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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.
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:
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:
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:
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.
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:
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%).
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:
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.
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.
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.
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 HealthCare.gov 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 HealthCare.gov and establish their own exchanges. As of the 2023 plan year, there are 18 fully state-run exchanges.
Health Source RI
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.
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.
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.