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.

What to know about insurance 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 2022 in Idaho runs from November 1, 2021 through January 15, 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.

How do I enroll in Idaho’s Health Insurance Marketplace?

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.
  • Molina Healthcare of Idaho
  • Mountain Health CO-OP
  • PacificSource Health Plans
  • Regence BlueShield of Idaho, Inc.

How do I enroll in Idaho’s individual and family insurance?

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.

How much does health insurance cost in Idaho?

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 2019 2020 2021 2022
Most affordable Bronze plan $294 $329 $330 $323
Most affordable Silver plan $492 $512 $492 $452
Most affordable Gold plan $504 $551 $526 $480

  • 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 $323 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 $452 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 $480 a month.

Can you get cheap health insurance in Idaho?

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.

What are Idaho’s Medicare options for seniors and people with disabilities?

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.
  • 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.

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.

Are there short-term health insurance plan options in Idaho?

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.

Idaho Insurance FAQs

Does Idaho require health insurance?

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.

Do I have to use the Health Insurance Marketplace in Idaho?

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.

What types of alternative health insurance plans (like cost-sharing plans) are available in Idaho?

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.

Do I need health insurance in Idaho if I have an HSA/FSA?

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.

Do I need short-term disability coverage in Idaho if I have health insurance?

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.

Do I need long-term disability coverage in Idaho if I have health insurance?

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.

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Insurance and healthcare consultant

Tammy Burns is an experienced health insurance advisor. She earned her nursing degree in 1990 from Jacksonville State University, obtained her insurance billing and coding certification in 1995, and holds a health and life insurance license in Alabama, Georgia, Iowa, Mississippi, and Tennessee. Burns is Affordable Care Act (ACA)-certified for health insurance and other ancillary, life, and annuity products. She maintains an active nursing license and practices private-duty nursing.

Burns’ background as a nurse, insurance biller and coder, and insurance consultant includes infectious disease, oncology, gynecology, phlebotomy, post operative, family medicine, geriatrics, home health, hospice, human resources, management, billing, coding, claims, fixed annuities, group and individual health and life products, and Medicare. She’s always been driven by a desire to help people, spending more than 25 years as a practicing nurse in hospitals, private doctors’ offices, home health, and hospice. As a nurse, Burns supported patients filing insurance claims with Medicare, Medicaid, and private insurance companies as well as responding to billing questions from confused patients.

Seeing firsthand how unsuspecting patients are frequently confused by an overly complex system they don’t understand led Burns to become an insurance agent and health care consultant, now helping people understand the medical system. Since becoming an insurance agent in 2013, she has worked with some of the largest and most reputable insurance carriers and agencies in the nation, and she has built a large and loyal clientele by way of her commitment to transparency and personalized service.

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