RI health insurance plans

RI health insurance plans

Having health insurance is crucial for both financial stability and overall well-being, especially in the state of Rhode Island (RI). Having a comprehensive health insurance coverage helps shield people and families from unforeseen medical bills, particularly in light of the rising costs of healthcare and the growing prevalence of chronic conditions. It is essential for Rhode Islanders to comprehend the subtleties of the RI health insurance plans in order to make well-informed judgments regarding their medical needs.

From employer-sponsored plans to individual policies accessible through the state’s health insurance marketplace, RI health insurance plans provides a range of health insurance options. In addition, the state offers Medicaid and other assistance programs as options for low-income individuals and families. It can be difficult to navigate these possibilities, but with the correct knowledge, residents can select the option that best suits their needs.

We will look at many facets of RI health insurance plans in this extensive overview. We’ll talk about the availability of free health insurance, the state’s requirements for getting insurance, and how much insurance costs in various areas. We will also talk about Rhode Island’s policies regarding out-of-state medical cards, the minimum insurance requirements, and the need for medical cards. The purpose of this book is to give residents of Rhode Island a comprehensive understanding of health insurance so they may make educated decisions.

Is There Free Health Insurance in Rhode Island?

RI health insurance plans provides qualified people with free or inexpensive health insurance through a number of programs. Medicaid, or RIte Care in Rhode Island, is one of the main programs. RIte Care is intended for people with impairments, children, pregnant women, and low-income households. Preventive care, prescription drugs, hospital stays, doctor visits, and other medical services are all covered by the program.

RIte Care eligibility is determined by household size and income. For instance, Rite Care is available to children residing in households earning up to 261% of the federal poverty level (FPL). Parents and pregnant women who make up to 190% of the federal poverty level may also be eligible. In addition, the program offers coverage to disabled people who fulfill specific requirements. Residents can apply online, by mail, or in person at a local DHS office. The application process is simple.

In addition to RIte Care, Rhode Island takes part in the Children’s Health Insurance Program (CHIP), which offers health insurance to children from low-income households who do not meet the requirements for Medicaid but do not have health insurance. Immunizations, emergency treatments, and dental and vision care are all covered in full under CHIP. Family size and income determine eligibility for CHIP, with stricter income limits than for Medicai.

Adults who do not meet Medicaid eligibility requirements can search for health insurance plans on the HealthSource RI marketplace, which is provided by the state of Rhode Island. The cost of premiums may be lowered for people through tax credits or subsidies, depending on their income. There are numerous plans offered by HealthSource RI, each with varying levels of coverage, so residents are sure to find something that suits their requirements and budget.

Does RI Require Health Insurance?

Rhode Island has enacted an individual mandate requiring health insurance coverage for its citizens as of 2021. This requirement is a component of the state’s initiatives to preserve the stability of the health insurance market and guarantee that all citizens have access to reasonably priced healthcare. The mandate is in line with the objectives of the Affordable Care Act (ACA), even if in 2019 the federal individual mandate penalty was eliminated.

Residents of Rhode Island are required to maintain basic essential coverage, which includes Medicaid, Medicare, employer-sponsored plans, individual health insurance plans obtained via HealthSource RI, and other acceptable health plans. When submitting their state income taxes, those without health insurance coverage may be subject to a penalty from the state.

In Rhode Island, the cost of going without health insurance is determined by taking the higher of two figures: a fixed monetary amount for each adult and kid living in the home who is not covered by insurance, or a percentage of family income. The penalty is specifically 2.5% of household income, which works out to $695 for each adult and $347.50 for each child, whichever is higher. On the other hand, maximum penalty limitations are determined by household income.

The individual mandate is not applicable in some situations. Residents who satisfy certain requirements, have a short coverage gap of less than three months, are members of a recognized religious sect that objects to insurance, or face financial hardship may be eligible for an exemption. You can seek exemptions via the HealthSource RI or when you file your state taxes.

How Much is Health Insurance in RI?

Numerous variables, such as the kind of plan, the extent of coverage, and the state’s location, affect the price of health insurance in Rhode Island. Regional variances in healthcare prices, provider networks, and demographics can all have a substantial impact on health insurance rates.

The state’s health insurance marketplace, HealthSource RI, is where Rhode Islanders can get health insurance. A variety of plans are available from HealthSource RI, divided into four metal tiers: Bronze, Silver, Gold, and Platinum. With Bronze plans often having the lowest premiums and greatest out-of-pocket costs and Platinum plans having the highest premiums and lowest out-of-pocket costs, each tier denotes a different degree of coverage and cost-sharing.

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Regions with Highest Payment Structure

  • Providence County: Compared to other areas, Providence County typically has higher health insurance premiums due to its high population. A greater population and an increase in the demand for healthcare services may result in higher insurance costs. Depending on age and other variables, an individual’s typical monthly premium for a Silver plan in Providence might vary from $450 to $600.
  • Newport County: In addition to having a high cost of living and a posh population, Newport County also has higher health insurance rates. A Silver plan in Newport can cost between $460 and $610 per month for an individual, which is comparable to or somewhat more than in Providence.

Regions with Lowest Payment Structure

  • Washington County: Compared to Providence and Newport, Washington County, which is in the southern portion of the state, usually offers cheaper health insurance costs. In average, living expenses and medical costs are lower in this area. Here, an individual’s typical monthly premium for a Silver plan can vary from $430 to $580.
  • Bristol County: This area also has comparatively cheaper health insurance costs. Affordable rates can be attributed to factors like as a smaller population and decreased demand for healthcare services. A single person’s monthly Silver plan in Bristol can cost anything from $440 to $590.

What is RI Short For?

Rhode Island, often abbreviated as RI, is the smallest state in terms of land area in the union. Rhode Island, despite its tiny size, has a rich history, a diversified population, and has made substantial contributions to the cultural and economic fabric of the country. The state is surrounded by the Atlantic Ocean to the south, Massachusetts to the north and east, and Connecticut to the west. It is situated in the New England region.

The marine heritage, sand beaches, and coastal villages of Rhode Island are well-known. The official moniker of the state is “The Ocean State,” which alludes to the significance of nautical operations and its vast coastline. A center of the arts and sciences, Providence is home to the Rhode Island School of Design and Brown University, two of the nation’s most esteemed universities.

Rhode Island is known for its historical significance, stunning natural surroundings, and healthcare initiatives that aim to give its citizens access to reasonably priced health insurance. The state’s dedication to guaranteeing that every citizen has the chance to acquire high-quality healthcare coverage is demonstrated by HealthSource RI, the state’s health insurance marketplace.

What are RI Minimum Insurance Requirements?

Rhode Island has set minimum insurance requirements to guarantee citizens’ access to necessary medical care and financial security. Both health insurance and other insurance kinds, such auto insurance, must comply with these rules. We will concentrate on the minimum needs for health insurance in this post.

Health Insurance

In order to comply with each state’s unique requirement, health insurance plans in Rhode Island are required by law to offer a minimum degree of coverage. This bare minimum necessary coverage consists of:

  • Preventive services: Immunizations, screenings, and yearly physicals are examples of preventive care that health insurance companies are required to provide without requiring a copayment. This guarantees that locals will have access to the preventive care they need to stay healthy.
  • Essential Health Benefits: Plans have to cover ten categories of services, or essential health benefits.
  1. Ambulatory patient services
  2. Emergency services
  3. Hospitalization
  4. Maternity and newborn care
  5. Mental health and substance use disorder services, including behavioral health treatment
  6. Prescription drugs
  7. Rehabilitative and habilitative services and devices
  8. Laboratory services
  9. Preventive and wellness services and chronic disease management
  10. Pediatric services, including oral and vision care
  • Pre-existing Condition Coverage: Pre-existing conditions cannot be excluded from coverage or subject to increased premiums from health insurance programs. This prevents people who have a history of chronic illness from being denied access to essential medical care.
  • Mental Health Parity: Plans have to cover mental health and drug-related disorders in the same way as they cover medical and surgical services. This guarantees all-inclusive assistance for mental health need.

Do You Need a Medical Card in RI?

While a medical card is not always required in Rhode Island in order to get healthcare services, it is required for several programs and benefits, especially for those who are enrolled in Medicaid. The medical card, also known as a Medicaid card or RIte Care card, enables beneficiaries to get approved medical services and acts as documentation of their eligibility for Medicaid coverage.

Medicaid and RIte Care

The medical card is necessary for residents enrolled in Medicaid or RIte Care in order to obtain healthcare services from participating providers. Important elements including the beneficiary’s name, Medicaid ID number, and coverage details are all on the card. Presenting the medical card to a healthcare practitioner when visiting them guarantees that the treatments are billed to Medicaid, which lowers or eliminates the beneficiary’s out-of-pocket expenses.

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HealthSource RI

A medical card might not be required for people who buy health insurance via HealthSource RI unless their selected insurance plan offers one. Rather, upon enrolling, individuals obtain an insurance ID card from their provider, which they need to show in order to obtain medical care. This card indicates the person’s insurance status and makes billing and claims processing easier. It functions similarly to the Medicaid card.

Private Health Insurance

An insurance ID card is also provided by the insurer to residents who have private health insurance, whether via individual policies or through their employment. This card contains information on the policyholder, the insurance plan, and the coverage. In order to obtain healthcare services, it is utilized to process claims and confirm coverage.


The federal government issues Medicare cards to those who qualify for the program. This card, which contains the beneficiary’s Medicare number and coverage details, is required in order to obtain Medicare-covered services. At doctor’s appointments, presenting the Medicare card guarantees that the services are correctly invoiced to Medicare.

Does RI Take Out-of-State Medical Cards?

When it comes to accepting out-of-state medical cards, Rhode Island has strict policies, especially for Medicaid recipients. For routine medical treatments in Rhode Island, out-of-state medical cards are typically not accepted. There are, however, some exceptions made for emergency situations and care that has been scheduled in advance.

Emergency Situations

Healthcare professionals in Rhode Island are obligated to treat patients in an emergency, regardless of their insurance status or country of origin. An out-of-state Medicaid beneficiary may be able to receive emergency medical care while in Rhode Island, and the costs may be covered by their home state’s Medicaid program. In order to file claims and get paid, the healthcare practitioner usually works with the Medicaid program in the patient’s home state.

Pre-arranged Care

Out-of-state Medicaid enrollees must have prior authorization from their home state’s Medicaid program in order to receive non-emergency medical services, pre-arranged care, or specialist treatments. To make sure the services will be paid for, this entails working with Rhode Island healthcare providers as well as the state where the patient resides. The patient can receive the required care in Rhode Island if authorization is granted, with the expenses being billed to their home state’s Medicaid program.

Medicare and Private Insurance

Medicare beneficiaries can obtain services from any provider who accepts Medicare, and their coverage is typically nationwide. Out-of-state Medicare cards are honored by Rhode Island healthcare providers who take Medicare, enabling patients to access care without further hassles.

In a similar vein, Rhode Island services are accessible to those who have private health insurance that covers them both nationally and outside of their state. To prevent further out-of-pocket expenses, it is crucial for these people to be sure their insurance plan covers benefits for out-of-state medical care and that the Rhode Island healthcare provider is part of the insurance network.

HealthSource RI Plans

Rhode Island citizens can only purchase health insurance policies through HealthSource RI. A resident with HealthSource RI coverage who relocates to a different state will have to buy a new health insurance plan via the state’s marketplace. Outside of Rhode Island, HealthSource RI does not offer coverage, unless the plan has particular features that are available outside of the state.

How Do I Contact Medicaid in RI?

In Rhode Island, residents can easily contact Medicaid by choosing from a number of available alternatives whether looking for help, information, or to apply for benefits. The state’s Medicaid program—which includes RIte Care and additional health care options—is managed by the Rhode Island Department of Human Services (DHS).

Contact Information

Customer Service Phone Number: If residents need help with Medicaid applications, questions, or general information, they can contact the DHS customer service number. One can reach them at 1-855-697-4347. Customer support agents are on hand to respond to inquiries, offer advice, and assist with the application procedure.

Online Portal

The DHS web portal, available at www.healthyrhode.ri.gov, enables citizens to maintain their benefits, apply for Medicaid, and check the progress of their application. The portal offers a practical means of obtaining data and services without the requirement of physically visiting an office.

In-Person Assistance

Residents can speak with representatives in person at any of the state’s DHS field offices if they would rather receive assistance in person. Applications, eligibility checks, and other Medicaid-related services can be assisted by these offices. The DHS website lists the locations and office hours for each DHS office.

Additional Resources

  • HealthSource RI: Residents can contact HealthSource RI’s customer service line at 1-855-840-4774 or visit their website at www.healthsourceri.com to learn more about obtaining health insurance through the state marketplace. Information regarding available plans, financial aid, and application support can be obtained at HealthSource RI.
  • Executive Office of Health and Human Services (EOHHS) in Rhode Island: Medicaid and other state health programs are supervised by the EOHHS. They have detailed information regarding Medicaid programs, eligibility, and contact information on their website.
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How Much Does It Cost to Go to Healthcare in Rhode Island?

Depending on the service type, healthcare provider, and patient’s insurance status, the cost of healthcare in Rhode Island can vary greatly. An overview of the typical expenses for common healthcare services in Rhode Island, both with and without insurance, is given in the accompanying table.

Healthcare Service Average Cost with Insurance Average Cost without Insurance
Primary Care Visit $25 – $50 (copay) $150 – $300
Specialist Visit $30 – $70 (copay) $250 – $500
Emergency Room Visit $100 – $500 (copay) $1,200 – $3,000
Hospital Stay (per day) $200 – $500 (coinsurance) $2,000 – $5,000
Prescription Medications $10 – $50 (copay) $50 – $200
Diagnostic Tests (e.g., X-ray) $20 – $100 (copay) $200 – $500
Surgical Procedure $1,000 – $3,000 (coinsurance) $10,000 – $30,000
Mental Health Counseling $20 – $50 (copay) $100 – $250 per session
Physical Therapy Session $20 – $60 (copay) $100 – $200 per session


  • Costs with Insurance: This list includes copays and coinsurance as well as regular out-of-pocket payments for people with health insurance. Depending on the particular insurance plan and provider network, actual charges may differ.
  • Costs without Insurance: These represent the approximate expenses for those without insurance and may differ depending on the provider, the region, and the complexity of the services.

Because of the negotiated prices between insurance companies and healthcare facilities, the cost of healthcare can be considerably lower for those who are insured. Furthermore, preventative care is frequently covered by insurance plans at no additional expense to the policyholder.

What is the Penalty for Not Having Health Insurance in RI?

The individual mandate penalty, which mandates that residents have health insurance coverage or suffer a financial penalty, has been revived in Rhode Island. By encouraging ongoing health insurance coverage, this penalty seeks to lower the number of uninsured people and advance a healthier populace.

Penalty Calculation

In Rhode Island, the cost of going without health insurance is determined by dividing the total by two.

  • 2.5% of the household income over the federal tax filing level is the percentage of income. This sum is limited to the typical yearly premium for a Bronze plan offered by HealthSource RI.
  • Flat Dollar Amount: $695 for each adult without health insurance and $347.50 for each child without health insurance in the home, with a $2,085 cap per household.

Example Calculation

  • Income for the household: $60,000.
  • $12,400 is the federal tax filing threshold for a single filer.
  • Penalty Amount of Income: $60,000 – $12,400 = $47,600
  • The penalty percentage is 2.5% of $47,600, or $1,190.
  • One-time fee: $695 for each adult x two adults = $1,390
  • Penalty Owed: $1,390 is the greater of $1,190 as a percentage and $1,390 as a flat dollar amount.


There may be some people who are exempt from the punishment. Typical exclusions consist of:

  • Financial Hardship: Showing that, given income and expenses, coverage is not affordable.
  • A short coverage gap is one that lasts for fewer than three months.
  • Religious Exemption: If you are against insurance and you belong to a recognized religious sect, you are exempt.
  • Other Exemptions: These include being a prisoner, being a part of a ministry that shares healthcare, and having specific nonresident statuses.

Residents may apply online at HealthSource RI or claim exemptions when submitting their state income tax return.

Lastly, the state of Rhode Island levies a fine for non-ownership of health insurance, which encourages continuous coverage and promotes access to healthcare and financial security against medical costs. It is imperative that locals investigate their alternatives for coverage through HealthSource RI or other resources and comprehend the possible financial consequences of being without insurance.

In summary: RI health insurance plans

In order to guarantee access to high-quality healthcare and guard against financial hardship brought on by medical bills, health insurance is essential. Rhode Islanders can choose from a number of health insurance options, such as private insurance plans, Medicaid, and HealthSource RI. It is crucial to comprehend the prerequisites, expenses, and advantages of these choices in order to make well-informed choices regarding health insurance.

The individual mandate in Rhode Island, which imposes fines on those who do not obtain health insurance, emphasizes the significance of doing so. To ensure that healthcare is accessible to all citizens, the state does, however, also provide programs and subsidies to assist low-income individuals and families in obtaining affordable coverage.

Although navigating the intricacies of health insurance can be difficult, there are resources like HealthSource RI, the Rhode Island Department of Human Services, and other neighborhood organizations that offer invaluable help and direction. Residents can obtain the coverage they require to safeguard their health and financial security by being proactive and knowledgeable about their health insurance options.

Residents are advised to get in touch with the appropriate organizations, make use of internet resources, and consult medical specialists for more help or to investigate their possibilities for health insurance in Rhode Island. Rhode Islanders can have more peace of mind and access to the necessary healthcare services if they have the appropriate coverage.

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