Idaho Health Insurance: Find Affordable Plans

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.

• Your Health Idaho: Idaho has a state-run platform that offers ACA plans: Your Health Idaho. All insurance plans provide quality, affordable health insurance coverage. Many insurance plans also provide premium tax credits and cost-sharing reductions (CSRs).
• Open enrollment: The open enrollment period for coverage beginning in 2023 in Idaho runs from October 15 to December 7, 2022. If you miss open enrollment, you can only enroll if you qualify for a special enrollment period.
• Special enrollment: You may qualify for a special enrollment period if you have experienced a qualified life event (QLE) that caused you to lose coverage, if you need to make changes to your current plan (due to a life change such as getting married, having a child, or getting divorced), or if you have had a change in eligibility for Medicare or Medicaid. You have 60 days from the time of the event to sign up for a new plan or make changes to your current plan.
• Off-market plans: If you don’t want to purchase an ACA plan on Your Health Idaho, you can buy off-exchange insurance plans from a broker or an insurance agent. Under the ACA, all insurance plans sold, whether on or off-exchange, must comply with ACA rules regarding coverage. Insurance plans must cover pre-existing conditions, mental health care, and other essential benefits. However, off-exchange plans do not offer tax credits or CSRs.
• Coverage types: Many residents in Idaho, 49%, obtain health insurance through an employer. The next largest groups are low-income adults and children on Medicaid (15.6%), and seniors and disabled people on Medicare (15%). Non-group insurance covers 8.6% of Idahoans. The military covers 1.4%, while 10.5% are uninsured.

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:

• Blue Cross of Idaho Health Service, Inc.
• Moda Health
• Molina Healthcare of Idaho
• Mountain Health CO-OP
• PacificSource Health Plans
• Regence BlueShield of Idaho, Inc.
• SelectHealth, Inc.
• St. Luke’s Health Plan

There are some important considerations when shopping for individual coverage, whether for yourself or multiple people. These considerations include:

• Medical needs
• Preferred plan type
• Premium affordability
• Individual vs. family deductibles

Insurance for an individual in Idaho

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:

• A Health Maintenance Organization plan (HMO) offers the best choice if you don’t make many visits to a doctor or a specialist or require prescriptions. It has lower monthly premiums and higher deductibles. HMO plans are the least expensive plans. However, there are restrictions with an HMO plan. You’ll need to get a referral if you want to see a specialist, you’ll need to name a primary care physician, and you’re limited to using the HMO plan’s in-network medical providers.
• A Preferred Provider Organization (PPO) plan is a better idea if you regularly visit doctors or specialists. You’ll have more flexibility with a PPO plan, although you’ll pay more for it. You aren’t limited to in-network providers, you don’t need to name a primary care physician, and you’ll never need to obtain a referral to see a specialist.
• A Point of Service Plan (POS) is a hybrid of an HMO and a PPO. You can use out-of-network providers, but any time you want to see a specialist, you’ll need to get a referral.

Insurance for families in Idaho

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.

• Bronze plans are for relatively healthy people seeking affordable health insurance, as these plans have low monthly premiums but high deductibles and coinsurance fees of 40%. If you don’t have frequent health care needs, Bronze plans are a great way to keep your costs low. In Idaho, Bronze plans often come with premium tax credits and CSRs, further reducing the price. The most affordable Bronze plan in Idaho before calculating any possible credits or benefits is $325 a month.
• Silver plans are for those who require moderate, regular health care needs. Silver plans have lower deductibles and a lower coinsurance payment of 30% but cost more in monthly premiums. Silver plans can offer tax credits and CSRs to eligible individuals and families. The least-expensive Silver plan in Idaho before any tax credits or benefits is $415 a month.
• Gold and Platinum plans are for those who have chronic health issues and regularly visit a doctor or a specialist and require numerous prescriptions. These plans have the lowest deductibles and coinsurance fees — 20% for a Gold plan and 10% for a Platinum plan. However, you will pay a high monthly premium. The most affordable Gold plan in Idaho is $444 a month.

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.

Medicaid in Idaho

To be eligible for Medicaid in Idaho, you must be:

• A resident of the state
• A U.S. citizen, permanent resident, or legal alien
• You must need health care/insurance assistance and have a low income.

You also need to belong to one of the following categories:

• An adult with income at or under 138% of the federal poverty level (FPL)
• Pregnant, regardless of age, with an income at or under 130% of the FPL
• A woman diagnosed with cervical or breast cancer, whose income is at or under 200% of the FPL
• Be blind or disabled
• Be aged 65 or older and meet income requirements.

The Idaho Medicaid program for adults is broken down into two plans that accommodate different medical needs of the individuals enrolled:

• The basic plan provides health, prevention, and wellness benefits for individuals who don’t have special health needs. It includes doctor’s visits, hospitalization, prescriptions, annual physicals, and immunizations.
• The enhanced plan is designed for adults with disabilities or special health needs. It includes everything from the basic plan but offers additional benefits. To be enrolled in the enhanced plan, you need to be referred by a doctor.

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 in Idaho

CHIP coverage for children in Idaho is separated into three categories:

• Children whose family income level is under 190% of the FPL
• Children who have disabilities
• Children who have behavioral health needs

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.

Medicare is the federal government’s health insurance program for those aged 65 and older or disabled. It’s composed of four parts: A, B, C, and D.

• Original Medicare is the basic form of Medicare managed by the federal government. It consists of Part A (inpatient care), and Part B (preventive care and outpatient medical services). It pays for hospital care, preventive services, durable medical equipment, and other medical services, but does not cover prescriptions. Supplemental plans are available to help with prescription costs – these plans are known as Medicare Part D. The Medicare Part A deductible for inpatient hospital stays is $1,600. Medicare Part B enrollees pay a standard monthly premium of $226 for 2023.
• Medicare Advantage Plans are sold by private insurance companies. Although plans must offer at least the same coverage as Original Medicare, Medicare Advantage Plans often cover extra services such as prescription medications, dental, and vision. As of 2023, there are 80 Medicare Advantage Plans available in the state, however, you can only select a plan that’s available in your county.

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.

Eligibility

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).

Enrollment

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:

• Initial enrollment: Your initial enrollment period starts three months before your 65th birthday and ends three months after your 65th birthday. If you’ve never had Medicare, you can enroll during this period. If you started receiving Medicare when you were younger, you can also make changes to your plan.
• General enrollment: Choose this enrollment period if you missed your initial enrollment period. The Medicare general enrollment period is January 1 to March 31. You can choose Original Medicare, Medicare Advantage, Medigap, or Part D.
• Medicare Advantage open enrollment: You can make changes to your Medicare Part C, also known as Medicare Advantage, from January 1 to March 31.
• Open enrollment: You can join, switch plans, or drop your coverage from October 15 to December 7 each year.
• Special enrollment periods: You may qualify for a special enrollment period if you lose your coverage or have changes to your eligibility outside the regular enrollment periods.

Medicare Resources

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.

• Benefits.gov | Idaho Medicaid | Last accessed  December 22, 2022
• Healthcare.gov | Deductible | Last accessed  December 22, 2022
• Healthcare.gov | Health Maintenance Organization (HMO) | Last accessed  December 22, 2022
• Healthcare.gov | Preferred Provider Organization (PPO) | Last accessed  December 22, 2022
• Healthcare.gov | Point of Service (POS) Plans | Last accessed  December 22, 2022
• Healthcare.gov | The ‘metal’ categories: Bronze, Silver, Gold & Platinum | Last accessed  December 22, 2022
• Healthcare.gov | Premium Tax Credit | Last accessed  December 22, 2022
• Healthcare.gov | Cost-Sharing Reduction | Last accessed  December 22, 2022
• Idaho Department of Health and Welfare |Medicaid Income Limits | Last accessed  December 22, 2022
• KFF | Health Insurance Coverage of the Total Population | Last accessed  December 22, 2022
• MedicareInteractive.org | The Parts of Medicare (A, B, C, D) | Last accessed  December 22, 2022
• Medicare.gov | Medicare Advantage Plans | Last accessed  December 22, 2022
• National Academy for State Health Policy | Idaho CHIP Fact Sheet | Last accessed  December 22, 2022