Rhode Island Health Insurance Consumer Guide

To sign up for health insurance through the Rhode Island Health Insurance Marketplace (HealthSource RI), you must:²

• Be lawfully present in the United States and live in Rhode Island
• Not be incarcerated
• Not be enrolled in Medicare

So most Rhode Island residents can enroll in coverage through the exchange. But eligibility for financial assistance is a bigger question for most people, and there are a few additional eligibility rules for HealthSource RI subsidies. To qualify for income-based Advance Premium Tax Credits (APTC) or cost-sharing reductions (CSR), you must:

• Not be eligible to enroll in an affordable employer-sponsored health plan. If you can enroll in an employer’s health plan and aren’t sure if it’s considered affordable, you can use our Employer Health Plan Affordability Calculator to see if you might qualify for premium subsidies to offset the cost of a plan obtained through HealthSource RI. 
• Not be eligible for Rhode Island Medicaid or CHIP, or for premium-free Medicare Part A.³
• File a joint tax return if you’re married.⁴ (with very limited exceptions)⁵
• Not be able to be claimed by someone else as a tax dependent.⁴

Beyond those basic parameters, qualifying for subsidies through HealthSource RI will depend on your household’s income compared with the cost of the second-lowest-cost Silver plan in your area – which will depend on your age. (In most states it also depends on location, but Rhode Island is all one rating area, so premiums do not vary by zip code).⁶

The open enrollment period for health insurance in Rhode Island runs from November 1 through January 31. Enrollments need to be completed by December 31 in order to have coverage effective January 1.⁷ (Note that the enrollment dates are potentially subject to change in future years.)

Outside of the open enrollment window, you may still be eligible to enroll or make a plan change if you experience a qualifying life event, such as giving birth or losing other health coverage. And some people can enroll year-round even without a specific qualifying life event. 

Rhode Island is one of several states where pregnancy counts as a qualifying life event, allowing an uninsured person to enroll in health coverage as soon as they find out they’re pregnant (in most states, the birth of a baby is a qualifying event, but pregnancy is not). This took effect in Rhode Island in 2023, due to legislation the state enacted the year before⁸

Enrollment in Rhode Island Medicaid and CHIP is available year-round for eligible residents.

To enroll in ACA Marketplace/exchange health insurance in Rhode Island, you can: 

• Visit HealthSource RI, which is the state’s health insurance exchange (Marketplace). It will allow you to compare available health plans, determine whether you’re eligible for financial assistance, and enroll in a health plan. 
• Enroll in a health insurance plan through HealthSource RI with the help of an insurance broker, Navigator, or certified application counselor. There is no charge to have assistance with the plan selection and enrollment process.

When you enroll in a Rhode Island health insurance plan through HealthSource RI, you may be eligible for financial assistance that reduces the monthly cost of your coverage (premium subsidies), and possibly also your out-of-pocket expenses (cost-sharing reductions, or CSR). These federal subsidy programs were created by the Affordable Care Act, and eligibility depends on your income and circumstances.

Income-based subsidies (APTC) are available to lower the amount you pay for your HealthSource RI coverage each month. Eighty-six percent of HealthSource RI enrollees were receiving premium subsidies as of early 2024. The subsidies covered an average of $454/month, and reduced the average enrollee’s premium (including those who pay full price) to about $153/month.⁹

Source: CMS.gov¹⁰

If your household doesn’t earn more than 250% of the federal poverty level, you’ll also be eligible for federal cost-sharing reductions (CSR) as long as you enroll in a Silver-level plan through HealthSource RI. CSR subsidies will reduce your deductible and other out-of-pocket expenses, making it more affordable for you to receive health care. More than a third of HealthSource RI enrollees were receiving CSR benefits as of early 2024.⁹

Rhode Island lawmakers introduced legislation in 2024 that would have created additional state-funded premium subsidies and cost-sharing reductions, but the legislation did not advance.¹¹ Several other states already offer state-funded subsidies in addition to the federal subsidies that are available nationwide.

Depending on your income and circumstances, you may be able to enroll in free or low-cost health coverage through Rhode Island Medicaid or CHIP. Learn more about whether you might be eligible for these programs.

On the other hand, if you’ve being disenrolled from Rhode Island Medicaid during the “unwinding” of the pandemic-era continuous coverage rule, you may find that you’re eligible to receive at least two months of premium-free coverage through HealthSource RI. For people in this situation with household income up to 250% of the poverty level, Rhode Island is covering the after-APTC portion of premiums for the first two months. And if your income doesn’t exceed 200% of the poverty level, HealthSource RI will automatically enroll you in a health plan when your Medicaid ends¹² (you’ll still have the option to select a different plan).

As of April 2024, CMS reported that 4,515 people in Rhode Island had transitioned from Medicaid to a Marketplace plan during the unwinding period. Nearly 2,000 of those people had been automatically enrolled.¹³

Two insurers offer health plans through HealthSource RI.¹⁴ Both will continue to offer coverage in 2025.¹⁵

For 2025, the following average rate changes have been approved for the insurers that offer individual/family coverage through HealthSource RI, amounting to an overall average increase of 7.8%.¹⁵

Source: Rhode Island Office of the Health Insurance Commissioner¹⁵

Average rate changes apply to full-price rates, and most enrollees do not pay full price: Eighty-six percent of the people enrolled in private plans through HealthSource RI were receiving premium subsidies in 2024.⁹

If the cost of your coverage is increasing for the coming year, you may want to consider some of the other plans that are available through HealthSource RI. You may find an alternative that better fits your budget and still meets your coverage needs.

For perspective, here’s how average full-price Rhode Island health insurance premiums have changed over the years:

• 2015: Increase of about 4%¹⁶
• 2016: Average increase of 6.5%¹⁷
• 2017: Average increase of 1.3%¹⁸
• 2018: Average increase of 21.7%¹⁹
• 2019: Average increase of 8.1%²⁰
• 2020: Average decrease of 0.5%²¹ (reinsurance and individual mandate took effect)
• 2021: Average increase of 4.2%²²
• 2022: Average increase of 2.1%²³
• 2023: Average increase of 6.1%²⁴
• 2024: Average increase of 5.9%²⁵

36,121 people enrolled in 2024 coverage through HealthSource RI during the open enrollment period.²⁶ This was a new record high for HealthSource RI (note that the state’s report showed a slightly lower total enrollment, but still a record high).²⁷

The chart below shows historical enrollment through HealthSource RI, which has previously hovered between about 28,000 and 35,000 people. Although nationwide Marketplace enrollment has increased sharply since 2021,²⁸ that has not been the case in Rhode Island. But 2024 enrollment did reach a new record high in the state.

Source: 2014,²⁹ 2015,³⁰ 2016,³¹ 2017,³² 2018,³³ 2019,³⁴ 2020,³⁵ 2021,³⁶ 2022,³⁷ 2023,³⁸ 2024³⁹

HealthSource RI
The state-run Marketplace/exchange in Rhode Island. Provides health insurance options for individuals, families, and small businesses, as well as financial assistance for individuals and families based on household income.

Rhode Island Insurance Division
Regulates the insurance industry in Rhode Island, and addresses consumers’ questions and complaints related to insurance.

Rhode Island Health Center Association
Navigator and Certified Application Counselor services to help people enroll in coverage through HealthSourceRI. Can provide assistance with private plan enrollment and Medicaid/CHIP enrollment, as well as information on applicable financial assistance available to offset costs in private plans.

Rhode Island Office of Healthy Aging, Medicare Counseling
The state health insurance assistance program for Medicare beneficiaries; can provide information, assistance, and counseling related to enrollment, eligibility, and claims.