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Rhode Island Health Insurance

Rhode Island Medical Insurance Overview
In general, Rhode Island has a good portion of healthy residents as compared to the rest of the country.  Many residents in this state are covered by health insurance.  The state ranks rather high with regard to the health of its residents, but it also has seen a lot of improvements in the health of its residents in recent years.  With the healthcare legislation coming into play as of recent, it is believed that the trend of good health in the state of Rhode Island will continue.  Health benefits are common in this state, but there are still a lot of people who don’t have some sort of coverage.

The Affordable Care Act was put into action in 2010 and along with it, each state was expected to see improvements in their healthcare and health insurance.  The ACA is expected to show increased numbers of insured people throughout 2020.  The provisions listed under the ACA are hoped to provide insurance policies for as many as 30 million more Americans in the coming years.

Rhode Island’s Health Care Issues
According to a report from the United Health Foundation, the state of Rhode Island is ranked in 14th place when compared against the health status of the rest of the states in the U.S.  From 2011 to 2014, the state has seen a rise in its rankings, showing its health status as strong in general.  With healthcare reform recently passed, the state will see more strengths and less weaknesses in the future.

Among the state’s strengths are its high per capita public health funding, its high percentage of vaccinations among children of adolescent age and its readily available primary care doctors.  Challenges in the state include its high prevalence for excessive drinking, its large disparity in health status by level of education and its high rate of deaths related to drugs.

Understanding Rhode Island’s Uninsured Population
Data offered by the Kaiser Family Foundation shows that five percent of residents in the state of Rhode Island had no insurance in 2014.  The percentage of uninsured people in the state was sixteen percent in 2010, so this drop is quite significant.

Provided below are statistics regarding the uninsured portion of Rhode Island’s residents:

  • 3% are children under the age of 18
  • 7% are adults between the ages of 19 and 64
  • 28% of the total uninsured population earns less than 199% of the Federal Poverty Level
  • The state has zero percent of uninsured people earning over 400% of the Federal Poverty Level, unlike other states

Group Health Plans
In the state of Rhode Island, Health Maintenance Organizations are regulated by the State of Rhode Island Department of Business Regulation and the Rhode Island Department of Health, and Preferred Provider Organizations are regulated entirely by the Rhode Island Department of Health.

While many of the regulations that are in place in this state try to urge companies to offer insurance plans to their workers, smaller companies have a more difficult time because of the associated costs.  It is almost always harder for smaller businesses to be able to afford their portion of the premiums, which results in employees being unable to obtain group coverage.

Despite group policies being subsidized, many require the employee to pay monthly premiums.  These premiums are typically deducted automatically from the worker’s paycheck each pay cycle.  If you need insurance in the state of Rhode Island, the best place to look first is through your employer for a group insurance plan.  Fifty-four percent of residents of this state are covered under a group plan offered by their workplace.

Signing Up
Registering for health insurance coverage is a tough decision because of the costs and coverage options involved.  Before you sign up for coverage under any policy, think about the factors listed below:

  • Do you have chronic medical needs that will need to be taken care of through the new policy?
  • Are there many options of which to select?  Some providers offer varying levels of coverage that can differ in cost.
  • Do you need to cover your dependents or your spouse?  Mention this information early so you can have them enrolled at the same time as you are.

In many cases, if you decide not to enroll in the company’s group plan, you can try to enroll at a later time, but only during the company’s enrollment period.  For information on the enrollment period, contact the person in charge of Human Resources at your workplace.

Pre-Existing Condition Exclusion Periods
Under a group insurance policy, you can’t be declined coverage based on a pre-existing condition.  However, you may be subject to waiting through an exclusion period for six months before your health insurance benefits can be used.

Despite the exclusionary period applying to you as the applicant, any dependents you want covered under the age of 19 are not subject to waiting through this period.  In addition, insurance companies providing this type of coverage can look back into your medical files for a period of six months to determine whether or not you have a pre-existing condition.  Lastly, just because you may be genetically predisposed to having an illness or condition, it does not meet the requirements to be considered a pre-existing condition absent an official diagnosis from your physician.

Affiliation or Waiting Periods
If the company you work for gets its health insurance policy from an HMO, you may be required to wait through an affiliation period of two months.  However, enrolling late will cause the affiliation period to be extended to three months.  During this period of time, you will not have access to your health insurance policy’s benefits.

Individual Health Plans
In the state of Rhode Island, individual health insurance covers nine percent of the overall population.  This coverage is available to people who are unemployed, self-employed or employed through a company that does not offer insurance benefits.

People enrolling in this sort of coverage are at a disadvantage, primarily because the insurance companies offering these plans do a lot of medical underwriting when determining your eligibility for coverage.  In addition, they can limit coverage for those suffering from pre-existing conditions.  According to estimates, a young person who is healthy in Rhode Island can obtain an individual insurance policy for around $100 every month.  This is somewhat high when compared to the costs of individual policies in other states and the plan won’t necessarily be comprehensive in nature.

Continuation Coverage
Continuation coverage through the Consolidated Omnibus Budget Reconciliation Act (COBRA) is available if you have lost your job, are divorced or have lost your dependency status for any reason.  If you need coverage, group insurance benefits can be extended for up to 18 months.  To determine your eligibility for this kind of coverage, it solely depends on the amount of employees that the original policy issuing employer had.

Rhode Island Health Benefit Exchange
In order to comply with the mandates under the Affordable Care Act, the state of Rhode Island created its own state-run benefits marketplace.  To access the website, go to  On this website, consumers can access different health insurance options, compare plans and select appropriate levels of coverage.

For detailed information on the history of Rhode Island’s benefits exchange, refer to the Henry J. Kaiser Family Foundation’s website.

Rhode Island State Insurance Programs
If you cannot obtain group coverage because it is unaffordable or not offered – and individual coverage proves to be too expensive, you can apply for coverage through one of the state’s many publicly funded programs.  Various factors come into play, such as age, gender, health condition and medical history.

The following plans are offered to residents in Rhode Island:

Pre-Existing Condition Insurance Plan (PCIPRI)
For residents of Rhode Island who are suffering from pre-existing medical conditions.  Under this program, participants are able to access comprehensive health benefits as long as you have not had any kind of insurance for six months prior to enrollment.  In order to qualify, you must be able to show proof that you have been denied insurance coverage based on your pre-existing condition.

Medical Assistance
This plan is geared toward Rhode Island residents who have low incomes.  There are many services that are covered and income is used to determine eligibility.  At times, there is a zero cost for monthly premiums, but in the event you are charged premiums, they are rather small.

For children whose families earn moderate levels of income, this program gives them three different choices of which to select.  RiteShare offers families who are covered under group plans the ability to receive help with the costs associated with their monthly premiums.

Katie Beckett
Through this program, uninsured kids along with their families in Rhode Island can get coverage if the family unit earns a moderate level of income.  This program is also geared toward assisting kids who have special needs.

General Public Assistance (GPA)
For adults in the state who don’t have insurance coverage, this program covers generic prescription medications and doctor’s visits.  In order to be eligible, you must be between the ages of 19 to 64 and have a qualifying level of income.

Women’s Cancer Screening (WCS)
This program works to provide various cancer screening services to women living in the state of Rhode Island.  In order to qualify, income and age guidelines must be met.  Premiums are typically at no cost or a minimal cost to participants.

Medicare, Medicare Prescription Drug Program, and the Senior’s Health Insurance Program (SHIP)
For seniors, people suffering from Renal Disease or disabled people, the Medicare program offers health insurance benefits.  In order to offer coverage to seniors, you or your spouse must have worked in a job that was covered by Medicare for at least ten years.

There are four parts to Medicare: Part A, Part B, Part C and Part D – each with varying levels of coverage and required contributions.  SHIP is a counseling service for those looking into Medicare in Rhode Island.

Health Coverage Tax Credit
For people receiving trade assistance, the health coverage tax credit is a subsidy offered.  In order to qualify, you must be over 55 years old and receiving pension benefits through the Pension Benefits Guaranty Corporation.

VA Medical Benefits Package
Military vets are able to secure a comprehensive benefits package if they have completed 24 consecutive months of service and received an honorable discharge.  The branch of the military served is not taken into account.

Partnership for Prescription Assistance
The PPA is a free service that is geared toward helping the nation’s citizens get help paying for prescription medications.  There are 475 programs available and they all work to get prescription drugs for lesser costs to anyone who needs this type of assistance.

Women, Infants, and Children (WIC)
WIC is a nationwide program that offers many benefits to pregnant women, postpartum women, infants and children through the age of five.  Women can receive educational services on breastfeeding and infant care along with supplemental food items like milk and peanut butter.  To be eligible, you must qualify based on income, and there are typically no premiums to pay for this program.

National Association of Mental Illness (NAMI) Helpline
This is a nationwide helpline that is geared toward helping those persons suffering from mental illness.  The NAMI Helpline is staffed by volunteers who provide resources on treatment options to those who call in.

The Health Insurance Portability and Accountability Act (HIPAA)
HIPAA affects consumers with regard to how their medical records are treated.  It also offers protections regarding health insurance companies.  HIPAA limits an insurance provider’s ability to deny coverage through a group plan to those suffering from pre-existing medical conditions.  It also regulates the amount of time designated for affiliation and exclusion periods.  Additionally, it has provisions regarding COBRA coverage, but it does not make it mandatory for companies to offer insurance benefits to their workers.