Rhode Island has many affordable health insurance options, with 11 insurance companies that offer cheap health insurance policies as well as a state health insurance marketplace. Families and individuals can review the numerous plans within the state to find one that best fits their lifestyle.

This guide explains your Rhode Island affordable health insurance options in detail.

What to know about insurance in Rhode Island

  • Marketplace plans: If your employer doesn’t offer affordable health insurance, you’re self-employed, or the plan offered by your employer doesn’t meet your needs, you can purchase individual insurance.
  • Open enrollment: Rhode Island’s open enrollment period varies from year to year. For 2022, it’s open November 1, 2021 through January 31, 2022.
  • Premium tax credits: The American Rescue Plan (ARP) made premium tax credits available to more people. In addition, ARP reduces the monthly cost of health insurance through HealthSource RI, the state’s official Health Insurance Marketplace. The subsidies will run through the end of 2022.
  • Special enrollment: If you have a major life change such as getting married, having a baby, moving, or losing health insurance coverage, you may qualify for a special enrollment period.
  • State health insurance exchange: HealthSource RI is Rhode Island’s health insurance exchange. It has more than a dozen plans available through different providers in the state.
  • Coverage types: 95.8% of Rhode Island’s residents are insured, with 54% receiving health insurance through an employer. Another 20.5% receive Medicaid,14.6% have Medicare, 5.9% have non-group insurance plans, and 0.8% receive insurance through the military. Only 5.9% of Rhode Island residents are uninsured.

How do I enroll in Rhode Island’s health insurance marketplace?

HealthSource RI makes enrolling in marketplace plans easy. On the site’s front page, you can begin the enrollment process, get help, or compare plans and get a quote before deciding. If you choose to compare plans first, the site will take you to a tool that will list the plans available to you.

To begin the enrollment process, you’ll need to make an individual or family account that includes your:

  • Name
  • Phone number and email
  • Birthdate
  • Address
  • Social Security Number
  • Health insurance information
  • Income and tax information
  • Immigration or citizenship information

Once you start the process, you can watch a short video that explains how to compare plans or start the process yourself. After entering your information, you can enter the same information about the other people in your household, such as your spouse and children. Finally, you can choose to include dental plans in your search.

The page also asks if you want to know if you can get help paying for coverage for more affordable health insurance. If you choose yes, you’ll answer a few more questions. After you see the financial assistance available to you, you can continue to the next page, which will ask if you want to name your doctor. The page after allows you to list your prescription medications to see which plans include these medications and how much they will cost.

The final page will show you which plans are available to you. The dental plans you qualify for will be listed under a separate green tab toward the top of the page.

The following companies offer affordable health insurance plans in Rhode Island:

  • Blue Cross & Blue Shield of Rhode Island
  • Tufts Associated Health Maintenance Organization, Inc.

How do I enroll in Rhode Island’s individual and families insurance?

There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:

  • Medical needs
  • Preferred plan type
  • Premium affordability
  • Individual vs. family deductibles

Insurance for individuals in Rhode Island

If you have health problems requiring frequent doctor visits or regularly use a particular service, you should choose a plan with a higher monthly premium and lower deductibles. However, if you have few health problems, you can choose a lower premium at the cost of a high deductible.

You can choose from different types of plans including.

  • Health Maintenance Organization (HMO) plans, which are the least expensive plans available. One reason these plans are less expensive is there are more restrictions. You’ll need to select a primary care physician, obtain referrals to see a specialist, and you can only use the plan’s in-network medical providers.
  • Preferred Provider Organization (PPO) plans, which are more expensive. But in exchange for that higher cost, you’ll face fewer restrictions. You aren’t limited to in-network medical providers. You don’t need to name a primary care physician nor obtain a referral to see a specialist.
  • Point of Service (POS) plans allow you to use out-of-network providers. However, when you want to see a specialist, you’ll still need to get a referral.

Insurance for families in Rhode Island

If you have young children, or immediate family members with a chronic illness, you may want to choose a plan with a higher premium that covers more regular care. These plans come with lower deductibles, making out of pocket costs more manageable.

If you have a family with few health problems, an HMO plan with a lower premium but higher deductible may be a better choice. HMO plans focus on general wellness and preventing illness, so these are a good option for people who don’t need to go out of network or who make few doctor’s visits.

PPO plans don’t require policyholders to have a referral for a specialist. In addition, they can be less expensive than HMO plans and more accommodating of out-of-network services. As a result, they might be the best fit for a family with a parent or child that has a severe and long-term health problem to manage.

How much does health insurance cost in Rhode Island?

HealthSource RI’s metal plans help you find a plan that best suits your needs. Bronze, Silver, Gold, and Platinum plans have different features and premiums, with the most affordable health insurance coverage at only $240 for a 20-year-old in 2022.

Average premiums in Rhode Island 2018 2019 2020 2021 2022
Most affordable Bronze plan $198 $215 $219 $231 $240
Most affordable Silver plan $287 $315 $314 $328 $341
Most affordable Gold plan $300 $323 $325 $339 $349

 

  • Bronze plans have the lowest monthly premiums, but also have higher deductibles and only pay 60% of covered medical costs. If you don’t have a chronic health condition and only want coverage for emergencies, a Bronze plan gives you basic affordable health coverage. In 2022, the most affordable Bronze plan in Rhode Island costs $240 per month.
  • Silver plans have higher premiums than bronze plans but also have lower deductibles and coinsurance requirements. The plans pay around 70% of your covered costs. In 2022, the most affordable Silver plan in Rhode Island costs $341 per month.
  • Gold and Platinum plans have the highest monthly premiums but also have lower deductibles and insurance requirements. If you have a chronic health condition, you may want to spend a little more per month to get a plan that gives you extra coverage. Gold plans generally cost more than Bronze or Silver plans, but they also cover about 80% of your covered costs (90% for a Platinum plan). As of 2022, the most affordable Gold plan in Rhode Island costs $349.

What kind of low-income health insurance is available in Rhode Island?

In Rhode Island, low-income individuals have access to health insurance through the state’s Medicaid program. If you don’t qualify for Medicaid, you may receive health care through the Rhode Island Free Clinic or Clinica Esperanza.

Medicaid in Rhode Island

Certain groups of people are eligible for Medicaid, including:

  • Low-income adults
  • Seniors
  • Children
  • People with disabilities
  • Pregnant women
  • Children in foster care
  • Former youths in foster care until they’re 26 years old

Through Medicaid, you can choose a plan from Neighborhood Health Plan of Rhode Island, Tufts Health Plan, and UnitedHealthcare.

Just as you would for an exchange plan, you can apply for Medicaid on HealthSource RI’s website. You’ll then receive a letter from the Department of Human Services that lets you know if your application has been accepted, denied, or if the state needs additional information. If you had Medicaid but are no longer eligible, you have a special enrollment period of 60 days to enroll in an exchange plan through the state.

The Rhode Island Free Clinic

The Rhode Island Free Clinic provides services to uninsured people for free. Its care includes primary and specialty care, medications, and wellness programs, among other services. To qualify, you must be at least 18 years old and an uninsured resident of the state with an ID. To prove this, you’ll need a bill or a piece of mail with your name on it. In addition, if you’re employed, you must have your last two pay stubs or proof of income. If unemployed, you’ll need to show a TDI or SNAP authorization letter.

According to their website, the Rhode Island Free Clinic covers multiple medical procedures, including primary care, labs and diagnostics tests, specialty care, follow-up visits with the clinic, prescription medications, and counseling and wellness programs.

Clinica Esperanza

Clinica Esperanza focuses on providing care to any resident that needs it, whether insured or not. It offers non-emergency medical care to adults and STD screening, help with managing chronic diseases, and certain vaccinations. Specialty services, such as mental health help or dental care, aren’t offered. It has walk-in hours and two locations, one of which is a pop-up clinic.

What are Rhode Island’s Medicare options for seniors and people with disabilities?

Rhode Island has Medicare options available to older adults and people with qualifying disabilities.

  • Original Medicare is the basic form of Medicare, which is composed of Part A (hospitalizations, home health care, hospice, skilled nursing care) and Part B (medical services, durable health equipment, ambulance services). Part A can cost as much as $499 a month depending upon how much you’ve paid in Medicare taxes in the past, while Part B always includes a $70.10 monthly premium. Original Medicare does not cover prescription drugs, so you’ll need a Medicare Part D plan, which is a Medicare prescription drug plan. Original Medicare has no out-of-pocket limits for deductibles, copays, or coinsurance.
  • A Medicare Advantage Plan is an alternative to Original Medicare, also known as Part C. These are private insurance plans which have been approved by Medicare and offer dental, vision, and hearing coverage. Fitness memberships and prescription drug coverage can also be included in many Medicare Advantage Plans. There are four types of Medicare Advantage Plan: HMO, PPO, Private Fee-For-Service, and Special Needs.

Medicare Supplement Insurance plans are designed to help cover out-of-pocket expenses that occur with Original Medicare. These plans won’t help you with the cost of vision, dental, hearing, or long-term care. If you’re traveling out of the country, however, a Medicare Supplement Insurance Plan can provide you with health coverage. Medicare Supplement Insurance Plans do not work with a Medicare Advantage Plan.

Rhode Island programs like the Medicare Premium Payment Program can help residents pay for Medicare. There are different requirements for disabled people and those older than 65%. Still, your income usually has to be at least below 100% of the poverty line.

Eligibility

To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

In Rhode Island, the Executive Office of Health and Human Services works with NHPRI to coordinate care for people that qualify and receive both Medicare and Medicaid.

Enrollment

If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:

  • Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
  • General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
  • Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
  • Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
  • Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Are there short-term health insurance plan options in Rhode Island?

Rhode Island hasn’t banned the sale of short-term health insurance plans, but currently, none are offered in the state. This may be because of restrictive guidelines that leave insurers unmotivated to sell short-term plans in the state.

Rhode Island Insurance FAQs

Does Rhode Island require health insurance?

Yes, Rhode Island requires all residents to have health insurance or face a tax penalty. However, you can apply for a hardship exemption if you were unable to obtain insurance. There are other types of exemptions, like those available to people who can’t afford coverage based on projected income, incarcerated individuals, and those who are members of Indian tribes.

Do I have to use the Health Insurance Marketplace in Rhode Island?

No, you are free to purchase coverage directly from an insurer.

What types of alternative health insurance plans are available in Rhode Island?

The most common kind of cost-sharing plan in Rhode Island is a faith-based plan. Members of these plans share health care costs. You don’t need to be a member of a particular denomination, or belong to any religious group, if you want to participate in a plan. These plans aren’t insurance and aren’t required to conform to ACA standards. Plans can be inexpensive but often don’t cover pre-existing conditions or other essential health care benefits.

Do I need health insurance if I have HSA/FSA?

Yes, you can only open an HSA if you have a high-deductible plan in Rhode Island. You also can’t be dependent on another person’s plan, eligible for Medicare, or covered by another health plan.

Do I need short-term disability coverage in Rhode Island if I have health insurance?

Yes, but it depends upon your job. You may not need it, but if you work at a job where injury is a possibility, it’s a good idea. Short-term disability coverage pays for household expenses like utilities, groceries, and your mortgage. These expenses are not covered by health insurance.

Rhode Island is one of six territories that offer temporary disability/caregivers insurance to insured workers for a period of unemployment caused by an injury. If you are injured, you have to apply for the benefits of Temporary Disability Insurance (TDI). You do not have to apply, but you can receive up to $978 in benefits if you choose to do so.

Do I need long-term disability coverage in Rhode Island if I have health insurance?

If you have a dangerous job, it’s a good idea to have long-term disability coverage. However, you also need health insurance. Disability coverage pays for household expenses that are not covered by health insurance.

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Insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity products.

She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies, as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and healthcare consultant, now helping people understand the medical system. Since becoming an agent, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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