En español | Rhode Islanders are required to have health insurance — and they can face a nearly $700 per person fine each year that they don’t. Those who don’t get it through an employer are eligible to buy high-quality coverage at low or no cost through HealthSource RI, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in the March coronavirus relief bill. HealthSource RI’s open enrollment period begins on Nov. 1 and runs through Jan. 31, extending the window beyond the federal Healthcare.gov marketplace. But you may still be able to switch to a marketplace plan if you get married, have a baby or experience another qualifying life event.
Most people already enrolled in ACA marketplace plans will also see their premiums go down this year because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. HealthSource RI has detailed what the American Rescue Plan means for Rhode Islanders. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible?
- Rhode Islanders — including legally present immigrants, asylum seekers and refugees —who are not receiving coverage through an employer or a spouse’s employer can buy health insurance through HealthSource RI.
- You may also qualify for Medicaid, which offers free or low-cost coverage to low-income people and families and has no monthly premium. When you apply for coverage through HealthSource RI, you’ll find out if you qualify for this option.
- If you’re uninsured and not eligible for Medicaid or coverage through HealthSource RI, you may qualify for health services through The Rhode Island Free Clinic or Clinica Esperanza.
- To find out what plans and financial assistance you are eligible for, visit HealthSource RI’s health and dental plan comparison tool.
When can I enroll?
- HealthSource RI open enrollment runs from Nov. 1 through Jan. 31.
- You can enroll anytime if you experience a qualifying life event, but in most situations you only have 60 days from that event to enroll. Qualifying events include certain moves, births and adoptions, loss of employer-provided coverage, marriage, divorce and other special circumstances.
- Rhode Islanders who qualify for Medicaid can enroll year-round.
How do I sign up?
You apply for coverage and choose your plan at the same time. As soon as you submit an application with HealthSource RI, you'll learn what coverage you're eligible for.
If you enroll in a plan through HealthSource RI, your coverage will not begin until you’ve paid your first monthly premium. You can make a payment in a variety of ways, including at any CVS Pharmacy in the country.
There are numerous tools to help you apply and enroll:
- Online: Go to www.HealthSourceRI.com, the marketplace's website, to apply and enroll. Get answers to questions through the site’s live web chat option – click on the blue “Chat with us!” icon – available in English and Spanish.
The site also lists virtual and in-person enrollment events, when specialists are on hand to assist you. Live events are limited due to the coronavirus pandemic.
- By phone: Call HealthSource RI’s contact center at 855-840-4774 between 8 a.m. and 6 p.m., Monday through Friday.
- In person: Arrange for one-on-one assistance from a navigator, who is someone that can walk you through the application process, by using HealthSource RI’s online tool or by calling 211. You can schedule an in-person appointment at HealthSource RI’s walk-in center, located at 401 Wampanoag Trail in East Providence.
What is covered, and how much will it cost?
Coverage and cost depend on family size, the age of family members, household income and the type of plan you choose.
If you qualify for Medicaid, you’ll be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All HealthSource RI plans are required by the Affordable Care Act to provide essential benefits, including:
- Emergency services and hospitalization
- Maternity and newborn care
- Mental health and substance use disorder services (including counseling)
- Chronic disease management
- Pediatric services, including dental and vision
- Prescription drugs
- Preventative care, such as vaccines, screenings and yearly physicals
Insurance companies cannot deny coverage because of preexisting conditions. When you apply for health coverage through the state’s marketplace, you can identify your medical needs and choose a plan that makes financial sense for you and your family. Deductibles and out-of-pocket costs vary between plans.
Dental coverage must be purchased separately, although children under 18 may already have basic dental services included in their HealthSource RI plans.
What about new federal assistance for premiums?
With the passage of the American Rescue Plan, most HealthSource RI customers are now eligible to get new savings. For example, a single 64-year-old filer earning $51,000 per year could save more than $5,000 annually in monthly health coverage premiums with the tax credits that are now available.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for out-of-pocket expenses such as deductibles and copays. You must enroll in a silver-level plan to get this assistance.
If you’ve collected unemployment benefits this year, even for just one week, you may qualify for an almost $0/month premium health coverage option, thanks to the American Rescue Plan. This subsidy became available in June for July coverage. If you’ve already received unemployment benefits this year while enrolled in a marketplace plan, you’ll be able to claim the additional subsidies for the months prior to July when you file your 2021 tax returns. This extra financial help will expire at the end of 2021.
What plans are available?
Most HealthSource RI plans are organized into four categories:
- Bronze plans have the lowest monthly premiums, the highest deductibles and copays, and cover roughly 60 percent of care costs.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover about 70 percent of care costs and potentially much more, if you come from a lower-income household and qualify for cost-sharing reductions – a subsidy only available through silver plans.
- Gold plans have higher monthly premiums, lower deductibles and copays, and cover roughly 80 percent of care costs.
- Platinum plans have the highest monthly premiums, the lowest deductibles and copays, and cover roughly 90 percent of care costs. These are for people who have significant health care needs and are willing to pay the highest premiums.
Compare plans with HealthSource RI’s plan comparison tool.
What if I already have health insurance?
If you don’t have coverage through an employer and instead pay for coverage directly through an insurance provider, you may be eligible for financial assistance and greater savings if you switch to pay for your plan through HealthSource RI. But you may need to wait until open enrollment.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours before Oct. 1, you may be able to save money by switching to a HealthSource RI plan during a 60-day special enrollment window. Be sure to apply and select your plan through HealthSource RI before your COBRA coverage ends to make sure there’s no gap in coverage. If you're not sure if this switch makes sense for you, call the HealthSource RI contact center at 855-840-4774.
If you already have a marketplace plan and want to adjust your coverage, you’ll need to wait until the renewal period opens this fall. If you don’t take action during the renewal period, you’ll automatically be reenrolled in the same or a similar plan.
Will I need to get a new doctor?
That depends. Major insurance providers, including Blue Cross Blue Shield of Rhode Island and Neighborhood Health Plan of Rhode Island, offer HealthSource RI plans, but not all doctors accept them. Check the provider directories to see if your doctor accepts a coverage plan. The comparison tool to shop for coverage also lists the plans a doctor accepts.
Will my family members qualify for the same health plan that I do?
In most cases, family members can enroll in the same plan. But in some cases, there may be certain family members, often children, who qualify for no-cost coverage through Medicaid. A specialist with HealthSource RI’s can answer your questions. Call 855-840-4774 or use the live web chat option on the marketplace’s website.
This guide, originally published on June 25, was updated on Oct. 1 to include information about open enrollment and COBRA.