Health Insurance in Rhode Island

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Trying to figure out how to get health insurance in Rhode Island? You’re in the right place. Benzinga can guide you toward everything you need to know.

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The Best Health Insurance in Rhode Island:

  • Best Overall in RI: BCBS of Rhode Island
  • Best for HMO: Neighborhood Plan of Rhode Island
  • Best Supplemental Health Insurance: UnitedHealthcare
  • Best for Telehealth Services: Cigna
  • Most Affordable in Rhode Island: Tufts Health Plan

What is Health Insurance? 

Health insurance is an insurance product that can help you pay for costly medical services.

You can get health insurance by enrolling in a:

  • Government-backed plan
  • Group plan through your employer
  • Plan with your spouse, domestic partner or parent
  • Private health insurance plan

These terms will help you understand the costs and advantages of health insurance plans.

  • Premium: The first number you will probably notice is your health insurance premium. This is the amount that you’ll pay each month to keep your health insurance plan active.
  • Deductible: You should also consider each health insurance plan’s deductible. Your deductible is the amount that you’ll pay out-of-pocket for medical services before you can use your health insurance coverage. Each time you pay for a covered medical service, your health insurance company counts it toward your deductible. After your deductible has been met, your health insurance company will start to contribute toward the costs of your medical services.
  • Coinsurance and copays: You’ll pay coinsurance or copays for your medical services after you meet your deductible. Coinsurance is a percentage of each covered medical service that you will need to pay. Copays are a set amount of money that you will pay for each medical service you receive. Your insurance company will cover the remainder of your medical bills.
  • Out-of-pocket maximum: An out-of-pocket maximum is the maximum amount of money your health insurance company will require you to pay for services. Each time you pay anything out of pocket, it counts toward this amount. Once you’ve met your plan’s out-of-pocket maximum, your health insurance company pays for 100% of your covered medical costs until your coverage expires.

Average Cost of Health Insurance in Rhode Island

The average cost of a health insurance plan for an individual in Rhode Island is $286 per month. Overall, your health insurance plan is affected by a number of factors, including:

  • Where you live
  • Your employer
  • Household income
  • Health
  • Age
  • Eligibility factors for a government-backed health care plan

There are some ways you may be able to save on your health insurance premiums, including:

  • Choose a higher-deductible plan. If you’re in good health, you might not need to visit the doctor or fill prescriptions often. In this case, you may want to choose a plan with a higher deductible. These plans typically come with lower monthly premium payments and can allow you to save money.
  • Look into government-backed plans. There are some government-sponsored health programs that you may be eligible for:

Medicaid is a program that offers health coverage to individuals and families across the U.S. It’s offered to low-income individuals and families, as well as those with disabilities and special needs. Rhode Island has expanded Medicaid — it’s available to adults between the ages of 19 and 64.

Medicare is a federal health insurance program, so the eligibility requirements are the same nationwide. You may qualify for this program if you are 65 or older, have a disability or have been diagnosed with end-stage renal disease. Medicare is offered in multiple parts, each of which covers a certain area of your medical insurance needs. You may also be able to enroll in a Medicare Advantage plan. These plans are not regulated by the federal government but offer an alternative to Medicare that allows you to bundle your health coverage into 1 plan.

  • See if you’re eligible for tax credits. You may be eligible for tax credits on your health insurance premiums if you fall within certain income limits. Visit Rhode Island’s Marketplace website to apply for coverage. This website will allow you to compare your health insurance options based on your income and other information. You will also be informed if you are eligible for a tax credit based on your information.
  • Speak to your employer. Some employers offer health coverage to their employees. Speak with your employer to see if it has a plan you can enroll in. Some employers will also pay for a certain percentage of your health insurance premium. 

Types of Health Coverage

There are 4 common types of health coverage you can get in Rhode Island: 

  • Health maintenance organization (HMO) plans have a network of health care providers and facilities. You need to visit doctors and facilities within your HMO plan’s network if you want to receive coverage for your visit. You must also have a designated primary care doctor who can refer you to a specialist if you need to visit one.
  • Preferred provider organization (PPO) plans also have their own network of providers. However, a PPO plan allows you a bit more freedom as you choose your medical providers. If you visit an out-of-network provider, you can expect to pay more out-of-pocket for your visit. With a PPO plan, you do not need to receive a referral from your primary care doctor before visiting a specialist.
  • Exclusive provider organization (EPO) plans often offer lower premiums than some other plans. You will not receive coverage if you visit a provider that is not within your EPO plan’s network. You don’t need a referral from a primary care doctor before visiting a specialist.
  • Point-of-service (POS) plans combine some of the advantages of an HMO and PPO plan. You can visit doctors that are both in-network and out-of-network but can expect to pay more for a visit with an out-of-network doctor. Your primary care doctor will need to refer you to a specialist if he or she decides you need one.

What Does Health Insurance Cover?

Under the Affordable Care Act, health insurance plans must cover certain essential health benefits. When possible, you should visit doctors and facilities that are within your plan’s network to ensure coverage.

  • Ambulatory care includes outpatient medical services. It may include outpatient treatment at hospitals, dialysis clinics and visits to your doctor.
  • Emergency services involve visiting an emergency room or urgent care facility.
  • Inpatient care means you’ll be admitted to the hospital for monitoring, treatment, surgery or another condition.
  • Laboratory services include diagnostic tests such as blood work, X-rays and MRIs.
  • Mental health services involve coverage for counselors and psychiatrists or for a substance use disorder.
  • Pediatric services include coverage for children as well as dental and vision coverage.
  • Pregnancy and newborn care involves doctor visits throughout pregnancy, as well as labor, delivery and newborn care.
  • Prescription drugs prescribed by your doctor must be covered by your insurance plan.
  • Preventive and wellness services allow you to receive annual wellness visits at no cost to you. You will also receive coverage for chronic disease management.
  • Rehabilitative services and devices mean you can expect coverage for treatment and devices to help gain or recover mental and physical skills.

What Does Health Insurance not Cover? 

Health insurance coverage can vary from state to state and between companies and plans. These services are typically not covered by health insurance.

  • Cosmetic procedures: Unless you are receiving a cosmetic procedure for a medical reason, it usually won’t be covered by health insurance. 
  • Newer medical devices and products: It takes time for medical companies to prove that a new medical device or product is worthwhile. Your health insurance may not provide coverage for some newer technologies.

Best Health Insurance Providers in Rhode Island

Before you choose your health insurance plan, it’s important to compare the providers available in Rhode Island. This will ensure that you enroll in the best health insurance for your needs.

1. Blue Cross Blue Shield of Rhode Island

Blue Cross Blue Shield of Rhode Island offers a variety of medical and dental plans to meet you or your family’s needs. Its plans come in a level of tier options to give you the flexibility your budget needs.

It also offers Medicare Advantage plans for qualified individuals. This insurance provider can give you access to exclusive member discounts on health and fitness products and services with Blue365.

2. Neighborhood Health Plan of Rhode Island

This is a nonprofit HMO insurance company founded in 1993. It strives to provide Rhode Island residents with access to comprehensive coverage and high-quality care.

It also provides insurance to qualified individuals with its ACCESS Medicaid plan, TRUST Medicaid plan and INTEGRITY Medicare-Medicaid plan. Individual and family plans are offered in a variety of tiers to allow you to select the coverage and premium that works best for you.

3. UnitedHealthcare

In addition to its traditional health insurance plans, United Healthcare offers additional health insurance options in Rhode Island. Its Health ProtectorGuard fixed indemnity insurance can supplement your major medical plan.

This supplemental insurance will pay for common covered medical services such as doctor and urgent care visits. It does not require deductibles or copays. It also provides dental, vision, Medicare and Medicaid plans.

4. Cigna

Cigna offers health insurance for individuals and families, dental insurance, Medicare Advantage plans and other supplemental insurances. Cigna’s $0 telehealth service gives you access to a doctor by phone or video chat at any time to help with common medical questions and concerns.

It offers affordable copays, including the ability to pay a copay when you visit your primary care doctor before you even meet your deductible. It also offers $0 preventive care, including health screenings, annual wellness visits and your flu shot. 

5. Tufts Health Plan

Tufts offers a number of health plans to Rhode Island residents that make affordable health insurance possible. You can choose from a traditional HMO or PPO plan or enroll in an Advantage or Advantage Saver HMO or PPO plans.

These plans can offer lower monthly costs and may be paired with a health savings account to help you cover your out-of-pocket costs. Tufts also offers its members health and wellness programs and tools to help you manage your care and reach your health goals.

Which Health Insurance is Right for Me?

The best way to find the right health insurance for you is to get specific. Write down your budget, doctors you normally visit and any prescription drugs you take. You can then choose your provider and plan based on who is in the network. Be sure to compare all costs so you choose the right plan for you.

Frequently Asked Questions

1) Q: Is health insurance required?

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1) Q: Is health insurance required?
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The federal mandate that required health insurance has been lifted but some states have enacted state-level mandates that require residents to have health insurance. Even where not required, health insurance can protect your family against catastrophic healthcare costs and help make routine medical expenses more predictable. Get your most affordable quote through our top providers today.

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2) Q: What does health insurance cover?

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2) Q: What does health insurance cover?
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Most health insurance plans provide the 10 essential health benefits that were part of Obamacare requirements. Coverages include preventative and wellness services, prescription drug coverage, emergency services, ambulatory services, lab services, pediatric services, and more. Many plans cover a wider range of healthcare expenses but may cost more than basic plans or may have higher out-of-pocket costs for some services.Get a custom health insurance quote to cover you and your family today.

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3) Q: How can I save money on health insurance?

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3) Q: How can I save money on health insurance?
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For healthcare plans that comply with the Affordable Care Act, only a handful of rating factors affect your premium. These include age and location, at least one of which can’t be changed. Smokers will pay more in most cases and your choice of plan level can affect premiums as well. Choosing a high deductible health insurance plan can reduce the cost of premiums. These plans can be combined with a health savings account to take advantage of tax-free savings for healthcare expenses. Get the cheapest health insurance premium from top providers.

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