With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Rhode Island, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Rhode Island
Rhode Island ranked 15th overall in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths include a low prevalence of obesity, high immunization coverage among adolescents, and ready availability of primary care physicians. Rhode Island’s challenges include a high rate of drug deaths, a high rate of preventable hospitalizations, and a large disparity in health status by educational attainment.
Rhode Island individual and family health insurance
Rhode Island’s created a state-based health insurance exchange under the Affordable Care Act. The state’s individuals and families may shop and apply for qualified health plans through Health Source RI. Those who buy health insurance through Rhode Island’s exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Rhode Island’s health insurance marketplace is not limited to Health Source RI. As in all states, Obamacare qualified health plans are also available in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a premium tax credit. If you qualify for financial assistance, visit the Health Source RI exchange to shop and apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 28,485 individuals in Rhode Island selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Rhode Island enrolled in a marketplace plan increased to 31,337 during the open enrollment period.3
|Rhode Island’s health insurance exchange:||healthsourceri.com|
|Rhode Island’s department of insurance:||ohic.ri.gov|
Rhode Island small group health insurance plans
In Rhode Island, small businesses with 50 or fewer employees may purchase small group health insurance plans through the Health Source RI exchange and in the private marketplace through websites such as such as HealthCare.com. Small businesses that use Health Source RI and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the state’s exchange.
Rhode Island state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Rhode Island’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||All sizes; law applies to employer group contracts, regardless of employer|
|Maximum continuation period – standard||18 months|
|Maximum premium Increase||100 percent|
|State legislation reference||Rhode Island Mini-COBRA Law – § 27-19.1-1 Extended Medical Benefits|
|More information||401-462-9517 – Office of the Health Insurance Commissioner|
|Additional notes||Available to the terminated member, the surviving spouse of a deceased member and any other dependents of the member who were covered under the plan|
Rhode Island high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Rhode Island Medicaid
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Rhode Island expanded its Medicaid program in 2014.7 Medicaid/CHIP open enrollment takes place year-round.
The information below is specific to Rhode Island’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Rhode Island Executive Office of Healthy & Human Services|
|How to apply||healthyrhode.ri.gov|
|Open-enrollment period||Year-round in all states|
Rhode Island CHIP
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to RIte Care, Rhode Island’s health insurance program for low-income children:
|Program name||RIte Care|
|How to apply||healthyrhode.ri.gov|
|Eligibility8||Based on income and family size—pregnant women with up to 253 percent of the federal poverty level; children up to age 19 with income up to 261 percent of the FPL; parents with children under age 18 with income up to 133 percent of the FPL|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 State of Rhode Island. Title 27 Insurance. “Chapter 27-19.1 Extended Medical Benefits. Section 27-19.1-1.” N.D. Retrieved from http://www.rilin.state.ri.us/Statutes/TITLE27/27-19.1/27-19.1-1.HTM.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. Retrieved from http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. Retrieved from https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Rhode Island.” Medicaid.gov. N.D. Retrieved from http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/rhode-island.html.
8 State of Rhode Island Executive Office of Health & Human Services. “Healthcare for Families with Children.” N.D. Retrieved from http://www.eohhs.ri.gov/Consumer/ConsumerInformation/Healthcare/FamilieswithChildren.aspx.