Health insurance in Rhode Island
- Rhode Island enrolls through a state-run health insurance exchange.
- Open enrollment for 2019 coverage ended December 31, 2018. Residents now need a qualifying event to purchase an ACA-compliant plan.
- Two carriers offer 2019 coverage through HealthSource RI.
- The average premium increase for 2019 is 9.66 percent.
- About 31,000 enrolled in 2018 coverage through the Rhode Island exchange.
- Rhode Island adopted the ACA’s Medicaid expansion and began enrolling residents in 2013.
- Due to the state’s strict regulations on short-term health insurance, no short-term plans have been approved for sale in Rhode Island for several years.
- More than 20 percent of Rhode Island’s population is enrolled in Medicare.
Rhode Island’s health marketplace
Rhode Island utilizes a state-run health insurance exchange – HealthSource RI – an active purchaser exchange. That means that the exchange negotiates directly with insurers, and determines which plans will be made available each year.
Open enrollment for 2019 plans ran from November 1 to December 31, 2018. This two-month enrollment window is the same schedule that Rhode Island used for 2018 coverage.
- Enrollments through Dec. 23 will have a Jan. 1 effective date.
- Enrollment between Dec. 24 and Dec. 31 will have a Feb. 1 effective date.
The only insurer in Rhode Island that sells off-exchange coverage is Blue Cross Blue Shield of Rhode Island, and they’ve aligned their off-exchange open enrollment period with the exchange’s dates.
Two carriers – Blue Cross Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island will offer 2019 plans through the Rhode Island exchange. Average rate increases for 2019 were calculated to be 9.66 percent.
In January, the exchange reported that 30,637 individuals had enrolled and paid for coverage – a 5 percent increase over the previous year.
Read more about the Rhode Island marketplace.
Medicaid expansion in Rhode Island
Former Gov. Lincoln Chafee made it clear immediately after the Supreme Court ruling that Rhode Island would be implementing Medicaid expansion. At the time, Rhode Island estimated that there were about 40,610 low-income childless adults in the state who would be newly eligible for Medicaid starting in 2014.
Since 2013, the state’s Medicaid population has grown by 119,754. Since 2013, the state has seen a 60 percent reduction in the uninsured rate.
Read more about Medicaid expansion in Rhode Island.
Short-term health insurance in Rhode Island
The sale of short-term health insurance plans is not banned in Rhode Island, but due to its strict regulations, no insurers offer short-term plans in the state. The state’s restrictions include a mandate that all plans sold in the state must cover essential health benefits, cover pre-existing conditions, and premiums cannot be based on medical history.
No short-term health plans have been approved for sale in the state for several years.
Read more about short-term health plans in Rhode Island.
How has the ACA helped Rhode Island?
With a state-based health insurance exchange (HealthSource RI) and Medicaid expansion, Rhode Island has fully embraced the Affordable Care Act. And, the healthcare reform law has been quite effective for the state. Rhode Island has seen the ninth largest reduction in percentage of residents without health insurance since 2013 and now has one of the nation’s lowest uninsured rates.
In 2013, about 13.3 percent of Rhode Island residents were uninsured. By late 2016, that number had plummeted 7.7 percentage points to 5.6 percent.
The Rhode Island exchange enrolled about two and a half times as many people in expanded Medicaid than in private plans during the 2014 open enrollment period, so Medicaid expansion has played a key role in reducing the number of uninsured residents in the state.
Rhode Island and Obamacare
In 2010, Rhode Island’s U.S. Senators – Democrats John Reed and Sheldon Whitehouse – both voted yes on the ACA. In the U.S. House, both of the state’s Representatives were also Democrats – Patrick Kennedy and Jim Langevin – and voted yes.
Kennedy has since been replaced by another Democrat, David Cicilline, who is also supportive of the ACA and has stated that “protecting the programs created through the recent health care reform is one of [his] top priorities in congress.” Thus, the entire U.S. congressional delegation from Rhode Island is Democratic and supportive of healthcare reform.
Rhode Island’s state legislature also has a very strong Democratic majority. Former Gov. Lincoln Chaffee, a Democrat, was an ardent supporter of the law, “fully committed to ensuring that Rhode Island is a national leader in implementing health reform …” Chaffee has since been replaced by Gov. Gina Raimondo, a Democrat who took office in 2015 and is strongly invested in healthcare reform.
The state has been fully on-board with ACA implementation from the get-go, opting for a state-run exchange (HealthSource RI) and agreeing to expand Medicaid to cover all of the state’s legal residents with incomes up to 138 percent of poverty.
In late spring 2014, there was some talk in the legislature about switching to a federally facilitated exchange in order to be more cost-effective, but that ultimately did not happen and the state is still running the exchange.
Medicare in Rhode Island
Rhode Island Medicare enrollment reached 216,980 in November 2018 – meaning that more than 20 percent of the state’s population is enrolled. (By comparison, about 18 percent of the U.S. population is enrolled in Medicare. About 82 percent of Medicare beneficiaries in Rhode Island qualify based on their age, while the other 18 percent qualify for Medicare as the result of a disability.
Most recent estimates reveal that Original Medicare spent about $8,900 per Rhode Island beneficiary. That’s slightly lower than the national average of $9,533 per enrollee.
Those eligible for Medicare in Rhode Island can select a Medicare Advantage plan instead of Original Medicare if they want additional benefits, and about 37 percent have done so. Nationwide, about 33 percent of Medicare enrollees have Medicare Advantage plans instead of traditional Medicare coverage.
Rhode Island’s Medicare enrollees can also select Medicare Part D. About 73,000 Rhode Island beneficiaries were enroll in one of these stand-alone prescription drug plans in 2018.
State-based health reform legislation
Here’s a look at state-level health reform bills in Rhode Island: