Consumers
The following link goes to an external site hosting the Consumer Guide for Getting and Keeping Health Insurance in Rhode Island. RI Consumer Guide (external)
The RI Department of Health has jurisdiction over the provider networks of insurers, overseening utilization review and health plan standards. For more information please visit the DOH Office of Managed Care Regulation (external)
The following is intended as an overview of the RI health insurance market and as pointer to relevant resources.
Direct PayDirect Pay refers to the non-group health insurance market in Rhode Island. Blue Cross Blue Shield of Rhode Island (BCBSRI) exclusively offers plans in this market. Direct Pay health insurance is intended for you and/or your family if you do not have access to health insurance through an employer and do not quality for public coverage of some type.
Currently, BCBSRI offers four plans in the Direct Pay market:
- HealthMate Coast-to-Coast Direct Plan 400/800
- HealthMate Coast-to-Coast Direct Plan 2000/4000
- HealthMate for HSA Direct Plan 3000/6000
- HealthMate for HSA Direct Plan 5000/10000
These plans differ in a variety of ways including different premium rates, different coinsurance rates, different copayments, and how large a deductible you must pay out-of-pocket before BCBSRI will cover some or all of your medical expenses. It is important to choose a plan that fits your health priorities and budget considerations.
For more information about plans, please contact BCBSRI at:
(401) 459-5000
(800) 639-2227
(401) 831-2202 (TDD)
(877) 232-8432 (TDD)
BCBSRI Direct Pay Plans (external link)If you are unable to resolve a Direct Pay complaint with BCBSRI, you can submit a complaint with our Office here.
Employer-Based Insurance
Most Rhode Island residents obtain health insurance through their employer or the employer of a family member on whom they are dependent. Depending on the particular plans that an employer offers, an employee may be subject to different degrees of cost sharing in the form of premiums, deductibles, copayments or coinsurance.
ERISA, the Employee Retirement Income Security Act, is a federal law passed in 1974 that sets federal reporting and disclosure rules for employer-sponsored health plans. Under ERISA, companies that self-insure and pay for workers' health benefits directly are exempt from state insurance regulation and taxes. This means that your employer may not have to follow state regulations concerning mandated benefits if they self-insure. Text of the Employee Retirement Income Security Act - 29 U.S. Code Chapter 18 (external link).
Employers are not required to continue insurance coverage if you cease to be employed. However, uou may be eligible for continuation of insurance coverage subject to federal/state law.
For information your rights under federal law, check out FAQs About COBRA Continuation Health Coverage (external link). If you have concerns, complaints, or questions about COBRA, please contact:
Kevin Murphy, United States Department of Labor
(617) 565-9622
(866) 444-3272In Rhode Island, we also have the Extended Medical Benefits statute, or "Mini COBRA" (external link). For information your rights under state law.
To contact:
Blue Cross Blue Shield of Rhode Island
(401) 459-5000
Mailing address:
Blue Cross & Blue Shield of Rhode Island 444 Westminster Street
Providence, RI 02903-3279To contact:
United HealthCare of New England
(401) 737-6900
Mailing address:
United HealthCare of New England
475 Kilvert St Ste 310 Warwick, RI 02886-1360Medicare
Medicare is the federal health insurance program for almost all Americans age 65 and older and for many adults with permanent disabilities. You are eligible for Medicare if you are a U.S. citizen or have been a permanent legal resident for five continuous years, and:
- You are 65 years or older and eligible to receive Social Security; or
- You are under 65, permanently disabled, and have received Social Security disability insurance payments for at least 2 years; or
- You get continuing dialysis for permanent kidney failure or need a kidney transplant; or
- You have Amyotrophic Lateral Sclerosis (ALS-Lou Gehrig's disease).
Three parts of Medicare - Part A, Part B, and now Part D - provide coverage for basic medical services and prescription drugs. Part A covers inpatient hospital care, some skilled nursing facilities (SNF), home health, and hospice care.
Part B pays for doctors' services, outpatient hospital care, and home health visits not covered under Part A.
Part C offers Parts A and B benefits, and may offer prescription drug coverage (Part D), through private health plans. This part of Medicare does not offer additional Medicare benefits.
Medicare began covering prescription drugs in 2006 under Medicare Part D. There is a separate monthly premium of about $27.35 in 2007 for Part D, but the premiums vary greatly among plans as do the drugs that are covered and the amounts charged for prescriptions. Medicare drug coverage is offered through Medicare-approved private plans.
For more information on Medicare, please check out the following resources:
The Henry J. Kaiser Family Foundation, Medicare at a Glance (external link)
The Henry J. Kaiser Family Foundation, Talking About Medicare: Your Guide to Understanding the Program, 2008 (external link)For questions specific to Medicare Part D’s prescription drug benefit, please contact the State of Rhode Island Rhode Island Department of Elderly Affairs (external link) or by phone at (401) 462-4000 or (401) 462-0740 (TTY).
RIte Care/Medicaid
The Rhode Island Medical Assistance Program, also known as Medicaid, is a federal and state funded program that pays for medical and health related services for eligible Rhode Islanders.
Medicaid is available to you based on income status and disability under the Medical Assistance Program. Medicaid is focused on providing health insurance coverage to low-income Rhode Islanders.
RIte Care is Rhode Island’s Medicaid health insurance program that provides eligible uninsured children, families, and pregnant women with comprehensive health care through one of three participating health plans: Neighborhood Health Plan of RI, United Health Care of New England, and Blue Cross Blue Shield of Rhode Island.
RIte Share is a premium assistance program that helps families get insurance coverage through their employer (or spouse’s employer). If a family qualifies, RIte Share will pay all or part of the employee’s share of the health insurance premium.
Generally, eligibility for RIte Care and RIte Share is based upon income level and family size. Both are administered through the State of Rhode Island Department of Human Services. For more information, please check out the following resources:
Rhode Island Medical Assistance Program web page (external link)
RIte Care and RIte Share Fact Sheet (external link to PDF)
Rhode Island Annual Medicaid Expenditure Report (external link to PDF)
If you have concerns, complaints, or questions about Medicaid, please contact:
Rhode Island Department of Human Services
(401) 462-1300
(401) 462-1500 (Spanish)Contact Information:
Neighborhood Health Plan of Rhode Island 299 Promenade Street Providence, RI 02908
1-401-459-6000 (local)
1-800-963-1001 (toll free)
1-401-459-6175 (fax)
TRICARE
TRICARE is the United States Department of Defense’s worldwide health care program for active duty and retired uniformed services members and their families. TRICARE consists of TRICARE Prime, a managed care option; TRICARE Extra, a preferred provider option; and TRICARE Standard, a fee-for-service option.
Tricare factsheet (external link)
If you have concerns, complaints, or questions about Medicaid, please contact the Office of the Assistant Secretary of Defense (Health Affairs) and the TRICARE Management Activity (external link) or by phone at (877) 874-2273.
Uninsured
11.5% of Rhode Island’s nonelderly population is without health insurance. The uninsured, as a group, are disproportionately poor, low-income, and working adults who face less access to medical care and poorer health status than their uninsured counterparts.
Related resources:
Rhode Island Free Clinic (external link) or (401) 274-6347.
