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Rhode Island health insurance marketplace guide 2023

Open enrollment for 2023 coverage continues through January 31; Average full-price rates increase by about 6% for 2023; Pregnancy a qualifying event as of 2023

Rhode Island health exchange overview

Rhode Island utilizes a state-run health insurance exchange – called HealthSource RI – for marketplace enrollment.

Two insurers offer health plans through the exchange: Blue Cross Blue Shield of Rhode Island, and Neighborhood Health Plans. Open enrollment continues through January 31 in Rhode Island. And enrollees can apply up until December 31 and still get a January 1 effective date (in most states, the deadline for that was December 15).

Full price (ie, before subsidies) premiums increased by an average of just over 6% in Rhode Island for 2023, after increasing by a little more than 2% in 2022.

HealthSource RI also still has a SHOP exchange for small businesses. 

Frequently asked questions about Rhode Island's ACA marketplace

Rhode Island has a state-run health insurance exchange, called HealthSource RI. It is an active purchaser exchange (as opposed to a clearinghouse model), which means that the exchange negotiates directly with insurers, and determines which plans will be made available each year, rather than simply accepting all qualified health plans that insurers offer.

HealthSource RI still has a functional SHOP exchange for small businesses, which is not the case in most states.

Rhode Island’s exchange also collects premium payments on behalf of enrollees and remits them to the insurers (in most states people pay their insurer directly, even if they’re enrolled through the exchange). To provide more flexibility for payments, Health Source RI partnered with CVS so that enrollees can pay their health insurance premiums at any CVS in the country, using credit cards, debit cards, or cash. Enrollees paying at CVS have the option to break up their monthly premium payment into smaller, more manageable chunks if they choose to do so.

HealthSource RI took a unique approach to renewals in the first year (at the end of 2014, for 2015 coverage), requiring enrollees to actively renew their coverage, with no auto-renewal option available. They abandoned that requirement in subsequent years, however, switching to the same sort of auto-renewal default that other states use. Requiring active renewal is a good concept in terms of ensuring that people end up with the plan that best fits their needs each year, as opposed to just keeping their existing plan due to inertia. But the downside is that people end up uninsured if they forget to actively renew their coverage, which is why Rhode Island switched to an auto-renewal default.

Open enrollment for individual/family health coverage runs from November 1 to January 31 in Rhode Island. In most states, open enrollment ends mid-January, so Rhode Island’s window gives residents a couple of extra weeks to select a plan for 2023. And applications can be submitted up until December 31 in Rhode Island and still have coverage effective January 1 (in most states, the deadline to get a January 1 effective date was December 15).

This enrollment window is an excellent opportunity to take advantage of the enhanced premium subsidies created by the American Rescue Plan and Inflation Reduction Act. The larger and more widely available subsidies will remain in effect through 2025.

In both the individual and small group market, there are two insurers that offer health plans through HealthSource RI:

  • Blue Cross Blue Shield of Rhode Island (BCBSRI)
  • Neighborhood Health Plan of Rhode Island (NHPRI)

UnitedHealthcare and Tufts offer small group plans in Rhode Island, but only outside the exchange.

In September 2022, Rhode Island’s Office of the Health Insurance Commissioner published the approved health insurance rate changes for 2023, which amount to an overall weighted average increase of 6.1%. For BCBSRI, the approved rate was lower than the insurer had requested, but for Neighborhood Health Plan, the approved rate was larger than the insurer had proposed.

The following average rate changes apply to pre-subsidy premiums for 2023:

  • Blue Cross Blue Shield of Rhode Island: 3.1% increase (BCBSRI has 17,635 members)
  • Neighborhood Health Plan of Rhode Island: 8.2% increase (NHPRI has 25,023 members)

But when we talk about overall average rate increases, it’s important to remember that the majority of enrollees receive premium subsidies (tax credits), so they don’t pay full price. When an enrollee receives a subsidy, their net rate change includes how much their plan’s rate changes as well as how much their subsidy changes from one year to the next.

(Scroll down this page for a summary of how premiums have changed each year since 2014 in Rhode Island.)

With the exception of 2018, when average rates increased by nearly 22%, premium changes in Rhode Island’s exchange have been fairly modest over the years, especially compared with many other states. A large enrollment pool is generally considered one of the cornerstones of a stable market, yet despite having an enrollment that hovers around 30,000 people (much lower than most other states), Rhode Island’s exchange has been remarkably stable. BCBSRI and NHPRI have offered plans statewide ever since the exchange debuted; the only change in insurer participation came when UnitedHealthcare joined the exchange for 2015 and 2016.

There are a variety of reasons for the overall stability. Rhode Island fully embraced the ACA, but also had previously implemented some of the same reforms that were part of the ACA. The state’s insurers are local, and have a long history in Rhode Island and strong connections with the health care providers

HealthSource RI is an active purchaser exchange, so the exchange takes an active role in determining which plans will be made available to consumers. And state regulators have a robust rate review process, working closely with insurers to set rates that are adequate but also competitive. Rhode Island also never allowed grandmothered plans, which helps to stabilize the ACA-compliant market.

Here’s a look back at how premiums and insurer participation have changed in Rhode Island since plans became available through the exchange:

  • 2014: Plans were available via HealthSource RI from Blue Cross Blue Shield of Rhode Island (BCBSRI) and Neighborhood Health Plan of Rhode Island (NHPRI). The average benchmark premium in Rhode Island was a little higher than the national average in 2014, at $293/month (versus $273 nationwide).
  • 2015: Average increase of 4.17%: UnitedHealthcare of New England joined the exchange in Rhode Island for 2015, so there were three insurers offering plans. Average premiums increased by 4.5% for BCBSRI, but decreased by 7.3% for NHPRI. In 2014, BCBSRI had garnered 97% of the exchange enrollments, while NHPRI had picked up just 3%. But when NHPRI decreased their rates for 2015, their market share increased considerably; during the 2015 open enrollment period, BCBSRI and NHPRI each got just under half of the exchange enrollees, while United snagged about 3% of the enrollees. The dramatic shift in market share was no doubt aided by the fact that Rhode Island required active renewals (as opposed to passive auto-renewals) for all policies during the open enrollment period for 2015 coverage.
  • 2016: Average increase of 6.5%: At ACAsignups, Charles Gaba calculated a weighted average rate hike of just under 6.5% in Rhode Island for 2016, including off-exchange enrollments. All of the approved rates were lower than the insurers had proposed. A legal challenge arose over BCBSRI’s rate change; RI Insurance Commissioner Kathleen Hittner approved a 10% rate increase for BCBSRI, which her office deemed a good compromise between keeping coverage affordable and maintaining insurer solvency. But Attorney General Peter Kilmartin announced on August 31 that he was taking Hittner to court over the rates, alleging that her office didn’t do enough to further reduce the rates before approving them. The BCBSRI rates approved by Hittner were upheld at the end of September, when a Superior Court Judge ruled in favor of Hittner.
  • 2017: Average increase of 1.3%: UnitedHealthcare left the exchange in Rhode Island (and most other states where they had been offering coverage) at the end of 2016, but they only had about 4% of the exchange market share in 2016. In August 2016, the Rhode Island Office of the Health Insurance Commissioner announced final approved rate changes for 2017. State regulators ultimately approved rates that were lower than the carriers had proposed. In the individual market, a 5.9% average increase was approved for BCBSRI, while a 5.9% decrease was approved for NHPRI. For the entire individual market, Rhode Island’s final weighted average rate increase for 2017 was just 1.3%, which is dramatically lower than the rest of the country. And if we only look at plans sold through the exchange (ie, not including the off-exchange market), Health Source RI officials announced in late October that average premiums would be 0.6% lower in 2017 than they were in 2016 — a dramatically different story than the rest of the country was facing for 2017.
    Average rates could have been even lower, if Health Source RI had approved two additional plans proposed by Neighborhood Health Plan. The plans were approved by the state insurance commissioner, but not by the exchange. The exchange was concerned that the additional low-cost plans would have reduced the subsidies available to all exchange enrollees, making coverage less affordable if people chose plans other than the new low-cost options. This tactic was heralded by some as the exchange taking active steps to keep coverage as affordable as possible for everyone, but was also castigated as limiting competition and preventing anyone from having access to the lowest-cost plans.
  • 2018: Average increase of 21.7%, mostly due to the loss of CSR funding: In August 2017, the Rhode Island Health Insurance Commissioner announced that the rate review process for 2018 plans was complete. Average rates increased by 12.1 percent for BCBSRI, and by 5 percent for NHPRI. But for both insurers, silver plan rates increased much more sharply, due to the Trump Administration’s decision to cut off funding for cost-sharing reductions (CSR). For both insurers, the premiums for silver on-exchange plans increased by an average of an additional 18 percent. Eligible enrollees continued to receive CSR benefits but the cost is now being added to silver plan premiums, rather than being reimbursed by the federal government (the majority of the extra cost is still actually being paid by the federal government in the form of larger premium subsidies).
  • 2019: Average increase of 8.1%: The Rhode Island Office of the Health Insurance Commissioner noted that their approval of lower-than-requested premiums for 2019 would result in total premiums that would be nearly $22 million lower than they would have been if the rates had been approved as requested, although that encompassed the small and large group markets, as well as the individual market.
    Blue Cross Blue Shield of Rhode Island noted in their filing that they did not add any premium adjustment to account for the elimination of the individual mandate penalty in 2019. Neighborhood Health Plan attributed a 1.9% rate increase to the impending repeal of the individual mandate penalty, so their average proposed rate increase would have been 6.8% if the individual mandate penalty was remaining in place (as noted above, Rhode Island has its own individual mandate starting in 2020).
    In many states, insurers increased their premiums for 2019 to account for the expansion of the short-term health insurance market, which will act to siphon healthy people out of the ACA-compliant risk pool, leaving a sicker pool and necessitating higher premiums. But Rhode Island’s regulations on short-term plans are substantial enough that no insurers offer short-term plans in the state. So Rhode Island’s ACA-compliant insurers did not have to add to their premiums to account for the Trump administration’s expansion of short-term plans, since the state’s restrictions on those plans continue to apply.
  • 2020: Average decrease of 0.5%: Overall average pre-subsidy premiums decreased slightly in Rhode Island in 2020, thanks in large part to the state’s individual mandate and reinsurance program. In September 2019, the Rhode Island Office of the Health Insurance Commissioner published the average rate changes that the state’s insurers would be implementing for 2020. The two insurers that offer individual market plans in the state had the following average rate changes:
    • Blue Cross Blue Shield of Rhode Island: 1.5 percent decrease (it would have been a 6.6% increase without reinsurance and the new individual mandate)
    • Neighborhood Health Plan of Rhode Island: 0.2 percent increase (it would have been a 5.4% increase without reinsurance and the new individual mandate)

    The average rate change across both companies was a decrease of about half a percent, as opposed to an increase of about 0.8% that insurers had initially proposed, and an increase of about 6% that would have applied without the individual mandate and reinsurance program. Although employer-sponsored health insurance premiums have tended to be more stable than individual market premiums over the last few years, most of the insurers in Rhode Island that offer small and large group health insurance implemented more significant rate increases for 2020 coverage.

  • 2021: Average rate increase of 4.2%: Rhode Island’s Office of the Health Insurance Commissioner published proposed rate changes for 2021 coverage in July 2020. In August, the Rhode Island Office of the Health Insurance Commissioner announced the approved rate changes, both of which were smaller than the insurers had proposed (3.3% for Blue Cross, and 4.7% for Neighborhood). Overall, this amounted to a weighted average individual market rate increase of about 4.2% for 2021. The approved rate increases were smaller than the insurers had proposed, and the Office of the Health Insurance Commissioner touted this as a win for consumers amounting to a total premium savings of nearly $13 million (compared with the prices that would have been charged if regulators had approved the insurers’ proposals without modifications). But the same day that the rates were approved by the Office of the Health Insurance Commissioner, Rhode Island Attorney General Peter Neronha issued a statement expressing disappointment over the approved rates, noting that his office considers the rate increases to be “unnecessary and ill-advised at this time.” Neronha went on to say that “the approved increases are significantly larger than the increases justified in this Office’s actuarial reports (the Attorney General’s office had recommended an average rate increase of just 1.2% for BCBSRI, and 0.6% for Neighborhood Health Plan).
  • 2022: The approved health insurance rate increases for 2022 were smaller than the insurer had proposed, saving consumers more than $41 million in premiums in 2022:
    • Blue Cross Blue Shield of Rhode Island: 0.1% increase (BCBSRI had 17,159 members)
    • Neighborhood Health Plan of Rhode Island: 3.5% increase (NHPRI had 24,866 members)

32,345 people enrolled in private health plans through Rhode Island’s exchange during the open enrollment period for 2022 coverage. Unlike many other states, Rhode Island’s 2022 enrollment was not a record high. But it was an increase from the year before.

Here’s a look at how enrollment (during the annual open enrollment period) in private individual market plans through the exchange has varied over the years:

  • 2014: 28,485 people enrolled
  • 2015: 31,337 people enrolled
  • 2016: 34,670 people enrolled
  • 2017: 29,456 people enrolled during the fourth open enrollment period. Overall, state-run exchanges saw an average increase in enrollment for 2017 (while saw an overall average decrease), but Rhode Island’s enrollment was 15 percent lower in 2017, which was by far the largest drop-off among the state-run exchanges where enrollment declined from 2016 to 2017. Health Source RI explained the reasons for the decline, including ongoing technical difficulties and the fact that UnitedHealthcare exited the exchange (that was the case in 31 states, although most of them use, where enrollees were automatically re-enrolled in a plan from another carrier for 2017 if their old carrier was exiting the market and the member didn’t return to the exchange to pick a new plan; Health Source RI didn’t have that automatic re-enrollment feature in place for people whose carriers exited the exchange).
  • 2018: 33,021 people enrolled. HealthSource RI opted to give residents until the end of December 2017 to enroll in a plan for 2018, with coverage effective January 1 (as opposed to the December 15, 2017 end date for enrollment in states that use
  • 2019: 34,533 people enrolled. Rhode Island was one of only 12 states where exchange enrollment was higher for 2019 than it had been for 2018 (six of those 12 states have state-run exchanges).
  • 2020: 34,634 people enrolled. As of 2020, Rhode Island requires residents to have health insurance, and there’s a penalty for non-compliance (modeled on the federal penalty that applied from 2014 through 2018). Rhode Island’s reinsurance program also took effect in 2020, keeping premiums lower than they would otherwise have been.
  • 2021: 31,174 people enrolled. The enrollment drop was likely related to the fact that more people were enrolled in Medicaid during the pandemic. 
  • 2022: 32,345 people enrolled. 

Rhode Island has a state-based individual mandate as of 2020, with a penalty modeled on the federal penalty that applied until the end of 2018. Rhode Island also implemented a reinsurance program that is helping to keep premiums more affordable, particularly for Rhode Island residents who don’t qualify for premium subsidies and have to pay full price for their coverage (subsidy ineligibility became less common in 2021, because the American Rescue Plan temporarily eliminated the income cap for subsidy eligibility; that has been extended through 2025 by the Inflation Reduction Act). Across the state’s two insurers, average pre-subsidy premiums dropped by 0.5% for 2020 (without the reinsurance program, rates would likely have increased by about 6%).

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Reinsurance and a state-based individual mandate took effect in 2020

Health Source RI and the Rhode Island Office of the Health Insurance Commissioner partnered in 2018 to create a Market Stability Workgroup, tasked with creating state-level strategies to stabilize Rhode Island’s health insurance market. The workgroup published their recommendations in June 2018. At that point, it was too late to make any major changes for 2019, but there was plenty of time to implement new programs for 2020.

During that time period, Congress and the Trump administration made repeated efforts to destabilize the insurance markets, including an expansion of short-term and association health plans, the elimination of federal funding for cost-sharing reductions (CSR), and the elimination of the individual mandate penalty. The Market Stability Workgroup considered actions that Rhode Island could take to counter the Trump administration’s efforts to “dismantle the Affordable Care Act” and “jeopardize the progress Rhode Island has made in recent years under the [ACA].”

Ultimately, Rhode Island’s workgroup recommended that the state take the following actions:

  • Implement a state-based individual mandate — this was part of the budget bill that Governor Raimondo signed into law in July 2019. Rhode Island has had a state-based individual mandate since 2020, with a penalty for non-compliance assessed on state tax returns.
  • Seek a 1332 waiver to implement a reinsurance program — legislation (S2934 / H8391) to get the ball rolling on this was enacted in 2018, and the state submitted its 1332 waiver proposal to CMS in July 2019, with approval coming the following month. Rhode Island’s reinsurance program has been in effect since 2020. The idea behind reinsurance is that premiums are lower when the reinsurance program is in place, which results in smaller premium subsidies paid by the federal government. By using a 1332 waiver, the state can keep the savings (referred to as pass-through funding).
  • Implement new rules that give the state additional regulatory control over short-term health insurance plans. These plans were already highly regulated in Rhode Island (including a requirement that they cover pre-existing conditions), and none are currently for sale. But the workgroup recommended additional regulations. Legislation (S2931) to this effect was considered in 2018, but was not enacted.

In September 2018, Governor Raimondo signed an executive order directing the state to do everything in its power to “ensure access to affordable and quality healthcare for all Rhode Islanders.” The executive order encouraged lawmakers to “codify and strengthen consumer protections,” including the ACA’s protections for people with pre-existing conditions, dependent coverage up to age 26, and essential health benefits mandates. The executive order built on the workgroup’s recommendations (and the reinsurance bill that was enacted in 2018), directing the state to submit a 1332 waiver for a reinsurance program and “aggressively guard against” health plans (such as short-term plans) that don’t cover pre-existing conditions and/or essential health benefits.

Rhode Island’s individual mandate took effect in January 2020 (penalties began to show up on 2020 tax returns that were filed in early 2021), and so did the reinsurance program. The two programs are intertwined, as the individual mandate penalty revenue is used to partially fund the reinsurance program.

Rhode Island’s individual mandate penalty amounts are modeled after the penalty amounts that applied under the federal individual mandate penalty in 2018: The greater of $695 per uninsured adult (half the amount for a child), up to a maximum of $2,085 per family, or 2.5% of income. The maximum penalty amount under the percentage of income calculation is equal to the cost of the average bronze plan in Rhode Island (at the federal level, it was equal to the nationwide average cost of a bronze plan).

Under the terms of the 2020 budget bill, any money collected by the state via the individual mandate penalty will be deposited into the Health Insurance Market Integrity Fund, which is used to fund the state’s share of the cost of the reinsurance program.

Rhode Island submitted its 1332 waiver for the reinsurance program to CMS on July 8, 2019. CMS determined the application to be complete the following week, and granted approval in late August. Insurers in the state had already based their proposed premiums for 2020 on the assumption that the reinsurance program would take effect in 2020, and also on the fact that the state would once again have an individual mandate penalty as of 2020.

Rhode Island’s reinsurance program is fairly modest in terms of the benefits it provides: For 2020, the state planned to use the reinsurance program to reimburse insurers for 50% of claims that were between $40,000 and $97,000 (in most states that have reinsurance programs, the upper cap extends at least twice that high). The state’s small population and modest reinsurance benefits resulted in a total projected cost of just $14.7 million for the reinsurance program in 2020. Of that amount, the state estimated that between $6.4 million and $7.4 million would come from federal pass-through funding, while the rest would come from the RI Health Insurance Market Integrity Fund.

Ultimately, CMS pegged the state’s pass-through funding amount for 2020 at just $5.2 million (for perspective, New Jersey’s 2020 federal pass-through funding was $190 million). For 2021, Rhode Island’s pass-through funding grew to $12.4 million, including an additional $2.6 million that stemmed from the American Rescue Plan’s subsidy enhancements.

2018 law directs RI to seek federal permission to allow self-employed individuals to buy small group health plans

In July 2018, Governor Raimondo signed H.7121/S.2019 into law. The legislation directs the state to submit a 1332 waiver to CMS, seeking federal permission to allow sole proprietors and self-employed people (without any employees) to purchase small group plans through HealthSource RI’s SHOP exchange. Currently, under ACA rules, sole proprietors and self-employed individuals (including a business that is comprised of only two people who are married to each other) can only purchase coverage in the individual market. Pre-ACA, many states allowed small business insurers to sell “group of one” coverage to self-employed people, but that option was no longer allowed once the ACA was implemented.

As of 2022, however, Rhode Island has not yet submitted a 1332 waiver proposal to CMS for the option to allow self-employed people to purchase small group plans. The only 1332 waiver the state has submitted was for reinsurance, which took effect in 2020 in Rhode Island.

It’s worth noting that Virginia passed similar legislation in 2018, but did not include a provision requiring the state to seek permission from the federal government. Instead, the Virginia Bureau of Insurance just implemented the legislation as of July 2018, allowing self-employed people to purchase small group plans.

Pregnancy is a qualifying event in Rhode Island as of 2023

In 2016, New York became the first state to make pregnancy a qualifying event that allows a woman to enroll in a health plan outside of open enrollment. HHS declined to do the same on a federal level, as have most of the other state-run exchanges. But that has been changing in recent years, with several other state-run exchanges beginning to offer a special enrollment period due to pregnancy. 

In 2017, five Democratic state senators in Rhode Island introduced S.201, which would have allowed a pregnant woman to enroll in a plan through Health Source RI at any time after the commencement of her pregnancy, with coverage effective immediately. However, S.201 did not advance to a vote during the 2017 session, despite a Democratic state government trifecta.

However, the issue was revisited in 2022, and H.7454/S.2548 was passed by lawmakers and signed into law in the summer of 2022. It ensures that as of 2023, pregnancy triggers a special enrollment period in both the group and individual insurance markets in Rhode Island. 

Health Source RI history

Former Gov. Chafee established the Rhode Island Health Benefits Exchange through an executive order in 2011. The state submitted a blueprint for a state-run exchange to the U.S. Department of Health and Human Services (HHS) and received conditional approval in December 2012. The state exchange was re-branded as HealthSource RI in July 2013.

Chafee’s executive order established the exchange with the executive branch of state government and set up a 13-member board of directors. The board receives input from the Expert Advisory Committee (which includes representatives of insurance brokers, insurers and medical providers) and the Rhode Island Healthcare Reform Commission (which includes more than 200 stakeholders).

Rhode Island’s next governor, Gian Raimondo noted that she wanted to keep HealthSource RI as a state-run exchange, although she has acknowledged that funding was an issue. Anya Rader Wallack, who headed the exchange for most of 2015, wanted to continue the state-run exchange model, but noted that in a small state, the exchange has to be “right-sized” to fit the state and its budget. The issue was debated by the largely Democratic legislature in the 2015 session, and while lawmakers ultimately decided to keep the exchange in the 2016 budget, some lawmakers favored turning the exchange over to the federal government instead.

Governor Lincoln Chafee (who was first a Republican, then an Independent, then a Democrat), did not run for re-election in 2014, and was replaced in January 2015 by Governor Gina Raimondo, also a Democrat. Prior to the election, Raimondo had said that her plan would be to keep the state-run exchange but with a lowered budget (this is in opposition to the other candidates who had said they would either support switching to or working with Massachusetts to form a regional exchange).

Ultimately, Rhode Island opted to keep its state-run exchange. And as time goes by, more states are opting to switch away from and establish their own exchanges. As of the 2023 plan year, there are 18 fully state-run exchanges.

Rhode Island health insurance exchange links

Health Source RI
855-840-HSRI (855-840-4774)

State Exchange Profile: Rhode Island
The Henry J. Kaiser Family Foundation overview of Rhode Island’s
progress toward creating a state health insurance exchange.

Health Care Advocate, Office of the Attorney General
Serves all consumer and health care professionals with health-related problems.
(401) 274-4400

Other types of health coverage in Rhode Island

Short-term health insurance is not available for purchase in Rhode Island. Learn about state regulations.

Rhode Island implemented Medicaid eligibility expansion in 2014. Since then, enrollment has increased by 84%.

All Medicare beneficiaries in Rhode Island can select from at least 35 different Medicare Advantage plans for 2023.

Find affordable individual and family plans, small-group, short-term or Medicare plans.

Rhode Island's $4,000 asset limit for aged/blind/disabled Medicaid eligibility is double the limit used in many other states.

Learn about adult and pediatric dental insurance options in Rhode Island, including stand-alone dental and coverage through the state's marketplace.

Learn about health insurance coverage options in your state.

Our state guides offer up-to-date information about ACA-compliant individual and family plans and marketplace enrollment; Medicaid expansion status and Medicaid eligibility; short-term health insurance regulations and short-term plan availability; and Medicare plan options.

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