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West Greenwich, RI Obamacare Guide

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What Rhode Island Residents Need to Know About Obamacare for 2021

The Affordable Care Act, also known as Obamacare, has not been struck down or repealed. Rhode Island open enrollment for 2021 plans runs from November 1 until January 23.

The news has been full of uncertainty about the future of the Affordable Care Act (Obamacare) as the law once again sits before the U.S. Supreme Court. However, a ruling on that case is still many months away and chaotic political winds could shift and affect the law before that time. For 2021 health plans, you can use Health Source RI to compare plans, sign up for coverage, and get financial assistance.

This website provides information about getting health insurance under the ACA, including:

To begin, keep in mind these key points about health insurance in Rhode Island:

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How To Sign Up for Obamacare in Rhode Island

To sign up for a health plan under the Affordable Care Act (Obamacare) you can go directly to the online health insurance marketplace for Rhode Island. If you need personalized help, you can reach out to one of the many types of enrollment assistants working remotely during the COVID-19 crisis.

For 2021 health plans, Rhode Island open enrollment runs from November 1 until January 23, 2021. If you enroll by December 15, your coverage will begin on January 1, 2021.

Enrollment for 2020 health coverage has ended, but you can get covered for the rest of the year if you qualify for a special enrollment period, including job loss due to the COVID-19 pandemic.

Where's the Rhode Island Health Care Exchange?

You can find the health insurance exchange for Rhode Island at Health Source RI. This is where you can learn about the various health insurance options available to you under Obamacare. If you see a plan you like, you'll be guided through the enrollment process online. 

Getting Personalized Help with Enrollment

In Rhode Island, if you need help understanding your options for coverage under Obamacare or signing up for a plan, you can get free help from an enrollment assistant or from a licensed health care agent or broker.

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How Much Does Obamacare Cost in Rhode Island?

This article explains the costs of health care plans offered under the Affordable Care Act (commonly called Obamacare) for individuals or families who are currently uninsured or not covered by a job-based health plan.

What you'll pay for an Obamacare plan depends on five things:

  1. The level of coverage you choose
  2. Whether you qualify for a subsidy
  3. Where you live in Rhode Island
  4. Your age
  5. Whether you smoke

Read on to learn more about each of these factors.

1. The Level of Coverage You Choose

Obamacare insurance plans offer four levels of coverage:

Platinum -- covers approximately 90% of health care costs
Gold -- covers approximately 80% of health care costs
Silver -- covers approximately 70% of health care costs
Bronze –- covers approximately 60% of health care costs

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Do I Have to Get Health Insurance In Rhode Island?

Rhode Island law requires you to have health insurance in 2021.

Since the federal penalty for going without health insurance went away in 2019, a handful of states -- including Rhode Island -- have passed their own health insurance requirements. These requirements are also called "health insurance mandates" or "individual mandates."

To avoid the Rhode Island tax penalty, you must have what the state considers "minimum essential coverage" or prove your eligibility for an exemption.

What qualifies as minimum essential coverage in Rhode Island?

In Rhode Island, if you have any of the following types of health coverage, you have minimum essential coverage and you won’t have to pay a penalty:

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Ways to Save Money on Obamacare in Rhode Island

There are three primary ways to reduce the cost of health plans under the Affordable Care Act in Rhode Island.

  • You may be able to lower the cost of monthly premiums when you sign up for a private health insurance plan. Your savings will come in the form of a federal tax credit.
  • You may be able to reduce your out-of-pocket costs -- including copayments, deductibles, and coinsurance -- with cost-sharing subsidies paid for by insurers.
  • You may qualify for free or low-cost coverage through Medicaid in Rhode Island, or your children may be able to obtain coverage through the Children’s Health Insurance Program (CHIP).

Each of these forms of assistance depends on your income and family size.

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Rhode Island Medicaid Expansion: Do I Qualify for Medicaid Under the ACA?

The Affordable Care Act (Obamacare) expanded Medicaid eligibility to include more people who couldn’t otherwise obtain health insurance. As written, the ACA would extend Medicaid to all adults with incomes at or below 138% of the federal poverty level. (For a single person in Rhode Island in 2020, that’s $17,609. For a family of four, it’s $36,156.)

However, the U.S. Supreme Court later ruled that it was up to individual states to decide whether to expand Medicaid. As of August 2020, 12 states have not expanded their programs.

Rhode Island Has Expanded Medicaid

Because Rhode Island did decide to expand its Medicaid program, residents can qualify for Medicaid more easily today than in years past.

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What to Do If You're Frustrated or Fed Up With Health Source RI

As Obamacare enters its open enrollment period for 2018 health plans, those seeking coverage face more chaos than ever. For many Americans, affordable coverage and streamlined enrollment still seem like faraway goals.

Below are a couple of strategies to help you get your health insurance needs met.

Common Complaints from Health Insurance Applicants

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Understanding Obamacare's Preventive Health Care Benefits

Get a colonoscopy, mammogram, vaccinations, and other essential services for free

The Affordable Care Act requires health insurance plans to offer certain preventive care services free of charge -- or more accurately, for nothing more than the cost of your monthly insurance premiums. This rule applies to most plans sold directly by insurance companies and all plans sold through Health Source RI, the health care marketplace for Rhode Island. Covered preventive services are available for free (meaning no co-pay or other out-of-pocket charges) whether or not you’ve met your plan’s annual deductible.

Tips for Using Your Preventive Care Benefits – And Avoiding Unexpected Charges

Below, you’ll find a list of free preventive benefits -- screening tests, counseling services, and vaccinations -- for adults, women, and kids. But first, here are some pointers to help you avoid an unexpected bill for services you thought were preventive.

Use a network provider. To get a preventive service for free, you must use a health care provider in your insurance plan’s network.

Know the difference between “preventive” and “diagnostic.” Doctors can use screening tests for either preventive or diagnostic reasons. For example, having a routine mammogram every year or two is preventive care for women over 40. But if you schedule a mammogram because you feel a lump or have breast pain, that’s diagnostic. Likewise, a routine colonoscopy is recommended for adults over 50, but if your doctor schedules a colonoscopy to investigate a problem like blood in your stool, it becomes a diagnostic procedure. Preventative services are free; diagnostic procedures are not. (If the timing is right -- say, you go to the doctor because you find a lump in your breast but you also happen to be due for an annual mammogram -- your doctor may bill the diagnostic procedure as preventive, but that’s not something you can count on.)

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Obamacare for Self-Employed Rhode Island Residents

Many self-employed people will be quick to tell you that getting and paying for health insurance is one of the biggest challenges they face. For some, however, the Affordable Care Act (Obamacare) may make things easier by providing new coverage options for the self-employed.

Are You Self-Employed or an Employer? 

Before you start evaluating your options for health coverage, you need understand whether the Affordable Care Act thinks you're self-employed.

The ACA says you are self-employed if you are an independent contractor or a sole proprietor without employees. (If you hire other independent contractors to do some work for you, you probably still qualify as self-employed.) If you are self-employed, you can use Health Source RI to compare health insurance plans and sign up for the one that works best for you.

If you have employees – usually, workers whose income you report on a W-2 at the end of the year -- you’re considered an employer. In that case, you can learn about purchasing health insurance for yourself and your employees through the SHOP Marketplace. You will be connected with a registered SHOP (Small Business Health Options) agent or broker who can help you understand your coverage options.

If you aren’t sure whether the people who work for you are independent contractors or employees, read "Independent Contractor (Self-Employed) or Employee?" on the IRS website.

What the Affordable Care Act (Obamacare) Means for Self-Employed People in Rhode Island

Here are seven things self-employed people should know about the Affordable Care Act:

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Get Help Finding a Health Insurance Plan in Rhode Island

Get Help From Rhode Island's Health Insurance Exchange

The following links and telephone numbers take you to the official help resources for Health Source RI, the health insurance marketplace for Rhode Island.

Get help by phone: 855-840-4774

Get help in person: To find a certified navigator, see Search for a Navigator at Health Source RI. 

Get Help From a Licensed Insurance Broker

To directly connect with a Rhode Island insurance broker who can help you evaluate insurance plans and choose a plan that's appropriate for your situation, call 800-943-6832. (We receive advertising income from the licensed brokers who offer their services through this telephone number.)

More Information

For more detailed information, see How Do I Sign Up for Obamacare in Rhode Island?

How Obamacare Affects Unemployed Rhode Island Residents

During this time of record unemployment, many people have lost not only their jobs, but health insurance, too. (Between February and May of 2020, an estimated 5.4 million people became uninsured because of job losses during the coronavirus pandemic.)

If you've suffered the dual blow of losing employment and your insurance, the Affordable Care Act (Obamacare) may offer relief in the form of readily available, affordable coverage. Usually, you must sign up during an open enrollment period. But leaving your job and losing job-based health insurance makes you eligible for special enrollment; you'll have 60 days to sign up for a new health plan. 

All plans available through the marketplace offer essential medical benefits, including preventive care, emergency services, and prescription drug coverage. You can't be turned away if you have a pre-existing medical condition and, because you're not working, you'll probably qualify for significant cost-saving subsidies.

When you sign up for a health plan under the ACA, your coverage can start within a few weeks.

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Rhode Island Has Its Own Obamacare Tax Penalty

In Rhode Island, you may be required to pay a state tax penalty if you don't have health insurance.

In January 2020, Rhode Island initiated its own tax penalty for residents who don't have health insurance. The penalty essentially replaces the federal Affordable Care Act penalty that ended at that time. Unless you qualify for an exemption, you will face a state tax penalty when you file your tax return.

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What Domestic Partners Need to Know About Applying for Health Insurance Under Obamacare

When registered domestic partners or civil union partners apply for coverage at an Affordable Care Act health insurance marketplace, there’s one question that almost always arises: Do we apply based on our separate incomes or must we include all the income we make as a couple?

The answer depends on the state where you live.

States other than California, Nevada, or Washington. In almost all states, registered domestic partners or civil union partners who apply for insurance via the state’s health insurance exchange must do so separately. Each partner includes only his or her separate income, and this amount determines health plan costs and eligibility for cost-saving subsidies. It works this way because domestic partners are not considered married for federal tax purposes. (If you registered first and got legally married later, this article doesn't apply to you. You must apply as a married person and report your combined income.)

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Rhode Island Obamacare Scams: What They Are & How to Avoid Them

If someone calls you on the phone in Rhode Island offering you discount health insurance for $29 a month, hang up and report them to the Rhode Island Department of Business Regulation

Worthless insurance is one of many scams that unscrupulous people are trying to sell to consumers confused by Obamacare. To satisfy the requirements of the new law, you must have a qualified insurance plan. If you don't, not only will you miss out on cost-saving insurance subsidies, you will probably be subject to a tax penalty.

Beware of scammers who may try to persuade to you buy insurance outside of Health Source RI. Below is a list of common types of scams.

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Obamacare and Seniors

If you’re over the age of 65, your health insurance options under the Affordable Care Act (Obamacare) depend on whether or not you’re covered by Medicare or another insurance plan. To find out what, if anything, you need to do, find the situation below that applies to you.

You have Medicare. If you’re already enrolled in Medicare, you’re considered covered under the ACA, and you don’t have to do anything. In fact, it’s illegal for someone who knows you have Medicare to try to sell you a plan through an ACA health insurance marketplace.

The Affordable Care Act does enhance your existing Medicare coverage by providing additional preventive care benefits, such as cancer screenings and an annual wellness visit.

For more information on Medicare coverage, go to Medicare.gov.

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Obamacare and Students

Under Obamacare, students who are U.S. citizens or legal residents have several options for getting covered under the Affordable Care Act (Obamacare).

1. Stay on your parents health insurance. If you’re under the age of 26, your parents may be able to add you as dependent to a health insurance plan purchased through the marketplace at Health Source RI.

2. Stay on your college or university’s health coverage. Because insurance plans offered by colleges and universities vary widely, you should talk to your school's health plan office to make sure its plan meets Obamacare rules. 

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Can I Use a Paper Application to Get Obamacare?

When Obamacare first launched, the federal and state health insurance marketplaces (also called “exchanges”) were plagued by technical troubles. Many people who tried to sign up for new health insurance plans online in the early days were unable to complete their applications.

Because of these difficulties, some individuals and application assistants turned to the old-school way of getting health insurance -- paper applications.

Applying on Paper May Not Be Better or Faster

When facing a slow or broken online health insurance exchange, using a paper application may seem tempting -- at least it would provide the feeling of getting something done. However, paper forms may not speed up the process at all. On the contrary, they could slow down your application even more.

The worker who reviews your paper application must manually enter the information from your forms into the same system you would use online at your state’s exchange. It won’t work any faster for them than it does for you. Plus, using a paper application opens up more opportunity for error by putting more people between you and your goal of getting insurance.

It’s still best to apply online if you can. That said, if you feel that you’re unlikely to come back and apply for health insurance later, you may want to go ahead and complete a paper application now. 

To get a paper application, call the Health Source RI customer service center and let them know you want to apply on paper. They'll point you to a downloadable application or send you one in the mail. For detailed Health Source RI contact information, see How To Sign Up for Obamacare in Rhode Island.

How an Insurance Agent or Broker Can Help You Sign Up for Obamacare in Rhode Island

If you’re confused by your health care choices under the Affordable Care Act (Obamacare) -- or if you’re having a difficult time completing an application -- there are many ways to get help. For example, you can call the Rhode Island health insurance exchange for telephone support or obtain free, in-person guidance from trained enrollment counselor. You can also seek help from a licensed insurance agent or broker.

Given the technical flaws in many online health care marketplaces, getting help from an agent or broker has become an attractive option for many people. Agents and brokers, while grappling with most of the same delays and hassles faced by individuals, can make the process easier in several important ways, including:

  • determining whether you qualify for subsidies
  • helping you compare plan prices and coverage details, while explaining any complicated features or terms
  • recommending plans that would be best for you (government enrollment assistants are not permitted to suggest specific plans), and
  • walking you through the application process.
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When Are You Legally Required to Report “Life Changes” to the Rhode Island Health Insurance Exchange?

Are you planning to get married, change jobs, or move to a new state? If so, you might have to share your big news with Health Source RI.

Which Changes Must You Report? 

If you buy a health insurance plan through the Rhode Island marketplace, the Affordable Care Act requires you to report changes that may affect your insurance coverage. These changes include: 

  • moving to a new state or insurance coverage area
  • significant changes in income
  • getting new health coverage through a job
  • signing up for Medicare or Medicaid
  • getting married or divorced
  • becoming pregnant, having a child, adopting a child, or placing a child for adoption
  • losing or gaining a dependent
  • becoming disabled, and
  • other changes that affect your income or household size.

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What Happens If I Missed the Rhode Island Obamacare Enrollment Deadline for 2021?

In most states, open enrollment has closed for 2021 health plans. After open enrollment ends, you won't be able to use Health Source RI to purchase a health insurance plan unless you qualify for an exception.

You Can Still Enroll If You Qualify for a “Special Enrollment” Period

Certain life events make you eligible to sign up for health insurance outside of open enrollment. The circumstances under which you may qualify for special enrollment include:

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About This Website

We built this website to get people the answers they need about the Affordable Care Act (Obamacare). Our goal is to guide you to reliable, local information about your new health insurance options.

When you choose your state or enter your zip code here, you will quickly learn:

  • whether or not you're required to get health insurance

  • what the available plans cover

  • how much coverage will cost, and

  • how to sign up in your state.

For those concerned about cost, we show you how to determine whether you qualify for subsidies.

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