Residents of the Ocean State are spoiled for choice when it comes to health care. According to US News, Rhode Island has the eighth best health care in the nation! That study looks at access, quality, and good public health.
Health insurance options in Rhode Island
According to Rhode Island’s Office of the Health Insurance Commissioner, there are several ways for residents to access health care in their state:
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Where do most Rhode Island residents get their health insurance coverage?
|Individual or family
|Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population
Four percent of RI residents are uninsured, significantly less than the national average. That’s good news for policyholders, as more uninsured people leads to higher rates for insured people.
Rhode Island health insurance companies
What are the best health insurance companies in RI? These providers offer both individual and family plans in your state:
- Blue Cross Blue Shield of Rhode Island
- Neighborhood Health Plan of Rhode Island
Rhode Island health insurance costs and rate factors
RI residents spend an average of $9,551 per year on health care. That’s more than the national average. So, what determines your health care costs in the Ocean State? Prices vary from person to person, but depend primarily on these factors:
Health plan type
The more coverage you want, the more you’ll have to pay in monthly premiums. Marketplace plans come in metal tiers: bronze, silver, and gold.
How much does each insurance plan type cost in RI? These are the monthly rates for a middle-aged state resident for each plan type in 2020:
|Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier
A gold plan costs about 48 percent more than a bronze plan. That’s because gold plans cover 80 percent of health care costs, whereas bronze plans cover 60 percent.
RI residents may also qualify for a catastrophic plan, the lowest level of coverage available in the health care marketplace. Catastrophic plans have low monthly premiums, but a high yearly deductible of $8,150. Because of the deductible, it may save you money to invest in a bronze or silver plan.
Body mass index
According to the CDC, a high body mass can lead to serious health conditions. That’s why insurance companies look at your BMI to assess your risk-level. A high BMI brings higher monthly premiums.
In 2019, RI had a 30 percent obesity rate, the 35th highest in the nation. Out of the many state residents who used QuoteWizard to compare health insurance plans, 26 percent had a BMI in the obese range.
Smokers pay more for health care because of the high risks from tobacco use. About 14.4 percent of RI residents are smokers, the 11th lowest rate in the country.
According to HealthCare.gov, older people are charged up to three times more for health care than younger people. State residents who used QuoteWizard to shop for health insurance are, on average, 38 years old.
Your zip code plays a role in your health care costs. Every state has different rules, regulations, and providers in their health insurance marketplace.
Insurance companies also use a community-rating system to determine your prices. Rates are partly based on the combined claims that everyone files. If your state files a too many claims, your rates could rise.
That means living in a health-conscious state can help keep your rates low. According to America’s Health Rankings, RI is the 11th healthiest state in the country.
Rhode Island has its own health insurance marketplace, which you can use to apply for health care plans.
Rhode Island health insurance laws
The Affordable Care Act limits what insurance companies can use to determine your rates.
- Pre-existing conditions: Before the ACA, insurance companies used to charge people with pre-existing conditions more for health insurance. Now, providers can’t use pre-existing conditions as a factor in your costs.
- Gender: Insurance companies also can’t charge women and men different prices for the same plan. That’s good news, especially because women historically pay more for health care.
- Insurance and medical history: Providers used to analyze your medical history and your past insurance coverage. They would use this information to charge people with previous medical problems or lapses in insurance more. Luckily, they can’t use insurance and medical history as a factor anymore.
There’s a limit to how much you’ll pay for out-of-pocket with a marketplace plan. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Rhode Island state law requires companies to provide at least some coverage for the following services:
- Maternity hospital stays
- Mental health and substance abuse
- Lead poisoning
- Lyme Disease treatment
- Diabetes treatment
- Emergency transportation
- Home health
There are additional services that providers need to offer coverage for. Find the full list on cms.gov.
Medicare and Medicaid in Rhode Island
Medicare and Medicaid are government-funded programs that offer affordable health care in your state. These programs cater to two different groups of people. Medicare covers seniors, whereas Medicaid helps low-income families and children.
RI residents 65 and over qualify for Medicare. There are several coverage options within the program, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for a Medicare Savings Program with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid aids low-income families and children in your state. These are the state’s Medicaid financial requirements:
|Maximum Yearly Income
Office of the Health Insurance Commissioner of Rhode Island
- Insurance Commissioner:
- Marie L. Ganim
- Insurance Hotline:
- (855) 747-3224
- Office Hours:
- Monday - Friday
8:00 am to 4:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
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