You’ve got a lot of options when it comes to health insurance in Rhode Island. Choosing between all the different options can get a little confusing, and even frustrating. But don’t let that discourage you. On this page, we’re going to discuss all the major options that are available to you right now and give a fair evaluation of their pros and cons. Once you’re done reading, you should have learned enough information to be able to make a decision for yourself and your family. And if not, that’s okay – you can reach out to ask for more info and assistance.
Major Medical Insurance in Rhode Island
A decade ago, the Patient Protection and Affordable Care Act was signed into law in the spring of 2010. It created a set of rules and regulations which both established the federal Health Insurance Marketplace and restructured health insurance products to give patients better coverage at a better rate. Despite what critics may have to say, it has helped millions of people gain access to life-saving healthcare that they would never have had before. And it does not appear as though the ACA is going away anytime soon.
The state of Rhode Island has its own Exchange – HealthSource RI – where you can apply for ACA approved major medical coverage in your state. They also have longer and more flexible open enrollment deadlines. For health coverage that starts on January 1st of 2020, the deadline was December 23rd (instead of December 15th on the federal Exchange). For health insurance that starts February 1st, the deadline is December 31st.
There are a few very important reasons why people might want to try enrolling in health care coverage through HealthSource RI first as opposed to seeking out private options like short-term health insurance or a health share plan. For starters, out of those three options, only ACA approved insurance is guaranteed issue. With guaranteed issue Insurance, you cannot be rejected no matter how sick you are. And even if you have a pre-existing condition, your insurance company cannot charge you a higher monthly premium compared to the next customer unless one of the following four factors would make you a riskier investment:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Unlike most other insurance options in Rhode Island right now, ACA approved major medical coverage also comes with the 10 guaranteed Essential Health Benefits. These benefits are what most people need in order to get the preventive care or disease management treatment that keeps them happiest and healthiest in the long run for the least medical cost:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
But the extra benefits and the guaranteed coverage don’t usually come cheap. However, you should be able to qualify for a money-saving subsidy if you make at least 138% of the federal poverty limit. This threshold is based on a combination of both your household size and your annual income. Qualifying for the subsidy, known as the premium tax credit, can save you hundreds of dollars a month on your premiums. You may also qualify for other cost-sharing discounts thanks to the unique nature of Rhode Island’s state Exchange. You can use this chart below to quickly figure out where your income puts you on the spectrum and how likely you are to qualify for a subsidy.
|Household Size||Annual Income (138% of FPL)|
But if your income isn’t high enough to meet the premium tax credit threshold, you might want to try applying for Medicaid. Thankfully for Rhode Island residents, the state accepted federal funds for Medicaid expansion many years ago during the early days of the ACA. It’s not too hard to apply – all you have to do is go online to the Rhode Island Medicaid website and fill out an application or contact your local office. From there, it’s just a matter of meeting their qualification requirements, which may or may not depend on being just low income enough for the program.
Short Term Health Insurance in Rhode Island
Short term health insurance has not been available in Rhode Island for many years. This has a lot to do with the way the state regulates its insurance laws in order to try and give its residents the best possible coverage. The problem with short-term health insurance, according to state legislators, is that the lack of guaranteed issue protections and the lack of Essential Health Benefits which are common with short-term health insurance fail to live up to the standard of care they think Rhode Island residents deserve. And if insurance companies who do business in the state cannot provide this basic, standard level of care, then lawmakers have given them the option to either change the way they do business or leave the state. Unfortunately for some Rhode Island residents, short term health insurance companies have chosen the latter option. But the laws have changed frequently in the years since the passage of the ACA, so who knows what will happen in the years to come.
Christian Health Plans/Health Share Plans in Rhode Island
In the meantime, there are things like Christian health plans to consider. When it comes to Christian health plans, the biggest appeal for purchasing one in Rhode Island is the fact that their biggest competition – short-term health insurance – isn’t available. So if you can’t find a way to get an affordable major medical policy through the Health Insurance Marketplace, a Christian health plan is likely at your next best option. But there are some things you should know about these health plans before you decide on one.
Don’t be fooled by the religious exemption associated with these plans – they are very different from major medical coverage through the ACA. Here are the biggest differences that you’ll run into with a Christian health plan compared to major medical insurance:
- Christian health plans are not guaranteed issue
- They also come with unlimited out-of-pocket costs
- Health share plans have lifetime and annual benefit caps
- You likely won’t be able to get all of the guaranteed Essential Health Benefits
- Plans require a less costly “monthly share amount” than an unsubsidized ACA monthly premium
- Not considered to be a “real” health insurance plan by major organizations and care providers
With a Christian health plan, you will have to adhere to certain participation guidelines if you want to stay in good standing and get your benefits paid out when you file a claim. Usually it’s something simple, kind of like declaring the same religious faith as the organization providing your plan or going to church more often. There could be other things, such as quitting alcohol or tobacco use in order to improve your overall health. Christian health plans typically charge you a monthly share amount instead of a monthly premium, and an “unshared” amount or a “personal responsibility amount” instead of things like deductibles, co-pays, or coinsurance. But if you find yourself to be a particularly religious person and you find the cost of one of these plans to be affordable to you, then it might be worth it to consider this option.
Fixed Indemnity Plans in Rhode Island
Fixed indemnity plans work differently from most of the insurance options we have discussed thus far. Instead of paying out a fixed percentage of a total medical costs, they pay out a fixed amount of money on a daily, weekly, monthly, per visit, or per-incident basis. On the one hand, you aren’t restricted to medical networks the way you are with a PPO or an HMO major medical plan. This means that you can visit almost anywhere you want and get care from providers and facilities where you need it most; but you will have to be responsible for a larger amount of your total medical expenses.
But there are some downsides to fixed indemnity plans that you should be aware of. For starters, it’s not a good idea to replace major medical coverage with one; it’s much better to use these as a supplement for when your out-of-pocket costs with major medical coverage are too high or when you have trouble seeing the doctors and getting the care you need because of restrictive medical networks. Fixed indemnity plans require medical underwriting, so you can be rejected for coverage if you have pre-existing conditions or you could be charged a higher amount for your monthly premiums. But if a fixed indemnity plan is all you can afford, it’s certainly better than nothing. Although you should try looking at some of the options we’ve already discussed first.
Discount Cards in Rhode Island
Shopping for a medical discount card in Rhode Island presents a unique set of challenges. But generally, they work the same way as any other membership club (like AAA for example): you get a card in the mail as soon as you pay a membership fee, either on a monthly or annual basis, and then you present your card whenever you shop around for medical products or services. You’ll get a discount right at the register without having to file any claims or wait to be reimbursed. Although medical discount cards will not take a huge bite out of your total medical costs, they can help alleviate your debt burden a little bit, especially if you have to pay for a lot of care or prescription drugs up front.
But don’t go making the mistake that medical discount cards are the same thing as major medical coverage. That’s the easiest way to get scammed. There are unscrupulous companies out there offering medical discount cards and claiming they are a viable insurance replacement when they are not. There are also some companies out there who might exaggerate or lie about the discounts they offer or the businesses and doctors they participate with. But you can easily call ahead to these establishments and double-check both their participation status and how big of a discount you can expect. In a best-case scenario, you can save more money with the discounts you receive than it costs to be a member of their medical discount card club. And if that’s the case, then a medical discount card can be a good buy, especially if you have a lot of out-of-pocket costs associated with other types of coverage.