Rhode Island residents have access to comprehensive health insurance options under the Affordable Care Act (ACA) through the state's own marketplace, HealthSource RI. Whether you are shopping for coverage for the first time, switching plans, or exploring financial assistance, understanding your Rhode Island ACA benefits and coverage options can help you find affordable, quality health care for you and your family.
Rhode Island consistently ranks among the states with the lowest uninsured rates in the nation. A big reason for that success is the combination of Medicaid expansion, a state-run marketplace, and generous subsidies that keep premiums manageable. In this guide, we break down everything you need to know about ACA coverage in Rhode Island for 2026.
What Is HealthSource RI?
HealthSource RI is Rhode Island's state-based health insurance marketplace. Unlike states that rely on the federal HealthCare.gov platform, Rhode Island operates its own exchange where residents can compare plans, check subsidy eligibility, and enroll in coverage.
Two private insurance carriers currently offer individual and family plans through HealthSource RI for 2026. All plans sold on the marketplace are ACA-compliant, meaning they must cover a set of essential health benefits and follow consumer protection rules like the ban on denying coverage for pre-existing conditions.
HealthSource RI also serves as the enrollment portal for Rhode Island Medicaid, so you can apply for both marketplace coverage and Medicaid through a single application.
Essential Health Benefits Covered
Every ACA marketplace plan in Rhode Island must cover these 10 categories of essential health benefits:
- Ambulatory (outpatient) care including doctor visits and outpatient surgery
- Emergency services at any hospital, in-network or out-of-network
- Hospitalization for inpatient care and surgery
- Maternity and newborn care before and after birth
- Mental health and substance use disorder services including behavioral health treatment and counseling
- Prescription drugs
- Rehabilitative and habilitative services including physical therapy and devices
- Laboratory services such as blood tests and screenings
- Preventive and wellness services including vaccinations, screenings, and chronic disease management
- Pediatric services including dental and vision care for children
All plans must also cover preventive care at no cost to you when you see an in-network provider. This includes annual checkups, immunizations, cancer screenings, and contraception.
Plan Types and Metal Tiers
HealthSource RI plans are organized into metal tiers that reflect how costs are shared between you and your insurance company:
| Metal Tier | You Pay (Approximate) | Insurer Pays | Best For |
|---|---|---|---|
| Bronze | 40% | 60% | Lower premiums, healthy individuals |
| Silver | 30% | 70% | Moderate use, subsidy-eligible households |
| Gold | 20% | 80% | Frequent care, predictable costs |
| Catastrophic | Very low premiums | Minimal until deductible | Under 30 or hardship exemption |
Silver plans are especially valuable if your household income falls below 250% of the Federal Poverty Level (FPL). When you choose a Silver plan, you may qualify for cost-sharing reductions (CSR) that lower your deductible, copays, and maximum out-of-pocket costs on top of any premium subsidy you receive.
Income Limits and Financial Assistance
Financial help through HealthSource RI comes in two forms: premium tax credits (subsidies that lower your monthly payment) and cost-sharing reductions (which lower what you pay when you use care).
2026 Federal Poverty Level Guidelines
The table below shows 100% FPL for 2026. Your eligibility for different programs depends on where your household income falls relative to these numbers.
| Household Size | 100% FPL (Annual) | 138% FPL (Medicaid) | 250% FPL (CSR Eligible) | 400% FPL (Subsidy Cap) |
|---|---|---|---|---|
| 1 | $15,960 | $22,024 | $39,900 | $63,840 |
| 2 | $21,640 | $29,863 | $54,100 | $86,560 |
| 3 | $27,320 | $37,701 | $68,300 | $109,280 |
| 4 | $33,000 | $45,540 | $82,500 | $132,000 |
| 5 | $38,680 | $53,378 | $96,700 | $154,720 |
| 6 | $44,360 | $61,216 | $110,900 | $177,440 |
Who Qualifies for What?
- Income below 138% FPL: You likely qualify for Rhode Island Medicaid (RIte Care for families and children). Medicaid provides comprehensive coverage with little to no cost to you.
- Income between 138% and 250% FPL: You qualify for premium tax credits AND cost-sharing reductions on Silver plans through HealthSource RI.
- Income between 250% and 400% FPL: You qualify for premium tax credits to lower your monthly premium.
- Income above 400% FPL: You may still qualify for some subsidy if benchmark plan costs exceed a percentage of your income. Check HealthSource RI or use our free screening tool to find out.
During the 2025 open enrollment period, 88% of HealthSource RI enrollees received premium subsidies averaging $470 per month, bringing the average monthly premium down to roughly $155.
How to Enroll: Step by Step
Follow these steps to sign up for ACA coverage in Rhode Island:
Step 1: Gather Your Information
Before you start, have the following ready:
- Social Security numbers for everyone in your household
- Immigration documents (if applicable)
- Income information such as pay stubs, tax returns, or W-2 forms
- Information about any employer-sponsored health insurance available to you
- Current health insurance policy details (if switching plans)
Step 2: Visit HealthSource RI
Go to healthsourceri.com and create an account or log in to your existing account. You can also call 1-855-840-4774 (Monday through Friday, 8 AM to 6 PM) for phone assistance.
Step 3: Complete Your Application
Fill out the application with your household and income details. The system will determine whether you qualify for Medicaid, premium tax credits, cost-sharing reductions, or a combination.
Step 4: Compare Plans
Browse available plans and compare premiums, deductibles, copays, provider networks, and prescription drug coverage. Pay close attention to whether your doctors and preferred hospitals are in-network.
Step 5: Select and Enroll
Choose the plan that best fits your needs and budget. Confirm your enrollment and set up your first premium payment. Coverage begins on the first of the month following your enrollment (or January 1 if you enroll during open enrollment by the December deadline).
Step 6: Pay Your First Premium
Your coverage is not active until you pay your first monthly premium. Set up autopay if your insurer offers it to avoid accidental lapses.
Important Enrollment Dates for 2026
| Date | What Happens |
|---|---|
| November 1, 2025 | Open enrollment begins for 2026 coverage |
| December 31, 2025 | Deadline to enroll for coverage starting January 1, 2026 |
| January 31, 2026 | Open enrollment ends |
| Year-round | Medicaid and CHIP enrollment always available |
| Year-round | Special enrollment for qualifying life events |
Qualifying Life Events for Special Enrollment
If you miss open enrollment, you can still sign up if you experience a qualifying life event, including:
- Losing existing health coverage (job loss, aging off a parent's plan)
- Getting married or divorced
- Having a baby or adopting a child
- Moving to Rhode Island from another state
- Becoming pregnant (Rhode Island is one of the few states where pregnancy alone qualifies you for special enrollment)
Rhode Island's Individual Mandate
Rhode Island has a state-level individual health insurance mandate. If you go without qualifying health coverage, you may face a tax penalty when you file your Rhode Island state taxes. The penalty is calculated similarly to the original federal mandate and can add up quickly, so maintaining coverage is both a health and financial priority.
Medicaid in Rhode Island
Rhode Island expanded Medicaid under the ACA, which means adults earning up to 138% FPL can qualify for coverage. Key Medicaid details include:
- Adults (ages 19 to 64): Income up to 138% FPL
- Children (RIte Care/CHIP): Income up to 261% FPL
- Pregnant women: Income up to 253% FPL
- Application: Apply online at healthyrhode.ri.gov or through HealthSource RI
- Phone: 1-855-697-4347
- Processing time: Up to 45 days
- Enrollment: Year-round (no open enrollment restrictions)
If your income is near the Medicaid threshold, HealthSource RI will automatically check your eligibility when you apply for marketplace coverage.
Other Benefits You May Qualify For
Many Rhode Islanders who qualify for ACA subsidies or Medicaid are also eligible for additional assistance programs. Check your eligibility for all programs with our free screener to see what you may be missing. Common programs include:
- SNAP (food assistance): Households up to 185% FPL
- LIHEAP (heating assistance): Households up to 60% of State Median Income
- WIC: Pregnant women, new mothers, and children under 5 with income up to 185% FPL
- Child Care Assistance (CCAP): Families with income up to 261% FPL
For a full overview of all available programs, visit our Rhode Island Benefits Overview page.
Frequently Asked Questions
How much does ACA health insurance cost in Rhode Island?
Costs vary based on your age, household size, income, and the plan you choose. With subsidies, many Rhode Islanders pay $155 per month or less. Some low-income enrollees pay as little as $0 per month for a Bronze plan. Use our screener to estimate your costs.
Can I get free health insurance in Rhode Island?
Yes. If your income is below 138% FPL, you likely qualify for Rhode Island Medicaid at no cost. Even above that threshold, premium subsidies can reduce your marketplace premium to $0 for certain Bronze-level plans.
What happens if I do not have health insurance in Rhode Island?
Rhode Island enforces a state individual mandate. You may owe a tax penalty when filing your state income taxes if you were uninsured during the year without an exemption.
Can I enroll outside of open enrollment?
Yes, if you have a qualifying life event such as losing other coverage, getting married, having a baby, moving to the state, or becoming pregnant. You can also apply for Medicaid at any time throughout the year.
How do I know if I qualify for Medicaid or marketplace subsidies?
Your income relative to the Federal Poverty Level determines your eligibility. Apply through HealthSource RI or use our free eligibility screener for a quick estimate of the programs available to you.
Are pre-existing conditions covered?
Yes. Under the ACA, insurance companies in Rhode Island cannot deny you coverage, charge you more, or exclude benefits based on pre-existing health conditions.
How do I get help choosing a plan?
You can get free help from a licensed insurance broker, Navigator, or certified application counselor. Contact HealthSource RI at 1-855-840-4774 to connect with local assistance, or use our screening tool to explore your options.
Next Steps
Do not leave money on the table. Rhode Island offers some of the most accessible ACA benefits and coverage options in the country, and financial help is available for a wide range of income levels. Start by checking your eligibility with our free screener to see what programs and savings you may qualify for today.
