Health insurance in Rhode Island
- Rhode Island uses a state-run health insurance exchange.
- Open enrollment for 2020 coverage will run from November 1 to December 15, 2019. Outside of open enrollment, residents need a qualifying event to purchase an ACA-compliant plan.
- Two carriers offer 2019 coverage through HealthSource RI, and both will continue to offer plans in 2020.
- The average proposed premium increase for 2020 is less than 1 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 2020 plans will run from November 1 to December 15, 2019. But for 2019 and 2018 coverage, Rhode Island opted to extend open enrollment until the end of the year, giving residents two full months to enroll. Another extension is possible but not guaranteed — residents should plan to complete the process by December 15.
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.
The only insurer in Rhode Island that sells off-exchange coverage is Blue Cross Blue Shield of Rhode Island, and in past years they’ve aligned their off-exchange open enrollment period with the exchange’s dates. If HealthSource RI extends open enrollment again, it’s likely that BCBSRI will follow suit.
Individual mandate + proposed reinsurance program = rate hike of less than 1% for 2020
Two carriers – Blue Cross Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island — offer plans through HealthSource RI, and both will continue to do so in 2020. Thanks to the state’s new individual mandate and pending reinsurance program, the overall proposed rate increase for 2020 is less than 1 percent
For 2019 coverage, 34,600 people enrolled in individual market plans through HealthSource RI. This was the second year in a row that enrollment increased, with total enrollment nearly back to the peak it reached in 2016.
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.
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. In that timeframe, the state has seen a 60 percent reduction in the uninsured rate, from 11.6 percent uninsured in 2013 to 4.6 percent uninsured in 2017.
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
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 enrolled in one of these stand-alone prescription drug plans in 2018.
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 also needs federal approval, which the state is awaiting as of August 2019).
Here’s a look at additional state-level health reform bills in Rhode Island: