Healthcare Reform Timeline

Where to Buy a Plan

 

Individuals and small employers have a new option for buying health insurance coverage: HealthSource RI, which is Rhode Island's health insurance marketplace (also called an exchange). But how is buying through HealthSource RI different from buying a plan directly from Blue Cross or a broker? Here's what you need to know about your options for buying a 2014 plan.

HealthSource RI: Explained

Under the Affordable Care Act, each state is required to have a health insurance marketplace where individuals and small employers can:

  • Compare plans from different insurers.
  • Qualify for tax credits that will help make coverage more affordable.
  • Buy plans.

It's similar to a travel site where you compare flights from different airlines. You can purchase a plan online, over the phone, or in person.

Small employers can SHOP

Small employers can take advantage of the Small Business Health Options Program (SHOP) through HealthSource RI. Small employers can choose a plan to offer their employees or allow employees to choose from all of the small group plans available. Until 2016, small employers with 50 or fewer eligible employees can use HealthSource RI. In 2016, employers with less than 100 employees will be considered "small employers" and eligible to buy plans. In 2017, Rhode Island will have the ability to allow large employers (100 or more employees) to buy plans through HealthSource RI.

How to choose a plan

To make comparing and buying a plan easier, all plans offered through HealthSource RI or directly from Blue Cross are categorized into one of four metallic levels: Platinum, Gold, Silver, and Bronze. All plans within each of these levels have the same actuarial value, which means that they provide a similar amount of coverage to the average member. For example, all Silver plans have an actuarial value of about 70 percent, which means the plans pay an average of 70 percent of healthcare expenses, and you pay the remaining 30 percent. The benefits may be slightly different depending on which plan you select. Keep in mind that how much you pay for each medical service will vary depending on the service. However, at the end of the year, you will have paid about 30 percent of the cost for those services. 

The more healthcare costs your plan covers, the higher the plan's actuarial value is. You pay a higher premium for plans with higher actuarial values, but you pay less for your healthcare expenses such as doctor visits and lab tests.

The four metallic tiers are:

  • Platinum (Actuarial value of about 90%) – The health plan pays an average of 90% of healthcare expenses, and you pay 10%.
  • Gold (Actuarial value of about 80%) – The health plan pays an average of 80% of healthcare expenses, and you pay 20%.
  • Silver (Actuarial value of about 70%) – The health plan pays an average of 70% of healthcare expenses, and you pay 30%.
  • Bronze (Actuarial value of about 60%) – The health plan pays an average of 60% of healthcare expenses, and you pay 40%.

In addition, individuals under age 30 or who demonstrate a financial hardship may also be eligible for a catastrophic plan, which falls below the metallic levels.

Your Choices for Buying a Plan in 2014 (and Beyond)

  1. You can purchase a plan as you always have.

    Whether you're an individual who bought plans directly from Blue Cross or an employer who purchased a plan directly from Blue Cross or through a broker, you can continue to do so. Our 2014 plan options meet the requirements of the Affordable Care Act. If you are an individual or small employer who is eligible for tax credits or other financial assistance, see #3 below.

  2. You can continue your coverage through your employer.

    If you work through an employer who is using HealthSource RI, you may still be eligible for coverage from Blue Cross, but you may also have other options. Please note that only employers with 50 or more full-time employees or full-time equivalent employees are required to provide coverage or may be subject to a penalty.

  3. You can purchase a plan through HealthSource RI.

     If you are an individual buying coverage for yourself and your family or if you are a small employer, you can purchase coverage through HealthSource RI.

    If you are purchasing coverage for yourself and your family, you may be eligible for tax credits that can help you pay your premium.  You can only take advantage of these tax credits through HealthSource RI.

    If you are a small employer, you may be eligible for small business tax credits.  The small business tax credit is only available to employers who purchase through HealthSource RI and is only available for two consecutive years. As a small employer, you can select a plan to offer your employees or offer your employees a choice of any plan available. The second option allows each employee to select the insurer, benefit plan, and premium level of their choice.