Transitioning from Medicaid to a Qualified Health Plan
Transitions from Medicaid to QHP
HealthSource RI has a Medicaid to QHP Transition Program to help people stay covered if their Medicaid coverage is ending. This program has a few components, including auto-enrollment for certain customers, and, for 2025 coverage, one month of premium payment for those and other customers. Even if you don’t qualify for these special programs, federal tax credits can help you afford coverage through HealthSource RI if you aren’t offered affordable coverage elsewhere.
If you have questions about Medicaid and renewals, please visit https://staycovered.ri.gov.
60-Day Special Enrollment Period Available for Medicaid Terminations
As Rhode Island’s state-based marketplace, HealthSource RI (HSRI) offers Special Enrollment Periods (SEP) for residents who have experienced a Qualifying Life Event (QLE). Residents whose Medicaid coverage ends are eligible for a 60-day Special Enrollment Period to apply for coverage through HealthSource RI. This is available prior to loss of coverage and for 60 days after loss of coverage.
Outside of termination from Medicaid, any other QLE still applies for eligibility to enroll in a plan. For more information about HSRI’s Special Enrollment Period or other ways you could be eligible to enroll, visit https://healthsourceri.com/sep.
Coverage through HealthSource RI is the Only Way to Take Advantage of Federal Tax Credits
HealthSource RI is Rhode Island’s official health coverage marketplace, which means we are your only source for getting financial assistance to help lower your monthly coverage costs. We connect Rhode Islanders to health plans that meet their needs and their budgets. A majority of our customers receive financial assistance, in the form of Advanced Premium Tax Credits (APTCs) to help lower their monthly coverage costs. We offer a range of plans to help each customer meet their health needs and budget.
HealthSource RI’s Auto-Enrollment Program and Premium Assistance
It’s essential that Rhode Islanders retain health coverage even if their Medicaid eligibility ends. As Medicaid renewals began again after the COVID-19 pandemic, HealthSource RI, in collaboration with Governor McKee, instituted the Auto-Enrollment Program. The goal of this program is to help residents avoid unnecessary gaps in health coverage that could occur when transitioning from Medicaid.
The Auto-Enrollment Program connects Rhode Islanders who are terminated from Medicaid with health coverage through HealthSource RI. Those eligible for auto-enrollment will be enrolled in a silver health plan. Silver health plans have low premium payments and allow individuals to access the reduced out-of-pocket costs of a Cost-Sharing Reduction plan. Eligible individuals will be able to enroll in a Qualified Health Plan (QHP) with financial support to cover the first month’s premium (in place through the 2025 plan year).
- Those at less than 250% of the federal poverty level (FPL) (for instance, $37,650 for an individual or $78,000 for a family of four) are eligible for federal premium tax credits and Rhode Island’s one-month premium support (for 2025 coverage only), ensuring a zero-cost transition to coverage through HSRI. They will have to pick a plan and enroll through HSRI.
- Those at less than 200% FPL ($30,120 for an individual or $62,400 for a family of four) are eligible for the federal premium tax credit and premium support (through December 2025). They will be automatically enrolled into a designated plan through HSRI.
Individuals will have 60 days to change their plan or disenroll from their plan in the program.
Individuals who are automatically enrolled in a qualified health plan (QHP) will also be eligible for the 60-day Special Enrollment Period. They will have sixty days from the end of their Medicaid coverage to select a different health plan from the one they were automatically enrolled in or retroactively disenroll. During this Special Enrollment Period, individuals may also select and enroll in a dental plan.
This initiative is critical to ensure Rhode Island’s families continue to have access to quality health coverage and do not experience gaps in health coverage after Medicaid. Having quality health coverage will also help ensure that people enrolled in this initiative can avoid high medical costs they might otherwise face if they were uninsured.
Frequently Asked Questions:
Auto-Enrollment
Who is eligible for auto-enrollment?
Most individuals and families who fit the following criteria will be eligible for auto-enrollment and one month’s premium payment through the Medicaid to QHP Transition Program:
- Your Medicaid coverage is ending
- You don’t have access to other coverage from an employer or elsewhere
- Your household has an income below 200% of the federal poverty level. Make sure your income is up to date in your application.
| Family Size: | 1 | 2 | 3 | 4 | 5 |
| 200% of FPL for 2025 coverage | $30,120 | $40,880 | $51,640 | $62,400 | $73,160 |
I was auto-enrolled. Do I need to do anything?
First, make sure your income and other application information is correct in your account. If it is out of date, your tax credits may not be accurate, and you might have to reconcile them later on your tax return. Second, you may want to browse other plans or add dental coverage. See the following questions for more information on coverage, changing plans, and adding dental.
I was auto-enrolled. Is dental coverage included in my plan?
No, you have not been automatically enrolled for a dental plan, BUT you can browse our plans and add one. The one month premium assistance available for 2025 applies to dental plans as well. Please note that tax credits do not apply to dental, so you will be responsible after the first month for the full premium payment.
I was automatically enrolled in a plan, but I’d like to learn about different health plans. If I want to, how do I change plans?
HealthSource RI offers plans from multiple insurance companies, and you may choose to switch to a plan with another company within this program. Visit HealthSourceRI.com/Calculator to view your options.
To change your health plan, please call 1-855-840-4774 for assistance or click here to learn about other ways to get help. If you would like to enroll in a different plan or add dental coverage, you may do so no later than 60 days from the day your Medicaid coverage ended.
I was automatically enrolled in a plan but do not need this health coverage. How do I disenroll from this program?
To disenroll from health coverage through HSRI, visit HealthyRhode.RI.gov or call us at 1-855-840-4774.
- If you do not need or do not want this coverage, you must opt-out no later than 60 days from the day your Medicaid coverage ended. Failure to do so may result in tax liability or premiums owed to the carrier.
- Keep in mind that health insurance is required in Rhode Island. See our website for details.
I was auto-enrolled after the end of my Medicaid coverage. Does my HealthSource RI plan cover abortion services?
Those who were auto-enrolled after January 2024 were put into a version of the Neighborhood Value Plan that does cover abortion services. However, there are plans available, including a different *Neighborhood Value plan, that do not include coverage for abortions.
Keep in mind that copays, deductibles, and monthly premiums vary for each plan, so consider these when looking at all HSRI plans.
Those who were auto-enrolled have a 60-day opportunity to switch plans after their coverage start date, and that plan change can apply retroactively if desired. When viewing HSRI materials or picking a plan online, plans that exclude most abortion coverage have an asterisk (*) before the name. Plans without an asterisk include coverage for abortion services.
Premium Assistance (through plan year 2025)
Am I eligible for my first month with HSRI to be paid?
You may be eligible for medical and dental coverage through HealthSource RI with payments to cover the first month if:
- You were recently disenrolled from no-cost coverage through RI Medicaid
- You don’t have access to other coverage from an employer or elsewhere.
- You are part of a household with an income below 250 percent of the Federal Poverty Level (FPL). Make sure your income is up to date in your application.
| Family Size: | 1 | 2 | 3 | 4 | 5 |
| 250% of FPL for 2025 coverage | $37,650 | $51,000 | $64,550 | $78,000 | $91,450 |
I am eligible for the state payment program. Will the State pay for any plan I choose?
Yes, the State will pay for one month of any health and/or dental plan you choose. However, be sure to pick one that you can afford when you need to make payment after the first month. To get the coverage activated quickly, you may make your own first payment. This will not reduce the payment the State will make. It will be applied as a credit toward your next month(s). The state payment might be a little less than one month of premium.
Does this premium assistance program apply to dental coverage as well?
Yes, the State of Rhode Island will also cover the premium payment for one month of dental coverage for individuals eligible for the Medicaid to QHP Transition program in 2025. You must choose dental coverage to have it. It is not part of auto-enrollment.
When does the State make payments for coverage?
The State will make payments once per month, shortly after the 18th of the month. The State will pay for one month of medical/dental (if selected) premium together. If you change plans or add a dental plan after payment was made, there might be a second payment to cover the difference.
What if I don’t need the coverage, or I choose less expensive coverage, but the State has already paid? Do I owe money back?
If you don’t need the coverage, please cancel it. You don’t need to do anything to pay back the money if a payment was already made. If the money is unused on your account, HSRI may recover it directly later.
What happens if I made a payment before the State could pay?
If you already made a payment before the State did, the State’s payment will be applied as a credit toward the next month.
What happens if the State makes a payment, but I don’t continue payments? Am I at risk of owing tax credits to the IRS?
Once you fall behind on payment, you have a grace period to catch up. If you don’t catch up, your coverage will be terminated. You may owe your insurance carrier for unpaid month(s) of coverage. When you file taxes, you may have to pay back tax credits paid on your behalf for month(s) where you didn’t make a payment. These tax credits can be significant. If you don’t need or can’t keep your coverage, please tell us as soon as possible to avoid owing money later.
What should I do if I would like to keep my coverage after the initial month?
First, make sure your income and other application information is correct in your account. If it is out of date, your tax credits may not be accurate, and you might have to reconcile them later on your tax return. After the first month of coverage, enrolled customers should be aware that they must make premium payments billed in future months to stay covered. Premium payments are due on the 23rd of each month. Your invoices will tell you the amount you owe and when it is due.
Other Coverage Questions
I wasn’t auto-enrolled, but I need coverage. How do I enroll?
Depending on your income and access to other coverage, you may still be eligible for our payment program. Even if you do not qualify for the payment program, you may still be eligible to enroll in health coverage with financial assistance through HealthSource RI. To get a quick quote and see how much financial assistance you may be eligible for, visit HealthSourceRI.com/Calculator. (The calculator will show you your monthly premium, but it will not tell you if you are eligible for one month of premium payment). To enroll, visit HealthyRhode.RI.gov, call us at 1-855-840-4774, or click here to learn how you can get enrollment assistance.
Why is it important to update my income and other account information?
If your income or other information, particularly access to other coverage, is out of date, your tax credits may not be accurate, and you might have to pay some or all of them back later when you file taxes. Also, if your information is out of date, you may not be receiving all the financial assistance you could be. Please update your account to make sure you don’t get too much or too little assistance.
My Benefits Decision Notice said my Medicaid coverage is ending, and I qualify for no tax credits. I need coverage. Is that right? What can I do?
First, make sure your application information is complete and up to date. Certain application questions, such as whether you give consent for us to obtain and use information from other sources to verify your eligibility, can disqualify you from tax credit assistance. Once you update them, you may be eligible.
Once you’ve updated your application, there are still some reasons you may not qualify for tax credits. Income that is too high or access to other coverage are common reasons. Contact us if you still need assistance in determining why you do not qualify. If you are still ineligible for tax credits, you can still buy a plan through HSRI at full cost if you choose.
HealthSource RI connects you with health and dental insurance from these companies:
