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Rhode Island Health Insurance

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Facts and Figures

  • Place in State
    Health Report Card
  • Insured 912,032
  • Uninsured 124,900
  • Insurance
  • Number of
    Primary Care Physicians
  • Number of
  • Average Cost of
    Health Insurance*

Breakdown of Insureds

  • Employer-sponsored health insurance 62%
  • Private plans 5%
  • Medicaid 19%
  • Medicare 15%
  • Others -1%

State Health Report Card

Smoking among adults went down from 23.4 percent to 15.7 percent in the last ten years. Today, there are 130,000 adult smokers in the state. Obesity went up from 17.1 percent to 26.0 percent among adults in Rhode Island. There are 215,000 obese adults living in the state. Children living in poverty went down from 22.2 percent to 20.4 percent of those under 18 years. Diabetes went up from 7.0 percent to 7.8 percent among adults. There are 65,000 adults with diabetes in Rhode Island. The rate of preventable hospitalizations went down from 74.1 to 70.0 discharges per 1,000 Medicare enrollees in the past year.

Rhode Island Health Insurance Laws and Regulations

Rhode Island health insurance plans are required to be sold with a guaranteed renewability clause. This allows policyholders to renew their coverage as many times as they want as long as they keep up with the premium payments and do not violate the terms of agreement. State laws also prohibit insurers from terminating health coverage based on failing health. When writing new Rhode Island health insurance plans, insurers can exclude coverage for a pre-existing condition for up to 12 months. However, should you transfer plans, you won’t have to go through this period again if you maintain continuous coverage for at least 12 months. Health insurers in Rhode Island can deny an application based on age, health status, family history, and other risk factors. However, applicants with continuous coverage for at least twelve months cannot be rejected under any circumstances. In any case, risk factors can be used to determine the cost of health insurance. Small businesses with two to fifty employees operating in Pennsylvania are qualified to purchase group health insurance comparable to other small group health plans available in other parts of the state. To maintain coverage, small groups may be required to meet certain requirements like having a minimum percentage of participating employees or a minimum employer contribution. Rhode Island health insurance quotes for group coverage can vary according to the risk factors of its members. However, small group health plans cannot be cancelled due to a member’s health condition. Self-employed individuals can purchase group health coverage only through Blue Cross Blue Shield. They can also purchase individual health plans, which has the advantage of having a portion of the premiums tax deductible.

Heath Care Reform

With the new health care law, children under the age of 26 can choose to stay under their parent’s Rhode Island health insurance as long as they are not offered an employer-based health insurance. This provision enabled 2.5 million young adults to have insurance nationwide. In Rhode Island, 7,573 young adults have insurance coverage through this provision as of June 2011.

The new health care law allowed 15,787 Medicare policyholders in Rhode Island to receive a $250 rebate check to help with prescription drug costs when they fell into the Medicare gap in 2010. In 2011, 14,822 Medicare plan holders were given a 50% discount on brand-name prescription drugs covered by their plans when they hit the donut hole. An average of $554 per person or a total of $8,217,475 was saved in Rhode Island.

Previously uninsured individuals without health coverage because of a pre-existing condition can now apply for a Pre-Existing Condition Insurance Plan. This plan is available to U.S. citizens or legal residents with a pre-existing condition and have been uninsured for at least 6 months. In 2011, 136 individuals in Rhode Island have benefited from this new law.

When looking at Rhode Island health insurance quotes, applicants are assured that at least 80 percent of the price will go directly to health care services and other related improvements. A rebate or premium discount shall be provided if the minimum is not met. The 273,000 private policyholders in Rhode Island will get greater value for their premium payments because of this 80/20 rule.

Preventive care services like immunizations, colonoscopies, mammograms, or annual wellness doctor visits must be included in all Rhode Island health insurance with no deductibles or co-pays. In 2011, more than 128,390 Medicare subscribers and 195,000 individuals with private policies received such services in Rhode Island.

Under the new law, insurance companies are no longer allowed to impose an annual dollar limit – a cap on the yearly spending for your benefits, or a lifetime dollar limit – a lifetime cap for spending for your covered benefits. This law frees chronically ill individuals like cancer patients from worrying about getting further treatment because of such limitations. In 2011, 374,000 Rhode Island residents have benefited from this law.

If insurance companies want to raise their premium rates by ten percent or more, they are required by federal law to publicly announce and justify their actions. To guard against such unreasonable increases, the state of Rhode Island received a total of $4.7 million.

All fifty states receive increases in funding for community health centers under the Affordable Care Act. This will help construct new health centers, provide medical services to more patients, improve preventive and primary health care services, and fund infrastructure projects. In Rhode Island, 48 community health centers received a total of $14.8 million to fund these improvements.

In 2010, the Affordable Care Act created the Prevention and Public Health Fund. This new fund was created for wellness promotion, disease prevention, and protection against public health emergencies. Rhode Island has already received a total of $2.6 million to support its policies, programs, and communities to help its residents lead healthier lives.

State Government Insurance Programs Offered

RI Medical Assistance Program

401-462-5300 401-462-3363 TTY

Medical Assistance offers health services to qualified Rhode Island residents who need help to pay for their medical bills. Services covered include physician and dental services, inpatient and outpatient hospital services, pharmacy, laboratory and x-rays, clinic and emergency room care, ambulance, community mental health center services, intermediate care facility and day treatment services for the developmentally-challenged, home health, nursing facilities, hospice care, optometry, podiatry, substance abuse, organ transplant services, durable medical equipment, surgical appliances, and prosthetic devices. Emergency services are also available for undocumented immigrants. Eligibility: Must be U.S. citizens or qualified residents living in Rhode Island. Rhody Health Partners and Connect Care Choice: Must be at least 21 years old; not eligible for Medicare coverage or other health insurance; live in the community. Medical Assistance: Must be at least 18 years old; or aged, blind, and disabled, receiving Supplemental Security Income (SSI); or have income not exceeding 100% of the FPL with assets less than $4,000 for singles or $6,000 for couples. Medically-needy: Singles with $800 monthly income and assets not exceeding $4,000; couples with $842 monthly income and assets not exceeding $6,000.

RIteCare/RIteShare (Click: Families with Children – Health/Medical Services)

401-462-5300 401-462-3363 TTY

RIteCare: Offers comprehensive coverage through 3 different options. RIteShare: Helps families get health insurance coverage through their employer by paying for all or part of the employee’s share of the health insurance premium. RIteShare also pays for co-payments in the employer’s health insurance plan. Eligibility: RIteCare/RIteShare: Must be Rhode Island residents and U.S. citizens or legal aliens, not covered by health insurance (including Medicaid), be pregnant women or children 0–19 years old with incomes of up to 250% FPL, or be parents with children ages 18 and with incomes up to 175% FPL.



Medicare is administered by the federal government and provides health insurance coverage to Americans aged 65 and above or those younger than 65 but have a disability or end-stage renal disease. Coverage has four parts: Part A: provides inpatient care in hospitals and rehabilitative centers. Part B: provides doctor and some preventive services and outpatient care. Part C: provides Medicare benefits through Medicare Advantage. Part D: provides prescription drug coverage. Eligibility: 1. Must be a U.S. citizen or permanent U.S. resident. 2. Must be 65 years or older, with you or your spouse having worked in a Medicare-covered employment for at least ten years; or have a qualified disability or end-stage renal disease, regardless of age.

VA Medical Benefits Package


The Veteran Affairs (VA) Medical Benefits provides standard health benefits plan to veterans enrolled in the program. Benefits are portable and can be accessed anywhere in the VA system. Benefits include preventive and primary care, and a full range of outpatient and inpatient services. Eligibility 1. Must have veteran status.

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