Rhode Island health insurance marketplace guide 2023

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 HealthCare.gov 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 HealthCare.gov, 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 HealthCare.gov).
• 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%).