Health Insurance Marketplace in Rhode Island
If you live in Rhode Island, HealthSource RI is the Health Insurance Marketplace to serve you. Instead of HealthCare.gov, you’ll use HealthSource RI website to apply for coverage, compare plans, and enroll. Visit HealthSource RI now to apply.
Choosing the Right Health Insurance Plan
There are a number of different tiers of plans available on the Rhode Island Health Insurance Exchange. Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:
NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.
Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.
Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.
Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.
Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.
Rhode Island health insurers don’t have to offer every tier of plan, but within the Rhode Island health insurance exchange, all health insurance companies must offer at least one silver plan and one gold plan to consumers.
Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.
f you’re a consumer and you live in Rhode Island, you’ll use HealthCare.gov to apply and enroll. Here’s what to know before you apply. You can see if you qualify for lower costs and preview plans and prices. Small businesses: Learn how to apply for SHOP coverage.
If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.
[contact-form-7 id=”73″ title=”Contact form 1″]
Accountable Care Organizations in Rhode Island
ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.
- University Of Rhode Island RI – Health Care Innovation Award
- Women & Infants Hospital of Rhode Island RI – Health Care Innovation Award
- Health Resources In Action RI – Health Care Innovation Award
- State of Rhode Island RI – Multi-payer Advanced Primary Care Program
- State of Rhode Island RI – State Innovation Models Initiative: Model Design Awards
- State of Rhode Island RI – Medicaid Emergency Psychiatric Demonstration
Health care facilities where Innovation Models are being tested
- Coastal Medical, Inc Providence, RI – Advance Payment ACO Model
- Newport Hospital Newport, RI – BPCI Initiative: Model 2
- The Miriam Hospital Providence, RI – BPCI Initiative: Model 2
- Rhode Island Hospital Providence, RI – BPCI Initiative: Model 2
- Kent Hospital Warwick, RI – BPCI Initiative: Model 2
- Homefront Health Care Providence, RI – BPCI Initiative: Model 3
- Visiting Nurse Home Care Lincoln, RI – BPCI Initiative: Model 3
- Steere House Nursing & Rehabilitation Center Providence, RI – BPCI Initiative: Model 3
- St. Clare Home for the Aged Newport, RI – BPCI Initiative: Model 3
- Saint Elizabeth Manor Bristol, RI – BPCI Initiative: Model 3
- Saint Elizabeth Home East Greenwich, RI – BPCI Initiative: Model 3
- Saint Antoine Residence North Smithfield, RI – BPCI Initiative: Model 3
- Carelink, Inc. Providence, RI – Community-based Care Transition Program
- East Bay Family Health Riverside, RI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Thundermist Health Center of West Warwick West Warwick, RI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- WellOne Primary Medical and Dental Care North Kingstown, RI – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
- Nancy Roberts RN, MSN Warwick, RI – Innovation Advisors Program
- Jean Sanders BSN Newport, RI – Innovation Advisors Program
- Betty Vohr MD Providence, RI – Innovation Advisors Program
- Gary Christensen MS Providence, RI – Innovation Advisors Program
The Insurance Exchange/Marketplace
What has been done, not been done, or left up to the federal government to do.
Establishing the Exchange in Rhode Island
After the legislature failed to pass exchange legislation during the 2011 session, Governor Lincoln Chafee (I) signed Executive Order 11-09 on September 19, 2011, to establish the Rhode Island Health Benefit Exchange.1 In July 2013, Rhode Island announced that its new marketplace would be called HealthSource RI.2
Recommendations by the Rhode Island Healthcare Reform Commission largely informed the Governor’s decision to issue an Executive Order. After SB 87 failed, the Commission regrouped to continue planning a state-based exchange.3 The Commission’s Executive Committee focused on evaluating non-legislative strategies to establish an exchange, while the Commission’s Health Insurance Exchange Workgroup began meeting biweekly to form recommendations on policy options to the Executive Committee.
Structure: The Executive Order establishes the Rhode Island Health Benefit Exchange as “a Division within the Executive Department.”
Governance: The Exchange will be governed by a 13-member board. The Board includes four ex officio members (or their designees): the Director of the Department of Administration; the Health Insurance Commissioner; the Secretary of the Executive Office of Health and Human Services; and the Director of the Department of Health. The Governor appoints nine Board members, two of whom will represent consumer organizations and two to represent small businesses. The remaining appointees will provide demonstrated expertise in a diverse range of health care areas including, but not limited to, individual health care coverage, small employer health care coverage, health benefits plan administration, health care finance and accounting, administering a public or private health care delivery system, state employee health purchasing, electronic commerce, and promoting health and wellness. Board members cannot be affiliated with in any way, an insurer, a health insurance agent or broker, a health care provider, or a health care facility or clinic. No Board member can be a health care provider, unless no compensation is received for services rendered and the provider has no ownership interest in a professional health care practice.
The Exchange Board is required to receive guidance from an Expert Advisory Committee comprised of health industry experts, including representatives of insurers, agents and brokers, and providers. The Board also collects feedback from the Commission’s Health Insurance Exchange Workgroup, which allows for stakeholder participation and input on policy decisions.
Current appointed Board members are:
- Margaret Curran (Chair), former United States Attorney for Rhode Island
- Geoffrey E. Grove (Vice-Chair), Pilgrim Screw
- Michael C. Gerhardt, Save The Bay and former Health Insurance Executive
- Margaret Holland McDuff, Family Services of Rhode Island
- Linda Katz, The Economic Progress Institute
- Marta Martinez, Progresso Latino
- Pamela McKnight, MD (not currently practicing)
- Dwight McMillan, The Basics Group
- Tim Melia, UFCW New England Council
In June 2012, the Board hired an Executive Director to oversee all Exchange activities. The Board has met regularly since October 2011 and receives feedback from the Commission’s Health Insurance Exchange Workgroup and the Expert Advisory Committee. Subcontractors have been solicited to provide Exchange technical assistance including, assistance with business processes, stakeholder support, health plan certification, financial management and oversight, and commercial market activities to support the viability of the Exchange.45
In June 2012, the Governor signed SB 2888 into law requiring the Office of the Health Insurance Commissioner and the state’s Executive Office of Health and Human Services to issues a series of reports to the Joint Committee on Health Care Oversight by October 1, 2012.6 The reports were required to analyze state options regarding the feasibility of implementing a Basic Health Program Option (BHP), the impact of merging of the small-group and individual markets on rates and coverage, and the feasibility of requiring the same insurance products to be sold inside and outside of the Exchange, including an assessment of coverage and rate impacts.
Contracting with Plans: The Exchange will function as an active purchaser that has “the discretion to determine whether health plans offered through the Exchange are in the interests of qualified individuals and qualified employers.” The Advisory Committee has explored Rhode Island’s options for risk adjustment and reinsurance, noting that legislation will be necessary in the future.7
The Exchange began direct negotiations with carriers in the fall of 2012. All four carriers in Rhode Island expressed interested in selling through HealthSource RI–Blue Cross Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island and United Healthcare (SHOP only) filed to offer in 2014 and Tufts Health Plan intends to file for 2015. There will be twelve plans offered through the individual market and sixteen on the small group market.8 In June 2013, the Office of the Health Insurance Commissioner approved final forms and rates for plans submitted by carriers.9 The HealthSource RI Board will certify QHPs for inclusion on the marketplace.
Consumer Assistance and Outreach: The state has hired staff to focus on public outreach for the Exchange. In November 2012, the Exchange Board reviewed a draft Request for Proposals for the Exchange Contact Center.10 In addition, a subgroup of the Exchange Board was formed to work on stakeholder issues and consumer support strategies. In May 2013, the Rhode Island Department of Administration/Division of Purchases issued a Request for Proposals (RFP) for a vendor to select and manage the state’s Outreach and Enrollment Support Program (OESP) network. The OESP will consist of assisters and assister entities that will provide outreach and enrollment assistance to individuals and families applying for coverage through HealthSource RI. The awardee will become the Network Manager and will be responsible for training, certifying, managing, and compensating the network of assisters. Applications were due on June 4, and the contract will begin at the end of July.11 In March 2013, the state released a RFP for a vendor to design and implement a contact center and in May 2013 selected a vendor.12 The contact center will be operational by September 15, 2013.
In July 2013, Rhode Island launched the “39 in 3” campaign, through which HealthSource RI officials will visit all 39 Rhode Island cities in three months to educate small employers, community organizations, and individuals about the health coverage options that will be available to them through the marketplace in 2013. Also in July, the state launched a marketplace website and contracted with a marketing firm to develop and produce a media campaign.13
Small Business Health Options Program (SHOP) Exchange: The Exchange Board has begun to engage in a broad discussion of SHOP issues and options, including how to best mitigate against adverse selection, how to broaden employee options in the SHOP, and how to develop sufficient data to be able to offer the consumer and employers information about value. The SHOP will use the full employee choice model; employers will give their employees the choice to enroll in any plan offered through the SHOP.8
Information Technology (IT): Rhode Island envisions building an integrated eligibility system that will make determinations for Medicaid, the Exchange, and eventually for other public programs. In January 2013, the state awarded a $105 million contract to a vendor to design, implement, and operate a technology platform to support the Exchange and the integrated eligibility system.14 In January 2012, the state solicited subcontractors to manage the transition to an upgraded Medicaid Management Information System.5, 15 The state is also part of a consortium participating in the “Enroll UX 2014” project, which is a public-private partnership creating design standards for exchanges that all states can use.16
Financing: The Executive Order authorizes the Exchange to receive funds from insurers or other entities, including the United States Department of Health and Human Services. The Board will determine how the funds are to be received from insurers and the amounts.
Essential Health Benefits (EHB): The Affordable Care Act requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. States must decide whether to benchmark their EHB plan to one of ten plans operating in the state or default to the largest small-group plan in the state. In September 2012, the state recommended Blue Cross Blue Shield of Rhode Island- Vantage Blue PPO to serve as the benchmark plan.
The Rhode Island Department of Business Regulation received a federal Exchange Planning grant of $1 million in 2010 and was awarded a $5.2 million federal Level One Exchange Establishment grant in May 2011 to “strengthen health information technology systems, develop an integrated consumer support program to provide support to individuals and small businesses, and strengthen its business operations.” In addition, Rhode Island is a member of the consortium of New England states that received a federal Early Innovator grant of $44 million to develop, share, and leverage insurance exchange technology. The multi-state consortium also includes Connecticut, Maine, Vermont, and Massachusetts with the University of Massachusetts Medical School as the grant holder. In November 2011, Rhode Island received the first Level Two Exchange Establishment grant. The $58.5 million grant will fund the development, design, and technology procurement of the Exchange through December 2014.17
Rhode Island, along with nine other states, is receiving technical assistance from the Robert Wood Johnson Foundation through the State Health Reform Assistance Network; this assistance includes help with setting up health insurance exchanges, expanding Medicaid to newly eligible populations, streamlining eligibility and enrollment systems, instituting insurance market reforms and using data to drive decisions.18
Expansion of Medicaid
From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.
As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.
However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.
Rhode Island is participating in Medicaid expansion.
On December 20, 2012, Rhode Island received conditional approval from the U.S. Department of Health and Human Services (HHS) to establish a state-based exchange. Final approval is contingent upon the state demonstrating its ability to perform all required Exchange activities on time, complying with future guidance and regulations, and developing a comprehensive implementation plan. The state must also participate in a working session with the federal government and their system integrator vendor before February 28, 2013, to update timelines, re-prioritize projects, and outline specific opportunities of reuse of IT system components.1920
Additional information about the Rhode Island Healthcare Reform Commission can be found at: http://www.healthcare.ri.gov/.
- Executive Order 11-09. Establishment of the Rhode Island Health Benefits Exchange.← Return to text
- ← Return to text
- SB87. Rhode Island’s bill to establish a health benefit exchange in 2011.← Return to text
- Rhode Island Level One Establishment grant application. Funding Opportunity IE- HBE-11-004.← Return to text
- Request for Proposals #7449222: Health Insurance Exchange Technical Assistance. November 9, 2011.← Return to text
- SB2888. An Act Relating to Insurance. 2012.← Return to text
- Risk Adjustment and Reinsurance. Rhode Island Health Benefits Exchange Expert Advisory Committee. November 22, 2011.← Return to text
- Rhode Island Health Benefits Exchange. Update on Qualified Health Plan Filings: Advisory Board Briefing. May 15, 2013.← Return to text
- Office of the Health Insurance Commissioner. “OHIC Approves Commercial Health Insurance Contracts, Rates and Rate Factors.” June 28, 2013.← Return to text
- RI Health Benefits Exchange Advisory Board. Meeting Minutes. November 13, 2012.← Return to text
- ← Return to text
- Request for Proposals: Rhode Island Health Insurance Contact Center. March 20, 2013.← Return to text
- ← Return to text
- “Deloitte Awarded $105m Contract to Create New Healthcare System.” January 24, 2013.← Return to text
- Request for Proposals. EOHHS PMO and IV&V Services for MMIS system transition and health information exchange/ eligibility system implementation. January 24, 2012.← Return to text
- Enroll UX 2014 website.← Return to text
- Rhode Island Affordable Insurance Exchange Awards List. CCIIO.← Return to text
- Robert Wood Johnson Foundation. ‘RWJF Seeks Coverage of 95 Percent of All Americans by 2020.’ May 6, 2011.← Return to text
- Letter from Governor Chafee to Kathleen Sebelius. July 5, 2012.← Return to text
- Letter from HHS to Governor Chafee. December 20, 2012.← Return to text
Also of interest