Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)


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How “HealthSource RI”, The Official Rhode Island Website for Health Insurance, Works

Subsidies for those with annual income up to percent of federal poverty can be calculated by those who are prepared to enter their confidential financial information. This report presents an analysis of changes in the premiums for the lowest- and second-lowest cost silver marketplace plans in major cities in 10 states plus the District of Columbia, where we were able to find complete data on rates for all insurers.


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It follows a similar approach to our September and analyses of Marketplace premiums. In most of these 11 major cities, the authors find that the costs for the lowest and second-lowest cost silver plans — where the bulk of enrollees tend to migrate — are changing relatively modestly in , although increases are generally bigger than in The cost of a benchmark silver plan in these cities is on average 4.

Benchmark premium changes in vary significantly across the cities, ranging from a decrease of This table includes additional states that have released average premium increases for all insurers intending to offer exchange plans next year. Insurer participation is down for from and premiums, particularly for the benchmark silver plans, are up dramatically, reflecting recent administration steps that have buffeted the marketplaces.

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Full summary by Prof. The report documents what was already widely known—insurer participation in the exchanges is down for from and premiums, particularly the benchmark silver plan premiums, are up dramatically. Advance premium tax credits APTC , however, are also up sharply, and most consumers who purchase coverage through the exchange may find that coverage costs less than last year after APTC are applied.

The following states offer their own healthcare exchange websites; all other states rely on HealthCare. For instance, bronze plan-holders pay the lowest premium of all four metal plans but also face higher deductibles and out-of-pocket costs. Platinum plan-holders, on the other hand, pay the highest premiums in exchange for lower deductibles.

Generally speaking, bronze and silver plans are best suited for young, relatively healthy individuals who do not require frequent physician visits, while gold and platinum plans are the best option for individuals with consistent medical needs.

Rhode Island Insurance Exchange Subsides and Tax Credits

As stated above, the open enrollment period for individuals seeking health coverage in ended on December 15, When the next open enrollment period kicks off in the fall exact dates TBD , individual coverage seekers can obtain plans by:. Regardless of the format one uses to obtain a health plan, he or she need the following materials in order to complete an application:. As mentioned above, individuals and families who fall within a certain income bracket qualify for tax subsidies from the federal government.

Eligible individuals and families who purchase a plan through the marketplace within the open enrollment period and do not qualify for an employer-sponsored or federal health plan, meet the income criteria, and cannot be claimed as dependents may be eligible for the Premium Tax Credit. Just as some individuals who purchase a health plan from the marketplace qualify for certain savings benefits, those who do not purchase a health plan within the open enrollment period and remain uninsured are charged a financial penalty.

Individuals who had not obtained insurance for received the higher of the two following penalties:. Uninsured individuals must obtain coverage of some sort, but they are not required to obtain a plan via the marketplace and may opt to shop for policies with providers who are not listed on the exchange.

Furthermore, a penalty is not given to individuals who are covered under the following plans and choose not to obtain coverage from a marketplace-based provider:. Additionally, some people may apply for an exemption for health insurance. Those who receive this exemption are not required to pay the penalty fee. Exemptions may be awarded to individuals under the following circumstances:. Click here to see the full list of healthcare exemptions and learn how to apply.

Finally, please note that certain health plans do not satisfy the requirements of the ACA.

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Health Insurance: Premiums and Increases

In these cases, plan-holders may be penalized even while receiving coverage:. Historically, Medicaid has only been available to children and their parents, disabled individuals, and the elderly. Adults with no dependent children, on the other hand, did not qualify for Medicaid. Furthermore, eligibility for parents was relatively limited and varied on a state-by-state basis. The ACA was designed to reduce the coverage gap for these individuals by providing Medicaid to all persons who fall within certain income brackets, regardless of whether or not they have children.

Citing the broad statutory language that created his office, Koller decided in the spring of to require insurers to do all four. Koller put forward four principles that he expected the state's three leading insurers to embrace. First, he asked insurers to increase the portion of their medical expenses that went to primary care by 1 percentage point for five consecutive years.

The goal was to raise Rhode Island's primary care expenditures from a substandard 5. Koller's second requirement was that state insurers support the expansion of the Rhode Island Chronic Care Sustainability Initiative, which seeks to pair providers with case managers who can direct care for patients with chronic conditions. Insurers would agree to pay a case management fee and fund nurse-case managers. Finally, he asked insurers to commit to a serious discussion aimed at overhauling the payment system as a whole.

From insurers, however, the reaction was mixed. But there was another consideration as well.


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In addition to pressuring insurers, Koller was preparing to take on one of the biggest cost drivers in health care -- rising hospital costs and utilization. The situation in crystallized the issue.

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As Purcell remembers it, "We were in the depths of the recession, and a number of community leaders, including the governor, asked if there was any way to skip an increase. I said, 'Governor, if I were you, I would be asking that too, but to agree to inadequate rates does nobody any favors. That year, Koller approved a much smaller rate increase. However, Koller and the business community took to heart one of insurers' primary arguments -- that hospital costs, primarily increases in outpatient utilization but also prices, were one of the major drivers behind rising premiums.

A study of insurer contracts with hospitals produced by Koller's office in January came to a conclusion already supported by the literature: Consolidation of hospitals makes cost containment difficult. And so in early , Koller extended his delivery overhaul efforts to the state's hospitals as well. Although Koller has no oversight authority over hospitals, he and his counsel decided that he did have the authority to present "contracting principles" that would guide insurers in their dealings with hospitals.

In July , he put forward six of them, among them provisions requiring quality incentives and standards for care coordination and simplicity. Perhaps the most controversial of all, however, was a provision that would cap the guaranteed rate of hospital cost increase at the level of the Medicare consumer price index, which in amounted to a mere 2.

In doing so, Koller was engaging in the kind of high-stakes bluffing he had perfected in dealing with insurers. At one end are formal regulations. At the other end is oral advice. In between there can be bulletins, guidance and information sheets. So it is very important to have the rate review process in place and functioning. But this time, Koller apparently overstepped. In December, Koller settled part of the lawsuit -- a setback for now. The health insurance commissioner has not, however, given up on his goals.

Despite all the tools and pressures he's put in place, premium increases in Rhode Island are not significantly lower than in surrounding states.

10 Best and Worst States for Health Insurance Costs

All of his actions, he points out, are consistent with what it takes to keep a lid on rates of increase. And he remains determined to ensure that Rhode Island is one of them. The policy failed another court test, this time in New Hampshire.

Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4) Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)
Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4) Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)
Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4) Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)
Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4) Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)
Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4) Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)
Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4) Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)
Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4) Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)
Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4) Health Insurance Plans and Prices for Rhode Island Businesses (Rhode Island Health Care Book 4)

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