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There are several ways for people in Idaho who need affordable health insurance to obtain it. Most employers provide health insurance for employees and their families. However, you can also opt to purchase plans on the state’s health insurance marketplace: Your Health Idaho. You could buy an off-exchange plan from a broker or an insurance agent, purchase a short-term insurance plan, or participate in a cost-sharing plan. If you are at least 65 years old (or have a qualifying disability), you may be eligible for Medicare. Finally, low-income adults and children in Idaho may be eligible for Medicaid.
This guide explains all of your affordable health insurance options available in Idaho.
Idaho has a state health insurance marketplace: Your Health Idaho. However, Your Health Idaho is more than just a marketplace for individual plans. It’s a hub that allows you to review many of your affordable health insurance options in Idaho, including on-exchange and off-exchange plans. You can speak to enrollment counselors if you’re interested in purchasing an ACA plan or to an insurance broker or an insurance agent if you want an off-exchange insurance plan.
If you are interested in an ACA plan, Your Health Idaho will ask questions to determine whether or not you are eligible for any special tax credits or CSRs. These include questions about your household size, your tobacco use, and the ages of people in your household. Once you’ve gone through the registration process, you’ll be able to browse plans until you find one that suits both your family and your budget.
Five companies offer ACA plans on Your Health Idaho:
There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:
When you’re buying insurance for yourself, the cost will depend on your overall health. If you don’t require much health care, you should probably select a plan that offers a low monthly premium and high deductibles.
If you frequently see a doctor or a specialist and need regular prescriptions, the deductibles can add up. Your best choice might be a plan with a higher monthly premium but lower deductibles. This can help you control your out-of-pocket expenses.
There are different types of plans you can choose from:
You’ll need to balance your budget with the health care needs of your family when you’re looking for an affordable family insurance plan. While you might be healthy, your spouse may have a chronic health condition like hypertension or heart disease. Likewise, one of your children may need regular medical care for asthma or a mental health condition.
A healthy family may be comfortable choosing an HMO plan. However, if anyone in your family has a chronic health condition, a PPO or a POS plan may provide you with the coverage you need to access specialists.
Another consideration for family plans is that many have an individual deductible and a family deductible. An individual deductible applies to each person covered by the plan, while the family deductible applies to the entire family. If one of your family members is hospitalized or undergoes an expensive surgery, it’s possible to meet the family deductible before every person on the plan has met their individual deductible.
Your Health Idaho uses a metal tier structure to organize insurance plans: Bronze, Silver, Gold, and Platinum. If you select a Bronze plan rather than a Gold plan, it doesn’t mean you’ll receive inadequate health care. All plans sold on Your Health Idaho offer health coverage that is affordable and essential; plans differ in the portion of coinsurance you’re responsible for. The metal tiers give you a basic understanding of how each plan handles what you’ll pay for coverage.
|Average premium in Idaho||2020||2021||2022||2023|
|Most affordable Bronze plan||$380||$358||$343||$325|
|Most affordable Silver plan||$506||$470||$445||$415|
|Most affordable Gold plan||$510||$464||$435||$444|
Idaho has two types of health insurance available for low-income individuals and families: Medicaid and the Children’s Health Insurance Program (CHIP). In 2021, 759,800 individuals enrolled in either Medicare or CHIP.
To be eligible for Medicaid in Idaho, you must be:
You also need to belong to one of the following categories:
The Idaho Medicaid program for adults is broken down into two plans that accommodate different medical needs of the individuals enrolled:
Idaho has income and resource limits for each of the above groups who apply for Medicaid. Resources are limited to $2,000 for an individual and $3,000 for a couple for regular Medicaid. If a couple is applying for nursing home care or home health care, that increases to $4,000 a couple.
CHIP coverage for children in Idaho is separated into three categories:
Children whose families qualify for CHIP receive annual physicals, dental and vision care, ambulance services, durable medical equipment, home health care, immunizations, lab tests, prescriptions, x-rays, orthotics/prosthetics, and more.
You can apply for Medicaid and CHIP through Your Health Idaho.
If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs.
Idaho requires companies selling Medicare Supplement Insurance/Medigap plans to offer coverage to those under 65. The state also limits premiums to 150% of what companies charge those 65 and above.
To qualify for Medicare, you must be at least 65 years old or have a qualifying disability. In most cases, a qualifying disability is a condition that makes you eligible for at least 24 months of payments from the Social Security Disability Insurance program or Railroad Retirement Board. You may be able to qualify sooner if you have end-stage renal disease or amyotrophic lateral sclerosis (Lou Gehrig’s disease).
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
Idaho’s Senior Health Insurance Benefits Advisors (SHIBA) provide Medicare beneficiaries, families, or caregivers with free, unbiased, and confidential counseling about their Medicare options. This includes Original Medicare, Medicare Advantage, Medicare Supplemental Insurance (Medigap), Medicare Part D one, and other Medicare plan options.
You can reach the trained and certified counselors at SHIBA by email, phone, remote communication, and (if necessary) in-person. Counselors will never try to sell you a plan.
You may find that short-term health insurance plans are a cheap health insurance alternative to ACA plans.
Traditional short-term health insurance plans in Idaho are nonrenewable and are only available for up to 12 months. Enhanced short-term plans are renewable and available for a total of 36 months. While traditional short-term insurance plans don’t cover pre-existing conditions, enhanced plans have a 12-month waiting period for pre-existing condition coverage. However, this period can be reduced or eliminated if you had prior coverage (such as coverage through an employer).
Some of these enhanced short-term plans offer some of the same coverage as ACA-compliant plans. For instance, premiums are only charged for the first three children under 21 on a family plan and include free preventive care. These plans also cover mental health care, prescription drugs, and maternity care. However, one drawback is that out-of-pocket costs are capped at $50,000.
Although the ACA originally required Americans to have health insurance and imposed a tax penalty on those who didn’t, legislation in 2018 and subsequent federal court rulings removed the penalty. While some states have enacted health insurance requirements, Idaho has not.
No, you can purchase health insurance in Idaho through a broker or an insurance agent, though you won’t be eligible to qualify for premium subsidies.
Faith-based insurance plans are the most common form of cost-sharing plan in Idaho. Members of these plans share health care costs. You don’t need to be a member of a particular denomination or any denomination if you want to participate in a health cost-sharing insurance plan.
However, these plans are not required to meet ACA standards, so these insurance plans may not cover pre-existing conditions and other essential benefits. If you’re thinking about selecting a faith-based plan, make sure it covers health conditions that affect your family.
Even if you’re insured, it’s still a good idea to have an HSA/FSA. These accounts are intended to cover deductibles, copays, vision and dental care, and other minor medical expenses after insurance has covered their portion of the bill.
Short-term disability coverage and health insurance are two different things. Short-term disability coverage helps pay for household expenses if you’re injured. Health insurance only pays for medical costs. If your job puts you at risk for potential injury, it may be wise to consider short-term disability coverage.
If you work at a job that could be considered dangerous, it’s not a bad idea to have long-term disability coverage. It will help cover your expenses like utilities, mortgage payments, or groceries when you’re injured. Your health insurance only pays your medical costs.