When the Affordable Care Act (ACA) was passed in 2010, states began launching health insurance marketplaces. These are called exchanges. HealthSource Rhode Island is the exchange for Rhode Island.
Through HealthSource you can:
- find a plan
- apply for coverage
- learn about tax credits
- pay for coverage
Keep reading to learn more about HealthSource and what benefits you may gain from the exchange.
All HealthSource plans must offer the following essential services:
- physician office visits
- emergency medical services
- inpatient hospital services
- maternity and newborn care
- mental health services
- substance abuse treatment
- prescription drugs (there may be some limits depending on the plan)
- rehabilitative services
- habilitative services (occupational, physical, and speech therapies)
- diagnostic lab studies
- preventive and wellness care
- dental care
- pediatric care
HealthSource has 20 health insurance plans. As of 2015, there are now three providers:
- Blue Cross Blue Shield of Rhode Island
- Neighborhood Health Plan of Rhode Island
- United Healthcare
Within each plan are three tiers of coverage. These include:
- bronze plan (which covers 60 percent of health costs)
- silver plan (covers 70 percent)
- gold plan (covers 80 percent)
A premium is the amount you pay for your plan, regardless of the medical services you use. In most cases, you pay your premium each month. Lower premium plans will have higher deductibles (the amount you must pay before insurance covers the remaining costs), fewer benefits, and larger out-of-pocket costs (costs that include your deductible, copayments, and coinsurance). On the flipside, gold plans offer more benefits but with higher premiums upfront. The choice depends on both your budget and your healthcare needs.
A catastrophic health plan is also available. This type of plan has a low premium but high out-of-pocket costs and doesn’t usually cover copays or coinsurance. Catastrophic health plans are available for adults under the age of 30 with lower income.
Dental coverage can be purchased from:
- Blue Cross & Blue Shield of Rhode Island
- Delta Dental
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, coinsurance, and deductibles vary.
The federal poverty level (FPL) can also play a role. If you or your family is considered within FPL limits, you may receive assistance for your health coverage. Below are some of the 2015 FPL stats:
- single adults making $11,770 per year
- family of two with an income of $15,930
- family of four with an income of $24,350
Adults living at or below 133 percent of the poverty level, and pregnant women living at or below 190 percent of the FPL, may qualify for Medicaid in RI. States can accept additional funds from the federal government to expand Medicaid.
More federal financial protection provisions include a maximum annual out-of-pocket cost of $6,350 for individuals and $12,700 for families. Capping these costs can help decrease the risk of bankruptcy from outrageous medical bills.
If your income is less than 400 percent of the federal poverty level but you don’t qualify for Medicaid, you may qualify for a premium tax credit. This is a subsidy that would help pay for part of your insurance. On average, individuals who earn about $45,960 a year or less qualify. For a family of four, the eligible income level increases to about $94,200 or less.
The percentage of your costs that this subsidy would cover depends on income level and the cost of a second-tier silver plan where you live. This silver plan is used as a baseline because the ACA was designed so everyone could afford a silver plan, regardless of how expensive the healthcare rates may be where you live.
For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for a second-tier silver plan is 9 percent of your income. This averages to about $2,926 a year, or $244 a month. You can choose a plan other than the second-tier silver plan and use your tax credit but the subsidy amount will stay the same. This means a gold plan would cost you more, even if you use a subsidy to cover some of the cost.
Some people may also be eligible for a cost-sharing subsidy. This subsidy is for silver plans only and reduces the total out-of-pocket cost of a plan. People who have household incomes between 100 and 250 percent of the poverty level may qualify for this subsidy.
The Kaiser Family Foundation has a free calculator that can also help you determine subsidies.
HealthSource has a grid that organizes plan costs by age and lists whether the plan is gold, silver, bronze, or catastrophic. If you use a premium tax subsidy to cover part of your health insurance, the silver plan is the benchmark for how much you will pay. If choose a higher (gold) or lower (bronze) plan, you must calculate for yourself how the different costs of those plans change the amount you’ll pay.
For example, a 25-year-old who purchases the Blue Cross Blue Shield silver plan may pay about $231 a month (the monthly premium) and be subject to a $3,000 individual annual deductible for services. If that same individual elects instead a gold plan with a $1,000 deductible, the monthly premium increases to $278. Regardless of the plan, the subsidy remains the same. That means the maximum cost difference to the individual is $47 per month, which is the difference between the two premiums.
To learn more about HealthSource, please visit http://www.healthsourceri.com. You can also call 1-855-840-HSRI (4774). Open enrollment lasts from November 1st to January 31st. The earlier you sign up, the sooner your coverage kicks in.
In Rhode Island, health plans don’t renew automatically. It’s important to keep tabs on your enrollment and ask questions early.