Mandatory Insurance for Individuals
Individuals must maintain minimum essential coverage each month or pay a penalty. The penalty is the greater of:
Federal Subsidies to Reduce the Cost of Insurance
Individuals and families who fall below 400 percent of the federal poverty level will be eligible for federal subsidies to reduce the cost of coverage. Learn more about financial help for individuals.
State-based Health Insurance Marketplaces
Individuals and small employers will have the option to purchase coverage through health insurance marketplaces, which will provide information about coverage options. In Rhode Island, the health insurance marketplace is called HealthSource RI. To receive federal subsidies, individuals must purchase coverage through Healthsource RI.
Small Group Tax Credits
Starting in 2014, tax credits for small employers will only be available through Healthsource RI. Employers can only receive the credit for two consecutive taxable years.
Essential Health Benefits
Most plans are required to provide coverage for essential health benefits, including emergency services, hospitalization, prescription drugs, maternity and newborn care, and more.
If a worksite wellness program has rewards for participation, the amount of the reward may not exceed 30 percent of the cost of employee-only coverage under the plan. The plan must offer alternatives (or waivers) for people with medical conditions.
90-Day Waiting Period
Individuals must be allowed to enroll in group health plans within 90 days of becoming eligible. Learn more about the waiting period in this FAQ.
No Pre-existing Conditions Exclusions for Adults
Health plans cannot limit or deny coverage to anyone due to a “pre-existing condition,” which is a health problem that developed before the person applied for the health plan.
Expansion of Medicaid
Each state operates a Medicaid program that provides health coverage for lower income people, families and children, the elderly, and people with disabilities. Beginning in 2014, most adults under age 65 with individual incomes up to about $15,000 per year will qualify for Medicaid.
No Annual Limits
Health plans can no longer have annual dollar limits on essential health benefits. An annual dollar limit is the most money the plan would pay for services each year. Essential health benefits include services such as hospital care, emergency care, doctor visits, prescription drugs, preventive care, and more.