See your Rhode Island health insurance coverage options.

Rhode Island utilizes a state-run health insurance marketplace – HealthSource RI – which is an active purchaser exchange. That means that the marketplace negotiates directly with insurers, and determines which plans will be made available each year.

The marketplace/exchange is used by individuals and families who need to purchase their own coverage, as well as small businesses buying group health coverage for their employees. People who purchase their own health coverage include the self-employed, early retirees who aren’t yet eligible for Medicare, and people employed by a small business that doesn’t offer health benefits for employees. Depending on household income, they can also qualify for premium subsidies and cost-sharing reductions through HealthSourceRI, which reduce premium costs and out-of-pocket costs for eligible enrollees.

Rhode Island is one of a handful of states where there is a tax penalty for not having health insurance. The state’s individual mandate took effect in 2020, and the penalty for non-compliance is assessed on state tax returns in Rhode Island starting with the returns filed in early 2021. 

Read our guide to the Rhode Island health insurance marketplace.

The open enrollment window for individual/family health coverage runs from November 1 through January 31 in Rhode Island. In most states, open enrollment ends in mid-January, but Rhode Island is one of several states where the open enrollment window extends beyond that. And Rhode Island also allows a January 1 effective date as long as the enrollment is completed by December 31 (as opposed to the mid-December deadline that applies in most states).

In Rhode Island, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). Nearly 90% of consumers who enrolled in 2022 coverage through their state exchange received premium subsidies.

Rhode Islanders may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Rhode Island.

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.

Rhode Island’s Office of the Health Insurance Commissioner published the approved health insurance rate changes for 2023, amounting to an overall weighted average increase of 6.1% (before any subsidies are applied):

• Blue Cross Blue Shield of Rhode Island: 3.1% increase
• Neighborhood Health Plan of Rhode Island: 8.2% increase 

See more about the history of rate changes in Rhode Island’s exchange.

32,345 people enrolled in private health plans through Rhode Island’s exchange during the open enrollment period for 2022 coverage. Unlike the majority of the states, Rhode Island’s 2022 enrollment was not a record high. But it was an increase from 2021.

Read more about the Rhode Island health insurance marketplace.

With a state-based health insurance marketplace (HealthSource RI) and Medicaid coverage 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. Medicaid expansion has played a key role in reducing the number of uninsured residents in the state.

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% 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.

Rhode Island immediately embraced the provision to expand Medicaid coverage under the Affordable Care Act.

Immediately after the Supreme Court ruled in 2012 that Medicaid coverage expansion would be optional for the states, Former Gov. Lincoln Chafee made it clear that Rhode Island would be implementing Medicaid expansion, expanding eligibility for coverage to all non-elderly adults with household income up to 138% of the poverty level.

At the time, Rhode Island estimated that about 40,000 additional people would enroll in Medicaid plans through 2022, with most of them (about 83%) 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 August 2022, Medicaid enrollment in Rhode Island was 86% higher than it had been in 2013, and included more than 164,000 additional enrollees. Enrollment has increased considerably during the COVID pandemic, driven in large part by the federal rules that provided additional Medicaid funding but also prevented states from disenrolling people from Medicaid during the pandemic (that rule is expected to end in April 2023).

Since the ACA was implemented, the state has seen a 64% reduction in the uninsured rate, from 11.6% uninsured in 2013 to 4.1% uninsured in 2018 and in 2019.

Read more about Medicaid coverage expansion 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 health insurance plans in the state. The state’s restrictions include a mandate that short-term health insurance coverage include essential health benefits, cover pre-existing conditions, and premiums cannot be based on medical history.

No short-term health insurance plans have been approved for sale in the state for several years.

Read more about short-term health insurance plans in Rhode Island.

Medicare is health coverage run by the federal government for people age 65 and older and people with long-term disabilities. As of August 2022, there were 232,144 Rhode Island residents enrolled in Medicare plans. Nearly 55% are enrolled in Medicare Advantage plans, while the rest have Original Medicare (nationwide, about 46% of beneficiaries have Advantage plans, but Rhode Island is one of the states where the majority of beneficiaries are enrolled in Advantage plans). Most Medicare beneficiaries in Rhode Island are eligible for Medicare due to age, but about 14% are under the age of 65 and eligible for Medicare because of a disability.

Read more about Medicare enrollment in Rhode Island.

Learn more about the Medicare open enrollment period, during which Medicare beneficiaries can change their Part D coverage or Medicare Advantage coverage.

• HealthSourceRI – The state-run marketplace/exchange in Rhode Island. Provides health insurance options for individuals, families, and small businesses, as well as financial assistance for individuals and families based on household income.
• Rhode Island Health Center Association – Navigator and Certified Application Counselor services to help people enroll in coverage through HealthSourceRI. Can provide assistance with private plan enrollment and Medicaid/CHIP enrollment, as well as information on applicable financial assistance available to offset costs in private plans.
• Rhode Island Office of Healthy Aging, Medicare Counseling — The state health insurance assistance program for Medicare beneficiaries; can provide information, assistance, and counseling related to enrollment, eligibility, and claims.
• Medicare Rights Center — A nationwide service that can provide advice, information, and assistance to Medicare beneficiaries and their caregivers.

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.

Rhode Island enacted legislation in 2021 that caps out-of-pocket costs for insulin at $40 for a 30-day supply. This applies to state-regulated health plans (ie, not self-insured plans) and took effect in 2022.

Rhode Island also enacted legislation in 2021 that prohibits state-regulated health plans from charging out-of-pocket costs for treatment of COVID while the public health emergency is in effect. 

Rhode Island enacted legislation in 2022 that creates a special enrollment period due to pregnancy, applicable for both individual/family and group health insurance. 

Yes. Rhode Island has an individual mandate as of 2020, with a penalty modeled on the ACA’s penalty.

The fee is calculated either as 2.5% of your yearly household income or per person ($695 per person and an additional $347.50 per child under age 18), whichever amount is higher.