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Individuals & Families

Find the plan that works for you.

Re-enroll through December 23, 2014.

If you have health insurance through HealthSource RI, it will end on the last day of 2014—and will not renew automatically. To ensure that you’re covered on January 1, you must choose your 2015 plan and pay your first premium by December 23, 2014.

Get Started

Enroll

HealthSource RI connects you with brand-name health insurance companies, giving you a whole new way to buy coverage and get the essential health benefits you need. Get started now.

Compare Plan Costs

Use our Savings Calculator to compare healthcare insurance plans and check for tax credits that can lower the cost of your health insurance.

Purchase a Plan

Click here to open a new window or tab to healthyrhode.ri.gov, where you can use the Insurance Selector Tool to buy the plan you’ve selected.

Learn the Basics

Whether you’re seeking a health insurance plan for you or your whole family, it’s important to consider more than just the amount of your monthly premiums. Be sure to also consider the following:

How you get your healthcare
 
Healthcare services
 
Preventive services & screenings
 
Health insurance deductibles
 
Co-insurance & Co-payments
 
Maximum out-of-pocket payments
 

How you get your healthcare

Health insurance plans help you get health services in different ways. Before you choose a plan, familiarize yourself with its provider network and the rules it has for picking a doctor.

Provider networks include PPOs (Preferred Provider Organizations), HMOs (Health Maintenance Organizations) and tiered networks.

If seeing a particular doctor (Primary Care Physician, or PCP) is important to you, make sure he or she belongs to your plan’s provider network.

Keep in mind that some health plans charge you less if your PCP belongs to a Patient Centered Medical Home. Also be aware that some types of health insurance plans require a referral from your PCP before you can see a specialist.

 

Healthcare services

All health plans must cover the same basic set of healthcare services. These include:

  • Ambulatory patient services
  • Emergency services
  • Hospitalization
  • Maternity care
  • Newborn care
  • Mental health and substance use treatment services (including counseling and psychotherapy)
  • Prescription drugs
  • Rehabilitative and habilitative services and devices
  • Laboratory services
  • Preventive and wellness services
  • Chronic disease management
  • Pediatric services

When choosing a plan, it’s critical to keep in mind what—if any—specialized services you or your family members use and what—if any—health conditions you or your family members have that require frequent doctor, specialist, or pharmacy visits.

 

Preventive services & screenings

No matter which plan you choose, there are certain medical services you can receive for free, including:

  • Blood pressure screening
  • Breast cancer screening and mammography
  • Cervical cancer screening (pap test)
  • Cholesterol screening
  • Colorectal cancer screening
  • Depression screening
  • Obesity screening and counseling
  • Adult immunizations (such as flu shots, Hepatitis A and B, and pneumonia vaccines)

Take a moment to review a complete list of free medical services.

 

Health insurance deductibles

Your deductible is the amount you pay for certain healthcare services before your plan will begin to pay for them. This amount is paid in addition to your premium.

 

Co-insurance & Co-payments

Health plans offer different combinations of co-payments and co-insurance.

A co-payment is the amount you pay per visit or healthcare service regardless of whether you have met your deductible. For example, you may pay $25 each time you visit the doctor.

Co-insurance is the amount you pay for certain healthcare services after you’ve met your deductible. It’s a percentage of the cost of your care, not a flat amount. For example, you might have 20% co-insurance for visits to the emergency room. That means if you’ve already spent your deductible, you pay for 20% of the cost when you go to the ER.

Some health insurance plans use a tiered network for their providers (such as doctors and hospitals). This means you pay less to see tier 1 providers than tier 2 providers.

Some plans may encourage you to use a Patient Centered Medical Home (PCMH)—a team of physicians, nurses, pharmacists, nutritionists, and social workers who work together to meet your health needs. You may have a lower co-payment if your health providers belong to a PCMH.

 

Maximum out-of-pocket payments

The money you spend each year on your medical care (excluding your monthly premium) cannot exceed your health insurance plan’s maximum out-of-pocket cost. Once you reach your maximum, you are protected from additional costs like co-payments and co-insurance.

Some plans have different maximum out-of-pocket charges for medical costs and prescription drugs. Some have different maximum out-of-pocket costs for individuals and families. Be sure to learn what your plan’s maximums are.

Lower Your Costs

Individuals and families who buy health insurance through HealthSource RI may be eligible for the following:

Individual and family tax credits

Cost-Sharing Reduction plans

Health Savings Accounts

Other programs

 

Individual & Family tax credits

Tax credits are based on your income and the size of your family. An individual making up to $46,680 a year may qualify for a tax credit. A family of four making up to $95,400 a year may qualify for a tax credit.

If you or your family qualifies, you can choose to receive your tax credit every month or at the end of the year when you file your taxes. If you receive your tax credit monthly, the money will go directly to your health insurance company while you continue to pay your share of the bill each month. If you prefer, you can choose to receive a smaller monthly tax credit and get the remainder back as a refund when you file your taxes.

It’s important to tell HealthSource RI if your income changes during the year. If your income goes down, you may qualify for a larger tax credit to help you pay for your insurance. If your income goes up, your tax credit eligibility may change. If you don’t tell HealthSource RI about changes to your income and the new amount does not qualify you for tax credits, you may have to pay back any tax credits you received during the year.

When you’re ready to compare plan costs, our Savings Calculator will help you determine if you’re eligible for a tax credit. For more information about how your health insurance might affect your tax return, click here.

 

Cost-Sharing Reduction plans

Cost-Sharing Reduction (CSR) plans offer lower deductibles, co-payments, and co-insurance for certain healthcare services—and may allow you to pay less for medical care.

Individuals earning up to $29,175 a year and families of four earning up to $59,625 a year may qualify. If you’re a member of an American Indian Tribe or are an Alaskan Native, you may also qualify.

When you’re ready to compare plan costs, our Savings Calculator will help you determine if you’re eligible for a CSR plan.

 

Health Savings Accounts

Health Savings Accounts (HSAs) give U.S. taxpayers enrolled in many high deductible health plans a unique way to save for certain healthcare costs.

HSA funds are not subject to federal income taxes. You can use them to pay for qualified medical expenses at any time—without incurring federal tax liabilities or penalties. You can also invest them to earn interest on your balance. Any unused funds will accumulate year to year.

How it works

  1. Enroll in a high deductible health plan eligible for a Health Savings Account (HSA). HealthSource RI offers a variety of these plans, which you’ll find listed below in the FAQ section.
  2. Open and activate an HSA with an IRS-qualified trustee. Be sure to find out if your trustee has a minimum balance requirement.
  3. Make contributions to your HSA as you see fit—without exceeding your annual contribution limit. You can also invest your HSA funds in financial opportunities offered through your trustee.
  4. Use your trustee’s preferred payment method—such as a debit card and/or checks—to pay for qualified medical expenses.
  5. Save all your receipts and complete the necessary tax forms to claim your deductions (IRS Form 8889).

 

Frequently Asked Questions

What is a high deductible health plan?

Who qualifies as a Health Savings Account trustee?

Who is eligible to open a Health Savings Account?

Which medical expenses can I pay for with my Health Savings Account?

Can I use my Health Savings Account to buy over-the-counter medications?

Can I withdraw Health Savings Account funds for non-medical expenses?

Can I use my Health Savings Account funds to pay for health insurance premiums?

Can I use my Health Savings Account funds for dependents not covered by my health insurance plan?

What are some other benefits of Health Savings Accounts?

Are there any disadvantages of opening a Health Savings Account?

Are there any Health Savings Account management fees?

Do I need permission or authorization from the IRS to open a Health Savings Account?

What happens to my Health Savings Account funds if I switch health plans and am no longer enrolled in a high deductible health plan?

How much money can I contribute to my Health Savings Account?

How do I spend my Health Savings Account funds?

What happens to my Health Savings Account funds at the end of the year if I don't spend them?

Can my employer contribute to my Health Savings Account?

Can anyone else besides my employer and me make contributions to my Health Savings Account?

What happens to my Health Savings Account if I lose my job?

Can my spouse and I both have Health Savings Accounts?

 

High deductible health plans available through HealthSource RI
HealthSource RI currently offers the following high deductible health plans. Enrollees in any of these plans are eligible to open a Health Savings Account.

 Individual Plans

BlueSolutions for HSA Direct 1500/3000
BlueSolutions for HSA Direct 2600/5200
BlueSolutions for HSA Direct 5000/10000
Neighborhood COMMUNITY
Neighborhood SECURE
UnitedHealthcare Gold Compass HSA $1,300
UnitedHealthcare Silver Compass HSA $2,000
UnitedHealthcare Bronze Compass HSA $5,500

 

Resources

Please see the following documents from the Internal Revenue Service:

 

Additional Information

To assist Rhode Islanders interested in opening a Health Savings Account (HSA), HealthSource RI invited interested HSA trustees to respond to a series of questions and informational requests regarding their offerings and services.

We received responses from two entities—RBS Citizens and HSA Bank, a division of Webster Bank, N.A.—and have provided a concise version of their responses below.

Please note that this content is provided for informational purposes only, and does not represent any endorsement or support for these particular institutions.

In addition, keep in mind that there are many HSA providers available to you, and this list represents only two of them. We encourage you to reach out to HSA trustees directly for the most accurate and reliable information.

RBS Citizens

Individual
Employee
Employer

HSA Bank

Individual
Employer

RBS Citizens HSA Bank
Type of Institution
  • $118 billion commercial bank holding company
  • Headquartered in Providence, R.I.
  • 82 branches and 192 ATMs in Rhode Island
  • HSA Bank is a division of Webster Bank, N.A.
  • Webster Financial Corp. is incorporated in Connecticut, with 13 banking centers in Rhode Island.
Experience offering HSAs
  • Offering HSAs for over 5 years
  • As of 2013, HSA custodial bank for over 135 employers and their employees, as well as individual clients
  • In 2013, estimated 15K HSA accounts; 5K will be RI residents
  • HSA Bank has over 16 years experience administering HSAs
  • Provides health-based savings solutions to over 25K employers, 600K HSA accounts, and managing over $2 billion in HSA deposits and investments
  • As of 2013, trustee for 163 employers with employees residing in RI and 2,132 RI residents
Markets Served
  • Individuals, Employers and Brokers
  • Offer to both group and non-group market segments
  • Individuals, Employees and Employers
  • Offer to both group and non-group market segments
Services Offered
  • Educational portal for Individuals, Employees and Employers
  • Discount pharmacy card
  • Tax reporting
  • Comprehensive investment options
  • HSA-specific call center in Massachusetts
  • 24/7 English and Spanish voice response unit
  • Online 24/7/365 self-service bank features available but not limited to: account look-up, online bill pay, track activity, statements, make investments, access to educational materials
  • Educational portal for Individuals, Employees and Employers
  • Tax reporting
  • HSA-specific call center
  • 24/7 voice response unit
  • Online self-service bank features available 24/7/365; account look-up, pay providers, track activity, make investments, access to educational materials
  • Offer a contribution monitor for internet banking customers
  • Accept check deposit contributions and Webster Bank banking centers
Consumer Benefits
  • Tiered interest rates from 1% to 2.35% offered
  • Health plan agnostic
  • Easy application process
  • Dedicated on-shore call center staffed with HSA experts
  • Online decision tools
  • Expenditure tracking (for a fee)
  • Comprehensive investment options
  • No set-up or account activation fee
  • Monthly fee applies, but waived when account balance maintained
  • Health plan agnostic
Payment Methods
  • Debit card
  • Online Bill Pay
  • Paper Check
  • Online transfers
  • Paper Check
  • Withdrawal forms for large medical expenses

 

Other Programs

The following organizations may be able to provide you or your family with financial assistance for health insurance and healthcare services.

 

260_logo_DHS

Rhode Island Department of Human Services

The Department of Human Services offers a wide range of programs, services, and benefits to Rhode Islanders. Economic Supports include the Supplemental Nutrition Assistance Program (SNAP); Medicaid eligibility; RIWorks; the Child-Care Assistance Program (CCAP); Long-Term Care; the Low Income Home Energy Assistance Program (LIHEAP) and Weatherization Assistance Program (WAP); General Public Assistance; and Federal Community and Social Services Block Grants. The Office of Child Support Services establishes paternity, locates parents, and creates, changes, and enforces child support orders. The Office of Rehabilitation Services manages vocational rehabilitation, disability determination, and services for the blind and visually impaired.

The Division of Elderly Affairs administers nutrition, information, home care, and protective services for elders. The Division of Veterans Affairs helps veterans through the RI Veterans Home, Veterans Services, and the RI Veterans Cemetery.

The Department of Human Services (DHS) offers resources and creates opportunities for families, adults, children, elders, individuals with disabilities, and veterans. People can get information and access services by visiting a DHS field office or the DHS website.

Visit http://www.dhs.ri.gov/ for more info.

 

EOHHS_RI_logo

The Executive Office of Health and Human Services

Under state law, the Executive Office of Health and Human Services (EOHHS) serves as “the principal agency of the executive branch of state government” responsible for managing the departments of: Health (DOH); Human Services (DHS); Children, Youth and Families (DCYF); and Behavioral Healthcare, Developmental Disabilities and Hospitals (DBDDH).

Last year, these agencies provided direct services to nearly 306,000 Rhode Islanders as well as an array of regulatory, protective and health promotion services to our communities. Health and human services and benefits represent $3.1 billion spending per year, or over forty percent of the entire state budget.

The EOHHS is designated by state law as the Medicaid single state agency and, in this capacity, administers the State’s major publicly funded healthcare program. RI Medicaid, as the program is known, provides health coverage to low income uninsured adults, families with children, and elders and persons with disabilities and special needs that otherwise might not be able to afford or obtain the services and support they need to lead healthy, safe and independent lives.

Visit http://www.eohhs.ri.gov/ for more info.

Choose the Right Plan

HealthSource RI connects you with brand-name health insurance companies so you can choose the coverage that best fits your budget, lifestyle, and healthcare needs. It all starts with asking yourself some basic questions:

  • Do I go to the doctor often or only when I’m very sick?
  • Do I (or does someone in my family) take special medications that a doctor prescribes?
  • Do I mind driving a while to see a doctor or do I prefer to see a doctor whose office is close to home?
  • Which hospital(s) does my doctor work with and can I get there if I need to?
  • Can I receive a tax credit to help pay for my insurance? How much will my tax credit reduce the cost of the plan I choose?
  • Would I rather pay more each month and pay less out of my pocket when I see the doctor?
  • Would I rather pay less each month and pay more out of my pocket when I see the doctor?

Your answers will help you determine which health insurance plan is right for you or your family. Once you’ve chosen one, you’ll be able to submit your first month’s payment by mail or through our secure website. If you have any questions along the way, our support team is available online, by phone, or in person to help.

Know your health insurance options

What’s New In 2015
 

Know your health insurance options

HealthSource RI currently offers 20 health insurance plans for individuals and their families from three health insurance companies: Blue Cross & Blue Shield of Rhode Island, Neighborhood Health Plan of Rhode Island, and UnitedHealthcare. Dental insurance is also available through Blue Cross & Blue Shield of Rhode Island, Delta Dental, and Guardian.

To learn more about plan offerings and rates, click on the links below:

All health plans available through HealthSource RI are organized into three “metal” categories: Bronze, Silver, and Gold. Catastrophic coverage is also available for Rhode Islanders under the age of 30.

The metal categories indicate whether you pay more for your monthly health insurance premium
or more for medical services on a per visit basis.

Gold plans require the highest monthly premium but allow you to spend less on co-payments, co-insurance, and deductibles if you get sick or need a particular healthcare service. If you or someone in your family has a chronic health condition and requires many healthcare services, a Gold plan may be the best choice for you. 

Silver plans have lower monthly premiums than Gold plans, but require you to spend more money when you visit the doctor than a Gold plan. If you’re healthy and don’t expect to see a doctor or specialist very often—or if you don’t take many prescription medications—a Silver plan may be the best choice for you.

Bronze plans offer the least expensive monthly premium, but require you to spend more money for healthcare services before your insurance will start paying the bill. If you’re generally very healthy and can set money aside to pay for a large medical expense, a Bronze plan may be the best choice for you.

Catastrophic plans are designed for Rhode Islanders under the age of 30. They offer the same coverage as a Bronze plan, but cost less because they are only available to younger adults. If you are under the age of 30, are generally very healthy, and are willing to take the risk of a large medical expense, a Catastrophic plan may be the best choice for you.

What’s New In 2015

If you already have health insurance through HealthSource RI, your current coverage will end on December 31—and will not renew automatically. To ensure that you’re covered on January 1, you must choose your 2015 plan and pay your first month’s premium by December 23, 2014.*

You should have received a HealthSource RI renewal packet that includes new rate sheets and information on the tools you can use to select your 2015 health insurance and/or dental plan. You’ll find that we have some new and lower-priced options for you in 2015, including some plans that are available only through HealthSource RI.

This year, we’re offering:

  • A new insurance company: We are excited to now offer individual and family plans from UnitedHealthcare.
  • Greater access to Neighborhood Health Plan: Everyone is now free to choose one of the company’s health plan options.
  • More plans: We’ve added 8 new health insurance options this year for a total of 20 plans to fit your needs and budget.
  • Lower Prices: Look for health insurance options that cost less per month than they did in 2014.

If you receive tax credits from HealthSource RI to help pay for your insurance, it’s especially important to review your options and compare plans before you choose your insurance coverage. As some plan prices have changed, the amount of tax credit you receive may also change.

Use our Savings Calculator to compare premium, deductible, co-payments and co-insurance costs—and to see if your income qualifies you for tax credits or other cost-sharing reductions that can lower the cost of your healthcare.


* To make sure that you have health insurance coverage that begins on January 1, 2015, and that you receive your insurance cards in the mail before the year starts, you must renew through HealthSource RI, pick a plan and pay for it by December 23, 2014.  If you do not take these steps by December 23rd, you will still have time to renew and pick a plan through December 31st, but you may not receive your insurance card(s) until mid-January.