HealthSource RI – Affordable Health Coverage

HealthSource RI is the state’s health insurance marketplace where Rhode Islanders can compare affordable health plans and purchase coverage that meets their health care needs and budget.

Who Qualifies

Individuals who are not eligible for Medicaid, Medicare, and other public health insurance coverage, and who do not have affordable coverage at work, may qualify for help purchasing a health plan and may also qualify for help paying for out-of-pocket costs.

Families and individuals with income below 400% of the federal poverty level (“FPL”) may be eligible for a tax credit from the federal government to help pay for enrolling in a health plan (see chart below).  The tax credit can be claimed at the end of the tax year when the person files their income tax return.  It can also be received in advance each month to help pay the monthly premium to enroll in coverage. This is commonly called the Advanced Premium Tax Credit or “APTC”.

If income is below 250% FPL, the family or individual may also be eligible for “cost-sharing subsidies” which reduce the out-of-pocket costs incurred when the person uses health care (see chart below).  These include co-payments (e.g. for doctor visits and prescriptions), deductibles, and co-insurance.  The person must choose a silver plan.

Lawfully present immigrants are eligible to enroll in health insurance through HealthSource RI and to qualify for tax credits and cost-sharing subsidies.  This includes lawful permanent residents who are ineligible for Medicaid during the 5 year waiting period.

 

Annual Income Guidelines for Cost-sharing Subsidies and Tax Credits

 Family Size
Cost-Sharing Subsidy Income Limit (250% FPL)
Tax Credit Income Limit (400% FPL)
 1 $29,425 $47,080
 2  $39,825 $63,720
 3  $50,225 $80,360
 4  $60,625  $97,000
 5  $71,025  $113,640
 6  $81,425  $130,280

How to Apply

Families and individuals can apply for health insurance on-line here or by submitting a paper application which you can download here. You can also request a paper application from a DHS office or by calling: 1-855-697-4347. Eligibility for tax credits and cost-sharing subsidies will generally be determined by using data about income, citizenship, immigration status, and other required documentation from other government agencies. Applicants will be asked to provide paper documentation if a computer data match is not possible. The first month’s premium must be paid to HealthSource RI before coverage starts. Payments can be made by check or electronic transfer from a bank account.

There is an open enrollment period for each year. The next open enrollment period will start November 2016 for enrollment for coverage for January 2017. Generally, people cannot enroll outside of the open enrollment period. However, if they have a “qualifying event” such as a birth of a child or marriage, they can enroll in coverage through HealthSource RI through a special enrollment period.

People needing help with the application can call the Contact Center at 1-855-840-4774. People who want to meet with a person to complete the application can find a “Navigator” in their neighborhood. Call 2-1-1 to find a Navigator.

Special Note for Parents with Children Enrolled In RIte Care:

For parents with children enrolled in RIte Care, whose income is between 138% FPL and 175% FPL, there is additional state assistance (The State Premium Assistance Program) to help parents pay their premium.

Parents must fill out and mail in an application to the state.  Parents must choose a silver plan to qualify for the state assistance

Annual Income Limit and Amount of Monthly State Premium Assistance Available (April 2016)

 Family Size  For Income Less Than  Monthly Reimbursement For Income Between Monthly Reimbursement
 2 $24,030 $39 $24,031-$28,035  $28
 3  $30,240  $49 $30,241-$35,280  $43
 4  $36,450  $59 $36,451-$42,525  $58
 5  $42,660  $69 $42,661-$49,770  $73
 6  $48,870  $79 $48,871-$57,015  $88