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Rhode Island Health Insurance Options 

Health Insurance in Rhode Island - Overview  for  2010

As too many of us Rhode Island residents and businesses know all too well, for the past 9 years Rhode Island has been limping along with only two insurance companies offering comprehensive major medical plans. Due to the lack of competition to keep costs competitive, they charge what the market will bear - and get it. 

Blue Cross Blue Shield of Rhode Island has added additional out of pocket exposure on their two most expensive individual  plans and  of course rates are rising.

Until state health insurance regulations are updated to align with those in the majority of states the rest of the country, Rhode Islanders will suffer. 

Many of our elected and appointed officials have proven to place tough insurance regulations, even if it means astronomical health insurance costs and few (for small businesses) or zero  (for individuals) choices in health insurance plans available.

It will be up to YOU the small business owner and YOU the RI resident who  will need to put pressure on your elected officials to change the Rhode Island Health Insurance regulations to align with the majority of the rest of the country where health insurance options are plentiful and competition keeps costs down.

Here are the three things that MUST CHANGE in Rhode Island before this state can expect to see more  carriers and legitimate health insurance options for Rhode Islanders -- both individuals and for small businesses:

1) A high risk health insurance pool MUST be established like more than 80% of the states rest of the nations have

2) A "File and Use" provision must be established so that when carriers have rate increases they can simply file them and start using them and avoid having to wait for up to two years before they are approved which is what is required now. Of course with "File and Use" carriers would be required to immediately stop using any rates that weren't reasonable after being notified.

3) Rhode Island MUST differentiate between Health Maintenance Organizations and HMO type plans where primary care physicians must approve all care and non-HMOs or Insurance Companies that allow the insured person to choose their own doctors and specialists and make their own decisions regarding care for medically necessary services. Currently Rhode Island is the ONLY STATE IN THE NATION that wants to force non-HMOs or regular insurance companies to be responsible for doctors quality of care when the insurance person is making all the decisions and the insurance company has no control over the decisions made by the doctor the way an HMO does. This expectation Rhode Island legislators have of non-HMOs is not only unreasonable but utterly rediculous!

These three changes all need to be made at the same time if Rhode Islanders are to see any improvement in health insurance price and availability - Obamacare aside (which will of course reduce choices and quality of protection even further AND raise rates HIGHER!

Health Insurance Tip for Rhode Island Small  Businesses:

There is no need to continue overpaying and underutilizing your group health plan. The way to stop paying so much for
health insurance is to have a  plan that covers all your needs and still saves you money.

BREAKING NEWS: The definition of "THE BEST" health insurance plan is NOT a low deductible plan with a $10 office visit co-pay and paying higher premiums doesn't always mean you'll get more protection. There has been lots of BAD advice given out by so called "experts about what constitutes a quality plan-- most of it DEAD WRONG.

The reason choosing as low deductible low co-pay plan is a BAD IDEA is  that since it has co-pays it will NEVER protect your out of pocket exposure to risk of run-away co-pays.  Imagine having to be on 10 of the most expensive prescription drugs each with a $75 co-pay. Your cost for your co-pays would add up to $750 every month or $9000 per year --just for one person's prescription drug co-pays!
Not only that but the insurance companies know how enamored Americans are with seeming low co-pay plans and low deductible plans, they CHARGE HIGHER PREMIUMS for these plans even though they provide ZERO STOP-LOSS protection.

The smarter plan design HAS ALWAYS BEEN TO CHOOSE A PLAN THAT PAYS !100% for EVERYTHING after a stop-loss point has been reached. These plans today can be found in high deductible plans  designed to be used with Health Savings Accounts. Better yet, because these plans have higher deductibles initially (even though the out of pocket risk is limited in a worst case scenario, where the co-pay plan provides little worst case scenario protection), when you add the high deductible plans deductible to the much lower premium you end up with better protection at a lower cost.


Health Insurance  Shopping Tip for Rhode Islanders: Be Forewarned! Please avoid the hospital - surgical plans advertised on the radio and on telephone poles as being priced right - just for the self-employed.
These plans are actually the most expensive kind of health insurance you can buy because even though the premiums may be 25% less than Blue Cross the coverage may  end up being 75% less. These plans are not comprehensive at all and only provided specified coverage outlined in the fine print of the policy which is rarely sufficient to cover your needs if you end up having to file a claim.


There is always a schedule of benefits that lists: what it will pay for certain surgeries; what it pays for anesthesia; what it pays per day in the hospital; how many office visits are allowed; how much if any it will pay for diagnostics and lab work. ETC ETC ETC.

The plan may also have a high deductible and a teaser lifetime maximum but in actuality after you pay out the huge deductible, all the company pays out is what is printed in the schedule.

AVOID THESE PLANS LIKE THE PLAGUE. Some companies use fancy radio advertising with famous spokes people like Bill O'Reilly, who have no idea how dangerous these products are, to push these plans. If they did they would surely not lend their name to them. They are sold through various associations offering various other discounts or benefits. You generally have to pay a substantial amount to join the association before you can get the crap%y  overpriced insurance plan.

There are numerous lawsuits against these companies by insureds who buy these plans thinking they "at least have catastrophic coverage after they have met their deductible". This couldn't be MORE WRONG.  With a comprehensive plan with a quality carrier the person would be covered but since they bought a limited benefit plan with the schedule of benefits listing what the benefits are, what they conveniently forget is that THEY ARE LIMITED TO THOSE PUNY BENEFITS which are NEVER ANYWHERE CLOSE TO BEING ENOUGH.


Health Insurance Options for Rhode island Small Businesses and the Self-employed:

For creative solutions to the problem of obtaining quality affordable coverage for yourself and or your employees, call to find out how a group plan with United Healthcare or a  custom Health Reimbursement Arrangement (HRA) might be a way to structure your group health insurance so you can provide the benefits your employees want at a price you can afford.