HealthSource RI:  

• Blue Cross Blue Shield of Rhode Island
• Neighborhood Health Plan of Rhode Island

You can also buy insurance directly from both. If you opt to do so, though, you won’t have access to financial help through HealthSource RI if you qualify based on your income.

What Are Your Coverage Options in Rhode Island If You’re Low-Income? 

ACA Marketplace Plans (Obamacare)

With an income of up to four times the federal poverty level (FPL), you may qualify for help from the federal government to pay your insurance premiums.¹⁴ In 2020, over 27,000 ACA enrollees in Rhode Island received help in the form of subsidies called Advanced Premium Tax Credits (APTC).¹⁵ These monthly subsidies averaged $323.¹⁶ 

Here are some examples of cost savings with subsidies:

• A 28-year-old in Providence who earns $24,000 a year could get a 2022 silver plan for $29 per month after subsidies.¹⁷ The same policy would cost $282 per month without the premium tax credits, which cover 90% of the cost. 

• A family of three in Warwick with an income of $50,000 a year could pay $130 per month after subsidies for a 2022 silver plan.¹⁸ This policy would cost them $830 per month without the premium tax credits, which cover 84% of the cost. 

If you purchase a silver plan on Rhode Island’s Marketplace and meet some other requirements, such as income, you may also qualify for cost-sharing reductions (CSRs). These reduce your out-of-pocket costs for things like doctor’s visits and prescriptions even more. In early 2021, 38% of enrollees in Rhode Island’s Marketplace plans received CSRs.¹⁹

By going through the Marketplace application process, you’ll find out, too, if you qualify for Medicaid, the Children’s Health Insurance Program (CHIP) or other income-based discounts. Use the HealthSource RI calculator tool to see if you qualify for financial help.

Medicaid

Medicaid is a publicly-funded program of healthcare coverage for Rhode Islanders who might otherwise not be able to pay for or get access to affordable insurance. Included are low-income families with children, pregnant women, senior citizens and people with disabilities and special needs.²⁰ The types of services vary with your age, family structure and needs.

In 2013, Rhode Island expanded its Medicaid program under the ACA to cover nearly all nonelderly adults under 138% of the poverty level.²¹

Rhode Island’s Medicaid program is administered by the Department of Human Services (DHS). You can apply online on HealthSourceRI.com, in person at your local DHS office or by phone by calling HealthSource RI at (855) 840-4774.

As of May 2020, nearly one-third of Rhode Island residents were enrolled in Medicaid or the Children’s Health Insurance Program (CHIP).²² Enrollment has increased by 58% since the Affordable Care Act was implemented.²³   

To qualify, recipients must meet income eligibility requirements as a percentage of the federal poverty level (FPL). The percentages vary for different groups:²⁴ 

• Parents: 133%
• Childless adults: 138%
• Pregnant women: 253%
• Children: 261%
• Seniors: 100%
• People with disabilities: 100% 

Help for Families with Children

Families with children may get Medicaid coverage through RIte Care and RIte Share. RIte Care is a managed care program for families with children, pregnant women and children under 19, offered through the Neighborhood Health Plan of Rhode Island, Tufts Health Plan and UnitedHealthcare Community Plan.

RIte Share provides premium assistance to Medicaid-eligible individuals who have access to health insurance through their employers. The program pays all or part of the monthly premium for the employer-sponsored plan instead of enrolling the individuals in RIte Care.²⁵

Adults 19 to 64 without children who are eligible for Medicaid can choose to enroll in one of the same three managed care plans: Neighborhood Health Plan of RI, UnitedHealthcare or Tufts Health Plan. (This category of Medicaid is sometimes called Medicaid Expansion, or ACA healthcare coverage).²⁶

CHIP (Rite Share)

The Children’s Health Insurance Program (CHIP) is a federal initiative set up to cover children whose parents earn too much to qualify them for Medicaid but aren’t covered on another health plan. In Rhode Island, CHIP plans are offered through RIte Share. For children to qualify, the maximum family income for a child from birth to age one is $190% to 266% of the federal poverty level (FPL) for its family size. For ages one to five, it’s 142% to 266%; and for ages six to 18, it’s 109% to 266%. (As an example, the 2021 FPL for a family of three is $21,960.)²⁷ 

What About Medicare Coverage for Rhode Island Seniors and People with Disabilities?  

If you’re over age 65, under 65 with long-term disabilities or have ALS or end-stage renal disease, Medicare is the federal insurance program that helps cover your healthcare costs. 

Each year, the Open Enrollment Period for Medicare runs from October 15 through December 7. Over 223,000 of Rhode Islanders receive Medicare benefits,²⁸ and almost 335,000 are enrolled in Medicaid.²⁹    

Original Medicare

Of the state’s 223,000 Medicare recipients,³⁰ nearly 59% choose to get their benefits from Original Medicare (Medicare Parts A and B). The remaining 41% prefer private Medicare Advantage plans.³¹ Both types of coverage will provide you with Part A (hospital insurance) and Part B (medical insurance), so hospitalization, doctor’s visits and emergency room visits are taken care of.

Medicare Advantage

Medicare Advantage (or Part C) offers additional benefits, such as Part D prescription drug coverage. (With Original Medicare, you would have to purchase a standalone Part D plan.) In 2020, four companies in Rhode Island are offering Medicare Advantage plans.³² 

Medicare Part D

More than 162,000 Ocean State residents bought a standalone Medicare Part D drug plan.³³ In 2022, premiums through nine insurers range from $7.40 to $136.20 per month, for an average premium of $49.63.³⁴ Among those with Part D prescription drug plans, over 3,300 people received both low-income premium and cost-sharing subsidies in 2018.³⁵   

Medicare Supplement

If you have Original Medicare, you can buy Medicare Supplement insurance (Medigap policy) from a Medicare-approved private insurer in Rhode Island. Medigap policies help pay the portion of your healthcare costs that Medicare doesn’t pay. 

Medigap offers 10 standardized plans. Each plan’s benefits are the same no matter which insurance company you choose, but premiums vary widely by company, so it pays to compare pricing.

Rhode Island’s State Health Insurance Counseling and Assistance Program (SHIP) is funded by the Centers for Medicare and Medicaid Services. Its volunteers help seniors find the right Medicare coverage at an affordable price and assist those with limited incomes in applying for programs. You can call (888) 884-8721.  

Medicare premium assistance is available for low-income seniors with Medicare coverage through the Medicare Premium Payment Program (MPPP). The program can pay all or some of the cost of your Medicare Part and Part B premiums, deductibles and copayments.³⁶

Can You Buy Short-Term Health Insurance in Rhode Island? 

Short-term health insurance is an affordable solution that can help you get coverage quickly when you’re in transition, such as when you’re between jobs or healthcare plans that are approved by the Affordable Care Act. 

Because Rhode Island requires such plans to cover ACA-type essential health benefits and preexisting conditions, no short-term plans have been approved for sale in the state for some time. They aren’t banned in Rhode Island, but at the moment they are simply not cost-effective for insurance companies to offer.³⁷