What's happening with Rhode Island's new health insurance mandate?

Starting on January 1, 2020, a mandate went into effect requiring all non-exempt Rhode Island residents to maintain qualifying health insurance coverage. If you live or practice in Rhode Island — or if you're located just over the border in Massachusetts — here's a recap of the mandate with answers to potential patient questions such as: What's adequate coverage? What will happen if I don’t have coverage? Can I get an exception? For complete information, visit the Rhode Island Department of Revenue Division of Taxation’s Summary of Legislative Changes.

What is considered adequate coverage?

Most of your patients are likely already covered according to the new mandate. The mandate requires that every Rhode Island resident have “minimum essential coverage,” which includes employer-sponsored health insurance plans, plans offered in the individual market, Medicare, Medicaid, and other health insurance plans. For a full list of accepted plans, see the Summary of Legislative Changes for a list beginning on page 23.

What are the penalties for not having coverage?

In early 2021, your patients will need to indicate on their personal income tax returns if and during which months your patient, as well as their spouse and dependents, if applicable, had minimum essential coverage. If there was no such coverage, then a penalty will be assessed on the return. The exact Rhode Island penalty will not be announced until close to the 2021 income-tax filing season.

Are there exceptions to the mandate?

The mandate applies to every “applicable individual,” which includes spouses and dependents. However, this only applies for every month the individual was a resident of Rhode Island. If your patient does not have minimal essential coverage but only lives in Rhode Island for part of the year, they will have to pay the penalty only for the months they lived in Rhode Island. Other people who fall outside the realm of applicable individuals are members of health care sharing ministries, those who are incarcerated, those who are not United States citizens, and those with a religious conscience exemption.

For more information, see the Summary of Legislative Changes for a full breakdown of the mandate, starting on page 22.

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