HealthSource RI (HSRI) is the state’s health insurance marketplace where Rhode Islanders can compare affordable health plans and purchase coverage that meets their health care needs and budget. HSRI also hosts the on-line application process for both Medicaid and subsidized commercial coverage.
Individuals who are not eligible for Medicaid, Medicare, and other public health insurance coverage, and who do not have affordable coverage at work, may qualify for help purchasing a health plan and may also qualify for help paying for out-of-pocket costs.
Families and individuals may be eligible for a tax credit from the federal government to help pay for the cost of coverage (see chart below). The tax credit can be claimed at the end of the tax year when the person files their income tax return. It can also be received in advance each month to help pay the monthly premium to enroll in coverage. This is commonly called the Advanced Premium Tax Credit or “APTC” and is typically how people use the credit. There is currently (through 2025) no income limit to qualify for tax credits, but the higher the income, the lower the amount of the credit.
Lawfully present immigrants are eligible to enroll in health insurance through HealthSource RI and to qualify for tax credits. This includes lawful permanent residents (people who have a “green card”) who are ineligible for Medicaid during the 5 year waiting period as well as people with Temporary Protected Status and Deferred Enforced Departure. DACA recipients are not eligible to buy coverage through HSRI.
How to Apply
Families and individuals can apply for health insurance on-line at https://healthyrhode.ri.gov or by submitting a paper application which you can download at https://tinyurl.com/RI-DHS-2-2018. You can also request a paper application from a DHS office or by calling: 1-855-697-4347. Eligibility will generally be determined by using data about income, citizenship, immigration status, and other required documentation from other government agencies. Applicants will be asked to provide paper documentation if a computer data match is not possible. The first month’s premium must be paid to HealthSource RI before coverage starts. Payments can be made by electronic transfer from online bank account, by phone, at CVS pharmacies (credit, debit or cash). For all options: https://healthsourceri.com/make-payment/
The next open enrollment period will start November 2022 for enrollment for coverage for calendar year 2023. Generally, people cannot enroll outside of the open enrollment period. However, if they have a “qualifying event” such as a birth of a child or marriage, loss of a health insurance due to loss of employment, they can enroll in coverage through HealthSource RI through a special enrollment period. Read more here.
People needing help with the application can call the Contact Center at 1-855-840-4774. People who want to work with a person in their community can find a “Navigator” in their neighborhood. You can find a Navigator at https://healthyrhode.ri.gov/HIXWebI3/DisplayNavigatorSearch or call 2-1-1. You can also contact RIPIN for assistance (401-270-0101).
Special Note for Parents with Children Enrolled In RIte Care:
For parents with children enrolled in RIte Care, whose income is between 138% FPL and 175% FPL, there is additional state assistance (The State Premium Assistance Program) to help parents pay their premium.
The parent must enroll in a “silver level” plan through HealthSource RI to quality for the SPAP. The parent submits an application to EOHHS. The application can be obtained at EOHHS or HealthSource RI. The parent pays the full premium to the plan and EOHHS sends the parent a check for the SPAP.
Annual Income Limit and Amount of Monthly State Premium Assistance Available (January 2022)
|Family Size||Income Less Than 150% FPL||Monthly Payment||Income Between 150% FPL and 175% FPL||Monthly Payment|