Paul Sanchez
Health insurance is required in the state of Rhode Island, and HealthSource RI is the official healthcare portal. The Rhode Island Executive Office of Health and Human Services (EOHHS) administers the publicly-funded Medicaid program, which is an important source of coverage for low-income families, pregnant women, older adults, and people with disabilities. Neighborhood Health Plan of Rhode Island also provides Rhode Islanders with access to affordable health insurance plans. For those interested in signing up for health coverage through the Affordable Care Act, there are various plans to choose from, including bronze, silver, gold, and platinum.
| Characteristics | Values |
|---|---|
| Official healthcare portal for the state of Rhode Island | HealthSource RI |
| Medicaid and HealthSource RI application | Online at HealthyRhode.ri.gov |
| Medicaid eligibility | Income, age, type of health care needs, and amount of resources or assets |
| Medicaid coverage | Families, children, pregnant women, older adults (65+), people with disabilities and special needs |
| Health insurance for veterans | US Department of Veterans Affairs |
| Health insurance for people with Medicare | Rhode Island State Health Insurance Assistance Program (SHIP) |
| Health insurance for people with end-stage renal disease | Rhode Island State Health Insurance Assistance Program (SHIP) |
| Health insurance for people with disabilities | Rhode Island State Health Insurance Assistance Program (SHIP) |
| Health insurance for low-income families with children | Medicaid |
| Health insurance for people with a "self-insured" employer | Contact the U.S. Health Insurance Assistance Team |
| Health insurance plans | Bronze, Silver, Gold, Platinum |
| Health insurance provider | Neighborhood Health Plan of Rhode Island |
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What You'll Learn
Eligibility for Medicaid
Medicaid is a crucial source of coverage for low-income families with children, pregnant women, older adults (65 and over), and people with disabilities and special needs who may otherwise lack access to affordable or quality healthcare. Since 2014, adults aged 19 to 64 who are neither eligible for nor enrolled in Medicare and are not receiving Supplemental Security Income (SSI) have been able to access Medicaid. If you fall within this age bracket and your monthly income is at or below 138% of the federal poverty level, you may be eligible for Medicaid.
The types of health services and level of coverage provided by Medicaid vary depending on age, family structure, and individual needs. Families, children, and pregnant women are offered full health insurance coverage through managed care organizations like RIte Care and RIte Share. Adults aged 21 and older are covered through a Rhody Health Partners (RHP) plan. Medicaid also provides long-term services and support (LTSS) for eligible individuals receiving Medicare.
To apply for Medicaid in Rhode Island, you must be a resident of the state and provide proof of citizenship or legal presence as a non-citizen. You can apply online at HealthyRhode.ri.gov or HealthSourceRI.com, which will determine your eligibility for Medicaid or other forms of affordable coverage. Paper applications are also available, and you can apply in person, by mail, telephone, or fax. If you are seeking long-term care, you must complete the DHS-2 application, and there may be instances where you need to fill out additional forms or provide extra documentation.
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ACA insurance plans
Health insurance is required in Rhode Island, and residents who do not have it may be subject to a tax penalty. Rhode Island residents can apply for Affordable Care Act (ACA) health insurance plans, also known as Obamacare plans, during the annual Open Enrollment Period, which usually runs from November 1 to December 15. The federal HealthCare.gov marketplace's enrollment period ends on December 15 for coverage that begins on January 1 and on January 15 for coverage that starts on February 1.
Rhode Island is one of several states where pregnancy counts as a qualifying life event, allowing an uninsured person to enroll in health coverage as soon as they find out they are pregnant. Other qualifying life events include giving birth, losing other health coverage, getting married, or relocating to a new home. Enrollment in Rhode Island Medicaid and CHIP is available year-round for eligible residents.
If you qualify for a subsidy, you must enroll in a silver plan to benefit from the savings. People with incomes above 400% of the federal poverty level ($60,240 for an individual) may be eligible for subsidies with a silver-level ACA plan if their premiums exceed 8.5% of their income. The eligibility threshold is lower for people with lower incomes. Bronze plans tend to have the lowest monthly premiums and the highest deductibles and copays, while silver plans are the most popular, with moderate premiums and copays.
Rhode Island residents can use the HealthSource RI platform to shop for individual and family health insurance offered by two private health insurance carriers. HealthSource RI is also among the state-based exchanges that offer small group health insurance for small businesses. Neighborhood Health Plan of Rhode Island is another option, providing Rhode Islanders with access to high-quality, affordable health insurance plan options.
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HealthSource RI
If you have difficulty affording health coverage, you can contact HealthSource RI (Medicaid) at the phone number or website provided. They can answer questions about eligibility for Medicaid and current Medicaid benefits. If you are not eligible for Medicaid, your child may still qualify for the Children's Health Insurance Program.
In addition to HealthSource RI, Rhode Islanders can access affordable health insurance plan options through the Neighborhood Health Plan of Rhode Island.
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Health Insurance Commissioner
Health insurance is required in Rhode Island, and HealthSource RI is the official healthcare portal for the state. The Office of the Health Insurance Commissioner can be found at 1511 Pontiac Ave, Building #69 First Floor Cranston, RI 02920, and can be contacted on (855) 747-3224. The office provides information on health coverage and can answer questions about eligibility for Medicaid and current Medicaid benefits. If you are not eligible for Medicaid, your child may still be eligible for the Children's Health Insurance Program.
If you are on Medicare and have a question, or if you have a disability or end-stage renal disease and want to enroll or find out if you are eligible for Medicare, you can contact the Rhode Island State Health Insurance Assistance Program (SHIP) Office of Healthy Aging in Cranston, RI 02920, on (888) 884-8721.
If you are a veteran with a question or concern about your healthcare benefits, you can contact the US Department of Veterans Affairs on (877) 222-8387.
If you are buying insurance on your own and not through an employer, HealthSource RI can help you choose, purchase, and get the most out of a plan for you and your family. If you are purchasing your health insurance through your employer, HealthSource RI can show you how to make the most of your plan, from benefits to extra perks.
If you are a state employee or dependent and are enrolled in one of the State Anchor Medical Plans, you are eligible for the Blue365 discount program, which offers exclusive health and wellness deals.
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Long-term care
Health insurance is mandatory in Rhode Island, and residents can compare and purchase health insurance coverage through HealthSource RI, the official healthcare portal for the state. For those who struggle to afford health coverage, Medicaid is a health insurance program for low-income individuals of all ages. In Rhode Island, Medicaid covers long-term care for seniors aged 65 and over, including care services in nursing homes, assisted living facilities, and shared living homes (adult foster care).
There are three categories of Medicaid long-term care programs for which Rhode Island seniors may be eligible:
- Institutional/Nursing Home Medicaid: Anyone who meets the eligibility requirements will receive assistance, but benefits are only provided in nursing home facilities.
- Medicaid Waivers/Home and Community-Based Services (HCBS): This is not an entitlement, and there are a limited number of participant slots, so waiting lists may exist.
- Regular Medicaid: For long-term care services via this program, a functional need with Activities of Daily Living (ADLs) is required.
To be eligible for long-term care Medicaid in Rhode Island, applicants must meet specific criteria:
- Residency and Citizenship: The applicant must be a resident of Rhode Island and a U.S. citizen or have a valid immigration status.
- Age/Disability: The applicant must be aged 65 or older, blind, or disabled, and meet certain medical requirements consistent with the level of care requested.
- Income Limitations: Applicants must have an income under $2,901 per month. A $75 monthly personal needs allowance is not counted towards this limit.
- Asset Limitations: Medicaid divides assets into exempt and non-exempt categories. Exempt assets include personal belongings, clothing, household furnishings, an automobile, a burial plot, and generally one's primary home. Non-exempt assets include cash, stocks, bonds, investments, promissory notes, and bank accounts.
Additionally, Rhode Island has a Spend-Down Program that allows seniors who are over the Medicaid income limit to become income-eligible if they have high medical expenses. This means that individuals can still qualify for Medicaid services by spending their income on private health insurance, unpaid medical bills, care assistance, and medical expenses that Medicaid does not cover.
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Frequently asked questions
Health insurance is required in Rhode Island. You can compare and purchase health insurance coverage on HealthSource RI, the official healthcare portal for the state. You can also apply for Medicaid through HealthSource RI. If you are on Medicare and have a question, or if you have a disability or end-stage renal disease and want to enroll or find out if you are eligible for Medicare, contact the Rhode Island State Health Insurance Assistance Program (SHIP).
The Rhode Island Executive Office of Health and Human Services (EOHHS) administers the publicly-funded Medicaid program. Medicaid provides coverage for low-income families with children, pregnant women, older adults (age 65 and over), and people with disabilities and special needs. Neighborhood Health Plan of Rhode Island also provides access to high-quality, affordable health insurance plans.
You can sign up for health coverage through the Affordable Care Act (ACA) during open enrollment. Bronze plans tend to have the lowest monthly premiums, while gold and platinum plans have higher premiums but lower out-of-pocket costs. You can use the Plan Comparison Tool on HealthSource RI to compare plans and get a quick quote.
