Short-term health plans in Rhode Island
- Due to the state’s strict regulations, no insurers offer short-term health insurance in Rhode Island.
- State rules require that health plans must cover essential health benefits, cover pre-existing conditions, and premiums cannot be based on medical history.
- Short-term health insurance in Rhode Island has not been approved for sale in many years.
- Federal regulations that were implemented in 2018 allow states to impose their own rules for short-term plans, and Rhode Island has continued to do so.
- Lawmakers considered (but didn’t pass) a bill to codify existing state regulations in 2018. But the regulations remained in effect.
Rhode Island’s short-term health insurance regulations
Short-term health insurance in Rhode Island is not banned, but the state’s regulations are strict enough that no insurers choose to offer plans in the state. The Rhode Island Office of the Health Insurance Commissioner (OHIC) has long enforced regulations requiring all state-regulated health insurance plans sold in Rhode Island — including short-term plans — to follow various state rules.
Short-term health insurance in Rhode Island must cover all essential health benefits and state-mandated benefits, and must maintain a medical loss ratio of 80 percent (this is the requirement that applies nationwide to ACA-compliant individual market plans, but short-term health plans tend to have much lower medical loss ratios). Insurance policies in Rhode Island are also required to provide coverage for pre-existing conditions and cannot adjust premiums based on an applicant’s medical history. Complying with these short-term health insurance rules is too onerous for most short-term insurers, and would result in much higher premiums than short-term plans usually have. As a result of Rhode Island’s rules, there are no insurers offering short-term coverage in the state.
The Rhode Island Health Insurance Commissioner’s Office confirmed that there used to be short-term insurance available in the state, but that they have not approved any for sale in the last several years.
Legislation (S2931) was considered in 2018 in an effort to codify and strengthen the state’s regulations for short-term plans into law. It passed in the Senate but not in the House. However, the Insurance Commissioner’s Office noted that nothing would change as a result of that bill not being enacted. The state continues to require all plans to cover state-mandated benefits and cover pre-existing conditions. So the type of short-term plans that are sold in most states are not approved for sale in Rhode Island.
The Trump Administration’s rules for short-term plans, which took effect in late 2018 and were roundly criticized by Rhode Island Governor Gina Raimondo, are clear in noting that states may continue to impose tighter regulations than the new federal rules, and Rhode Island has continued to do so.
How can I buy affordable coverage in Rhode Island?
Rhode Island requires residents to maintain health insurance coverage in 2020 and future years. The Rhode Island statute clarifies that residents must have minimum essential coverage, which is defined the same way it is under the Affordable Care Act. Short-term health insurance is not considered minimum essential coverage, so it would not meet the state’s requirement even if such plans were available in Rhode Island.
Rhode Island residents in need of healthcare coverage should check to see if they’re eligible for a special enrollment period that they could use to enroll in an ACA-compliant major medical plan available through Health Source RI, the state’s health insurance exchange (marketplace).
There are a variety of qualifying life events that will trigger a special enrollment period allowing you to purchase a plan through the health insurance marketplace in Rhode Island. These plans are purchased on a month-to-month basis, so you can enroll in a plan even if you only need coverage for a few months before another policy — like Medicare or an employer’s plan — takes effect. And premium subsidies are available based on household income; as of 2020, 82 percent of the people enrolled in private health insurance policies through Health Source RI were receiving premium subsidies that reduced their monthly premium costs.
Based on your income you may also qualify for health insurance in Rhode Island under expanded Medicaid coverage. When the Affordable Care Act was enacted in 2010, Medicaid expansion was a cornerstone of lawmakers’ efforts to expand realistic access to healthcare to as many people as possible. If you have a household income up to 133 percent of poverty (138 percent with the 5 percent income disregard) you should be able to enroll in Medicaid (note that the eligibility rules are different for people who are also eligible for Medicare, age 65 or older, or disabled, and Medicaid is available at higher income levels for children and pregnant women).
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.