Frequently asked questions about health insurance
coverage options in Rhode Island
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.
In most states, enrollments outside of the open enrollment period (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.
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 2022 individual/family health coverage begins November 1, 2021 in Rhode Island, and will run through January 31, 2021. In most states, open enrollment for 2022 coverage will end mid-January, but Rhode Island and several other states that run their own exchanges have opted to extend the enrollment window until the end of January.
The open enrollment period for 2022 coverage is an opportunity to take advantage of the enhanced premium subsidies created by the American Rescue Plan.
Although Rhode Island’s COVID-related special enrollment period for 2021 coverage ended in August 2021, residents may still be able to enroll or make a plan change for 2021 if they experience a qualifying life event.
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.
For 2021, Rhode Island marketplace plan rates increased by an average of about 4.2%.
- Blue Cross Blue Shield of Rhode Island: 3.3% increase
- Neighborhood Health Plan of Rhode Island: 4.7% increase
For 2021 coverage, 31,174 people selected private individual market plans through HealthSource RI during the open enrollment period. HealthSource RI reported that 30,071 of those enrollees effectuated their coverage by paying the necessary premiums).
The year before, for 2020 coverage, 34,643 people selected plans during open enrollment, and 32,704 effectuated their coverage. The exchange noted that the decreased enrollment could be mostly attributed to the increase in Medicaid enrollment during the COVID pandemic, and the federal rules (under early COVID relief legislation) that prevent states from disenrolling people from Medicaid during the pandemic emergency period.
Read more about the Rhode Island health insurance marketplace.
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 November 2020, Medicaid enrollment in Rhode Island was 68% higher than it had been in 2013, and included more than 130,000 additional enrollees. Enrollment has increased considerably since the COVID pandemic began in early 2020.
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 December 2020, there were 225,803 Rhode Island residents enrolled in Medicare plans. Almost half are enrolled in Medicare Advantage plans, while a little more than half have Original Medicare. Most Medicare beneficiaries in Rhode Island are eligible for Medicare due to age, but 17% 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.