Overview of Rhode Island’s Health Insurance Exchange
When the Affordable Care Act was passed in 2010, states gained the opportunity to build health insurance marketplaces called exchanges. Health Source Rhode Island, Rhode Island’s exchange, enabled Rhode Islanders to start shopping for plans on October 1, 2013. Open enrollment lasts until March 1, 2014, and plans will be effective on January 1, 2014.
The Health Source Rhode Island site offers an Insurance Selector Tool that will walk you through the process of finding a plan, applying for coverage, and paying for it. In the process, you’ll learn about what tax credits you qualify for. You’ll also be able to look at various points of comparison between plans, including their costs and levels of coverage.
Payments can be made through the Health Source Rhode Island website, or via mail. Help with the enrollment process is available via phone and Internet, as well as in-person.
Per the Affordable Care Act, plans purchased via Health Source Rhode Island must offer the following essential services:
- Doctor visits
- Emergency services
- Maternity and newborn care
- Mental health and substance disorder services
- Prescription drugs (limited to certain drugs depending on the plan)
- Rehabilitative services
- Habilitative services (occupational, physical therapy, and speech therapy to help people acquire, maintain, or improve skills and functioning for daily living)
- Lab services
- Preventive and wellness care
- Dental care
- Pediatric care including oral and vision
Rhode Island’s exchange will offer a total of 28 plans: 12 for individuals and 16 for small businesses. Blue Cross Blue Shield of RI (BCBSRI) and Neighborhood Health Plan of Rhode Island will offer plans for individuals and families.
Consumers can compare essential benefits and rates, and determine if they qualify for a tax-credit subsidy with built-in calculators provided on HealthSourceRI.
There are three tiers of qualifying health plans you or your employer can purchase on the exchange. They range from the lower quality (but more affordable) Bronze Plan, which covers 60 percent of health costs, to the Silver Plan, which covers 70 percent, to a more expensive plan with better coverage called a Gold Plan that covers 80 percent. Lower premium plans will have higher deductibles, fewer benefits, and larger out-of-pocket costs.
Monthly premiums for a 25-year-old ranges from $167 a month for a Bronze Blue Cross plan to $283 a month for a Gold Plan. For a 45-year-old, the monthly premium ranges from $240 for a Bronze Plan to $408 for a Gold Plan. Copayments, co-insurance, and deductibles vary. A “catastrophic health plan” with a higher deductible is available to people under the age of 30 with lower income. It allows them to be protected from through-the-roof costs.
Adults living at or below 133 percent of the poverty level (also known as the FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), and pregnant women living at or below 190 percent of the FPL, can qualify for Medicaid in Rhode Island, based on eligibility standards that take effect January 1, 2014. States can accept additional funds from the federal government to expand Medicaid.
Additional federal financial protection provisions will start in 2015 that include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping out-of-pocket costs will help consumers pay medical bills that aren’t covered by insurance, reducing the chances of bankruptcy.
How Costs Are Determined
The grid organizes the plan costs by age and lists whether the plan is Gold, Silver, Bronze, or Catastrophic. This is an important detail given that tax credits are based on the Silver Plan, so individuals can easily determine what their additional out-of-pocket costs will be if they elect a higher or lower plan compared to Silver.
For example, a 25-year-old who purchases the Blue Cross Blue Shield RI (BCBSRI) Vantage Blue Direct Silver plan would pay about $231 a month for monthly premium and be subject to a $3,000 individual annual deductible for services. The $231 premium is the starting point for applying the applicable tax credit subsidy. If that same individual elects instead a Gold Plan with BCBSRI that features a $1,000 deductible, the monthly premium increases to $278, with a maximum cost difference to the individual of $47 per month.
Information on Subsidies
Individuals with incomes less than 400 percent of the federal poverty level ($45,960 a year for individuals and $94,200 for a family of four) may qualify for a subsidy. Use this subsidy calculator from the Kaiser Family Foundation to determine your estimated subsidy.
People want to how much their subsidies are, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan (you may pay less). For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your income, which amounts to $2,926 a year, or $244 a month. The challenge is to look at the costs of Bronze, Silver, and Gold, and decide which plan offers the best value for you.