Rhode Island Health Insurance

Overview

If you live in Rhode Island and either buy your own health insurance or are currently uninsured, this guide is for you. It will help you:

  • Determine whether you may qualify for a credit to help you pay for health insurance under the Affordable Care Act (also known as Obamacare)
  • Compare private health plans using U.S. News & World Report's health insurance ratings for Rhode Island

From now until November 15, the start of the next open enrollment, you cannot get new yearly insurance unless you have a qualifying life event. See below for those options for coverage and how to avoid the penalty.

Do I Qualify for a Tax Break on Health Insurance?

Use the tool at right to determine whether you qualify to receive a tax credit (called a subsidy) that you can use to pay for health insurance. The calculator will also help steer you toward health insurance options that may be best for your needs.

If You Qualify: Plans That Cost Less

Under the Affordable Care Act, you might qualify for a subsidy to help pay for your health insurance. If you qualify, the subsidy can be used to reduce the cost of your monthly premium or can be taken as an annual tax credit. To take advantage of a subsidy, you must choose a health plan that has been approved by the federal government and the government of Rhode Island. These plans, known as Exchange Plans, meet a set of standards that aim to eliminate benefit loopholes to make sure that people with pre-existing conditions are not being denied coverage. 

Note: you had until March 31 to enroll for coverage for the rest of 2014 (enrolling on March 31 would cover you starting May 1). If you missed this date, with few exceptions, you will pay a penalty.

Premiums on HealthSourceRI

The average premium rates listed below are the lowest that might be charged to a 21-year-old. You can use the amounts listed to gauge the relative cost of each tier. Higher tiers tend to cost more, but offer better health coverage. Premium rates will vary depending on your age, where you live and whether the plan covers multiple members of your family or just one person.

Gold
Average Premium: $272 per month
Silver
Average Premium: $227 per month
Bronze
Average Premium: $170 per month
Catastrophic
Average Premium: $150 per month

If You Don't Qualify: Private Plans

If you don’t qualify for a subsidy, you can still choose among the Health Exchange Plans, or consider one of the many private health insurance plans available in Rhode Island’s private marketplace. We have rated these private plans on a 1-star to 5-star basis, with 5-star plans providing the most comprehensive coverage.  What’s the biggest difference between a private market health plan and a government-approved one? The trade-off is usually cost. Insurance companies can charge less for private plans with less-extensive network coverage or fewer benefits, which makes more-affordable options available to you.

Private Health Insurers in Rhode Island

Do I Have To Buy Health Insurance?

You may have heard that everyone in Rhode Island must have health insurance in 2014 or pay a penalty – Obamacare's so-called “individual mandate.” With a few exceptions, this is true. For 2014, not carrying insurance will cost $95 per adult plus $47.50 per child (up to $285 per family) or 1 percent of your family’s income, whichever is more. 

U.S. News generally recommends getting health insurance of some kind, even if it is only catastrophic coverage. That's because unexpected medical expenses can easily bankrupt anyone who is uninsured.

Where To Buy Health Insurance

Rhode Island's Official Marketplace

HealthSourceRI is Rhode Island’s official portal for buying an Obamacare Health Exchange Plan under the Affordable Care Act. To sign up online for coverage on HealthSourceRI, be prepared to fill out a form that could take 30 minutes or longer. To complete the process quickly, have this info handy:

  • Social security numbers for everyone in your household
  • Your employer’s name and address
  • Your most-recent pay stub or recent records of your wages
  • Information about other types of income you receive, such as alimony, unemployment benefits or a pension

 

Insurance Companies and Brokers

Some people prefer to buy health insurance directly from an insurance company or through a broker. Thanks to strict regulation, you'll pay the same price for a plan regardless of where you buy it – whether on the HealthSourceRI website, through a broker or directly from an insurer – and regardless of whether you sign-up via phone, online, or by filling out paper forms.

U.S. News & World Report has teamed up with GetInsured, an online broker licensed to sell health insurance, to help you buy the subsidized health plan you want. The GetInsured customer service team can answer questions, determine whether you're eligible for a subsidy and help you apply for insurance.

Qualified Plans on HealthSourceRI

Beginning October 1, 2013, each state was required by law to have a new online marketplace where residents can buy health insurance. In these marketplaces, most states offer five tiers of Obamacare Health Exchange Plans: platinum, gold, silver, bronze and catastrophic. Platinum plans will offer the highest level of coverage but tend to cost more in monthly premiums. Bronze plans will cover only a bare minimum of health care expenses but tend to have low premiums. If you are relatively healthy and want to pay less up front, consider a lower-tier plan such as bronze or silver.

You should also look at a HealthSourceRI plan if you are lower-income, because the government will give financial help on a sliding scale to pay for premiums, and better benefits if you select a silver-tier plan. If you have not already done so, we can tell you if a HealthSourceRI plan makes sense given your income. Use the "Shop for Health Insurance Now" section on the top right of this page.

Read ACA and Health Insurance: Which "Metal" Tier is Right for You? for more advice on choosing between metal tiers.

Participating Companies

Blue Cross and Blue Shield of Rhode Island. BCBSRI is affiliated with the Blue Cross and Blue Shield Association, the oldest U.S. health insurance system. The Blue Cross and Blue Shield Association offers coverage in all 50 states, Washington, D.C., and Puerto Rico and has 37 Blue Cross and Blue Shield companies that serve over 100 million members (one third of all Americans), according to the company. Nationally, Blue Cross and Blue Shield companies have contracts with over 96 percent of hospitals and 91 percent of providers. Rhode Island residents who purchase a BCBSRI exchange plan may not have access to the entire network of doctors and hospitals.

Neighborhood Health Plan of Rhode Island. Established in 1993 by thirteen community health centers as a response to RIte Care, the Rhode Island Medicaid program, this nonprofit has over 90,000 members. Its network includes all hospitals and most pharmacies in the state, over 900 primary care doctors and over 2,700 specialists. NHPRI plans are available to individuals with incomes below $28,275 or families of four with incomes below $48,825. 

The monthly premiums listed below are the lowest that might be charged to a 21-year-old. Premium rates will vary depending on your age, where you live and whether the plan covers multiple members of your family or just one person.  Depending on your income, you may qualify for a subsidy (tax credit) that covers part of your premium. 

Gold

Blue Cross Blue Shield of Rhode Island | BlueSolutions for HSA Direct
Premium $261   Deductible $1,500   Max Out-Of-Pocket $3,000

Neighborhood Health Plan of RI | Neighborhood Health Plan of RI Plus
Premium $269

Blue Cross Blue Shield of Rhode Island | VantageBlue Direct Plan
Premium $276   Deductible $1,000   Max Out-Of-Pocket $2,000

Blue Cross Blue Shield of Rhode Island | VantageBlue SelectRI Direct
Premium $282   Deductible $500   Max Out-Of-Pocket $1,000

Silver

Blue Cross Blue Shield of Rhode Island | BlueSolutions for HSA Direct
Premium $214   Deductible $2,600   Max Out-Of-Pocket $5,200

Blue Cross Blue Shield of Rhode Island | VantageBlue Direct
Premium $230   Deductible $3,000   Max Out-Of-Pocket $6,000

Neighborhood Health Plan of RI | Neighborhood Health Plan of RI Value
Premium $232

Blue Cross Blue Shield of Rhode Island | VantageBlue SelectRI Direct
Premium $235   Deductible $3,000   Max Out-Of-Pocket $6,000

Bronze

Blue Cross Blue Shield of Rhode Island | BlueSolutions for HSA Direct
Premium $166   Deductible $5,000   Max Out-Of-Pocket $10,000

Blue Cross Blue Shield of Rhode Island | VantageBlue Direct
Premium $169   Deductible $5,800   Max Out-Of-Pocket $11,600

Blue Cross Blue Shield of Rhode Island | VantageBlue SelectRI Direct
Premium $177   Deductible $5,800   Max Out-Of-Pocket $11,600

Catastrophic

Blue Cross Blue Shield of Rhode Island | BasicBlue Direct
Premium $150

Need More Help?

If you need help choosing a health insurance plan or filling out your application, Rhode Island has trained nongovernment groups to guide you through the process. Sometimes called “Navigators,” these groups can answer technical questions on insurance, Medicaid, and tax credits (subsidies on monthly premiums) . Navigators also specialize in assisting non-English speaking populations. For more information, contact the Health Source RI call center at 855-840-4774. The center is open Monday through Saturday from 8:00 a.m. to 9:00 p.m. and on Sundays from 12:00 p.m. to 6:00 p.m.

The Rhode Island Office of the Health Insurance Commissioner can help residents resolve issues with their insurance company, locate a doctor or other provider within their network, appeal a denial of service, and resolve billing problems with insurers and providers. Residents can call 401-462-9517 or email complaints (or a completed insurance complaint form) to healthinsinquiry@ohic.ri.gov.

Health Insurance Guide

U.S. News offers information on how to buy health insurance and publishes plan ratings for every state. If you’re over 65, see the guide to Medicare plans. Otherwise, start by looking up the Health Insurance Guide for your state.

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2014-08-01