Rhode Island is nicknamed as the Ocean State, as this state is framed by 643 kilometers of coastline with seafaring traditions, pristine beaches, fresh seafood and majestic fun on the water. The large bay and inlets amount to 14% of the state total area and is the second most densely populated state in the country. However, still this state is counted amongst the healthiest states in the country and ranks among the topmost states in the country’s health rankings. Despite being considered as the healthy state, residents need to maintain its position by giving due significance to their health and by enrolling in the best health insurance plan of Rhode Island. As far as health insurance exchange is concerned, Rhode Island is the state-run exchange and is an active purchaser exchange, which means that exchange directly negotiates with the insurance companies to make specific health insurance plans available for their residents rather than accepting all qualified health plans offered by the insurers. Due to the state’s new individual mandate and reinsurance program, the overall proposed health insurance rate increase for 2020 was less than 1 percent, which otherwise would have been 6% without reinsurance. Around 34,600 people enrolled in individual market through a state-based health insurance exchange, HealthSource, and it was the second year in a row in which enrollment increased. Rhode Island is one of the two states in which special enrollment period deadline is the 23rd of the month, so the residents enrolling by this date will have coverage effective from the 1st of the next month.
Highlights and Updates on RI Health Insurance
- Open enrollment for 2020 coverage in Rhode Island was extended until December 31, 2019.
- The state received federal approval for a reinsurance program, which will become effective in 2020.
- Rhode Island has one of the nation’s lowest uninsured rates.
- As of 2020, Rhode Island will be implementing an individual mandate and the penalty amount will be used to fund the reinsurance program.
- Insurers have proposed an average rate increase of less than 1% for 2020 due to reinsurance and the state’s new individual mandate that are keeping the premiums down.
- Rhode Island is among the twelve states in which enrollment for 2019 ended 5% higher.
- No short-term health plans have been approved for sale in the state due to its strict regulations on short-term plans.
- Only two insurers were offering coverage in 2019 and both will continue to offer plans in 2020.
Individual & Family Health Insurance in Rhode Island
Residents of Rhode Island are offered an array of individuals and family health insurance plans, which they can purchase through the state-run exchange, Health Source or through participating private insurance companies. Starting in 2020, if residents of Rhode Island don’t have coverage then they may have to pay a penalty under law. Therefore, to avoid penalty while filing taxes in 2021 residents should enroll in any of the health plan that meets their coverage needs and budget. Individuals and family health insurance plans in Rhode Island is broken into four different metal tiers such as Platinum, Gold, Silver, and Bronze. Bronze is the cheapest among the all having low monthly premiums but a high deductible, in which insured need to spend more out-of-pocket money before the start of any coinsurance benefits. Platinum plans have most expensive monthly premiums but the coverage quickly start in these plans. Some of the individuals and family health plans available in Rhode Island include:
Preferred Provider Organizations – Preferred Provider Organization plans have a large number of healthcare providers, thereby providing insured with greater options and flexibility of choosing any primary care doctor within the network and the members can visit specialist without requiring a referral from the primary care physician. However, the insured saves out-of-pocket expenses and receives best financial deal if they visit to in-network doctors and hospitals. On seeing out-of-network doctors, specialists and hospitals, members of PPO plans receive only partial financial assistance. With PPO plans, insured also have to pay deductibles and copayments before their coverage begins, though there may be a limit regarding annual out-of-pocket costs.
HMO – In Health Maintenance Organization plan there is a network of healthcare providers and insured need to select a primary care physician to manage their health and also provide referrals for visiting a specialist. If insured needs to visit a specialist, the primary care doctor needs to provide reference and the primary care provider decides if it is necessary for the insured to see a specialist. HMO plans usually have lower premiums compared to other plans. Limited network of doctors are available to the HMO plan members and if they prefer to see a doctor outside of the HMO network, then they have to manage the expenses from their own pocket. Outside the network doctors generally not accept the HMO insurance plan. Most of the HMO plans have no deductibles and out-of-pocket costs are usually reasonable.
High-Deductible Health Plans with Health Savings Accounts – High-Deductible Health Plans work in combination with Health Savings Account that allows individuals to pay for qualified out-of-pocket medical expenses. In HSA accounts individuals can save money while managing their health care costs. The money saved in this account is not subject to federal taxes however individuals can contribute a limited amount. The money accumulated in this account is owned by the member and can only be used for qualified medical expenses. If the money saved is not entirely used in the year then it can rolled over from year to year.
Flexible Spending Accounts – Flexible Spending Account can be conveniently paired with a health plan to manage healthcare costs. It is a tax advantaged account in which individuals save money to pay for many eligible medical and dental expenses. This allows individuals save money because they are using pretax dollars to pay for their medical expenses that also reduce their out-of-pocket costs. Besides, medical and dental expenses individuals can also use the money in this account to pay for daycare services, cost of eyeglasses and contact lenses, over-the-counter drugs along with transportation and parking expenses.
Short-term Health Plans in Rhode Island
Though short-term health plans are not banned in Rhode Island but because of its strict rules and regulations, no insurance carrier offer this plan in the state. It is mandated by the state that all plans sold in Rhode Island must cover essential health benefits along with pre-existing conditions and the premium amount of the plan cannot be based on the medical history of the person. Therefore, fro several years, no short term health plans have been approved for sale in Rhode Island.
Dental Insurance Plans in Rhode Island
Individuals looking for dental insurance plans in Rhode Island for themselves and their family can find different types of dental plans that provide coverage on many dental procedures. Individuals can select dental plans exactly as per their needs. Dental plans providing comprehensive dental coverage to plans with preventive care coverage, there are myriad options and individuals can find dental plan that best fit their budget and requirements. Types of dental plans available in Rhode Island are:
Preferred Provider Organization – A network of participating dentists are included in the PPO plans, who agree to provide dental care services to members of the plan at a negotiated rates. The dental insurance companies negotiate the dental care rates with the participating dentists in order to keep the dental care cost down for the plan’s member. Though, PPO plan members can visit out of network dentist but it will significantly increase the dental care costs.
Indemnity – Indemnity dental plans are more flexible, as members of this plan are free to visit any dentist of their choice because there is no network of dentist associated with the plan. Individuals when visit a dentist, their dental care cost is submitted by their dentist to the insurance company. The dental insurance company then cross-check the dental care cost with their in-network dentists and they pay benefits what their network dentists would have charged and the remaining balance has to be paid by the insured. The dental insurance companies only pay for the usual, customary and reasonable dental care costs.
Dental Discount – These are not actually dental plans but members of dental discount receive certain discounts on some specific dental care services. However, the members are required to receive dental care the network dentists in order to receive the discount. Members of this plan do not receive any bill and they do not have to fill any form either, as they are issued a card using which they can avail dental care and pay the specified amount on the card.
Vision Insurance in Rhode Island
Vision insurance plan is not exactly like the health insurance plans that protect against financial losses but vision insurance is a wellness benefit designed especially for routine eye care, prescription eye care along with other vision related services at a reduced cost. The vision insurance plans lower the expenses incurred on routine eye exams, prescription eye-wear and preventive eye care services. These plans are custom designed to cater the requirements of a large number of individuals and their families. There are two types of vision insurance plans in Rhode Island which include:
Discount Vision Plan – Discount vision plans allow members fixed discounts for certain eye care services and they need to pay annual premium or membership fee along with a deductible.
Vision Benefits Package – In this vision plan members are required to pay annual premium, a yearly deductible and a copay every tie they access a vision care service.
Insurance Carriers in Rhode Island
The two insurance carriers which were operational in 2019 and who will continue to offer plans through state-based health insurance exchange, HealthSource in 2020 are:
- Blue Cross Blue Shield of Rhode Island
- Neighborhood Health Plan of Rhode Island