Health insurance in Rhode Island
- Rhode Island uses a state-run health insurance exchange.
- Open enrollment for 2020 coverage is over, but HealthSource RI is offering a COVID-19 special enrollment period, through April 15, for uninsured residents.
- Outside of open enrollment, people can still buy coverage if they have a qualifying event.
- Two carriers offer 2020 coverage through HealthSource RI.
- Average premiums in RI’s individual market decreased by about half a percent for 2020, thanks to reinsurance and an individual mandate.
- 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.
In most states, enrollments outside of open enrollment (ie, during a special enrollment period) must be completed by the 15th of the month in order to have coverage effective the first of the following month. But Rhode Island is one of just two states where the deadline is the 23rd of the month.
Open enrollment for 2020 plans ended on December 31, 2019 in Rhode Island, which was an extension of the original deadline. But as a result of the COVID-19 pandemic, HealthSource RI is allowing uninsured residents an opportunity to enroll in health coverage. The special enrollment window runs through April 15, 2020.
Individual mandate + reinsurance program = rate decrease of about half a percent for 2020
Two carriers – Blue Cross Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island — offer plans through HealthSource RI. Thanks to the state’s new individual mandate and reinsurance program, the overall proposed rate increase for 2020 was less than 1 percent. And once regulators finished reviewing the filings, the average approved rate change was a decrease of about 0.5 percent
For 2020 coverage, 32,704 people selected private individual market plans through HealthSource RI during open enrollment.
Read more about the Rhode Island marketplace.
Medicaid expansion in Rhode Island
Rhode Island immediately embraced the provision to expand Medicaid under the Affordable Care Act.
Immediately after the Supreme Court ruled in 2012 that Medicaid expansion would be optional for the states, Former Gov. Lincoln Chafee made it clear that Rhode Island would be implementing Medicaid expansion. At the time, Rhode Island estimated that about 40,000 additional people would enroll in Medicaid through 2022, with most of them (about 83 percent) being newly-eligible as a result of Medicaid expansion. But the state noted that there was considerable uncertainty in terms of how many people would actually be newly-eligible and newly-enrolled.
As of late 2019, Medicaid/CHIP enrollment in Rhode Island was 53 percent higher than it had been in 2013, and included more than 100,000 additional enrollees. In that timeframe, the state has seen a 64 percent reduction in the uninsured rate, from 11.6 percent uninsured in 2013 to 4.1 percent uninsured in 2018.
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 the percentage of residents without health insurance since 2013 and now has one of the nation’s lowest uninsured rates.
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
State-based health reform legislation
In 2018 and 2019, Rhode Island enacted legislation to implement a state-based individual mandate starting in 2020, and to create a reinsurance program to stabilize the state’s individual insurance market (the reinsurance program was subsequently approved by the federal government and took effect in 2020).
Here’s a look at additional state-level health reform bills in Rhode Island: