People who require affordable health insurance in Idaho can get it in several ways. For employees and their families, the majority of employers offer health insurance. You may, however, choose to buy policies through the state’s health insurance marketplace: Idaho’s Health. You could purchase a short-term insurance plan, join a cost-sharing program, or purchase an off-exchange plan from a broker or insurance agent. You might qualify for Medicare if you’re at least 65 years old (or have a qualifying disability). Finally, Medicaid may be available to low-income adults and kids in Idaho.
All of the affordable health insurance options offered in Idaho are explained in this guide.
Information on health insurance in Idaho
Your Health Idaho: A state-run website that provides ACA health insurance plans is available in Idaho. Every insurance plan offers high-value, reasonably priced health insurance coverage. Numerous insurance plans offer cost-sharing reductions and premium tax credits (CSRs).
Open enrollment: In Idaho, the open enrollment period runs from November 1, 2021, through January 15, 2022, for coverage starting in 2022. Only those who meet the requirements for a special enrollment period may enroll if open enrollment is missed.
A qualifying life event (QLE) that resulted in your loss of coverage, the need to modify your existing plan due to a change in your circumstances (such as getting married, having a child, or divorcing your spouse), or a change in your Medicare or Medicaid eligibility may all qualify you for a special enrollment period. You have 60 days following the occurrence to enroll in a new plan or modify your existing one.
Off-market plans: You can purchase off-exchange insurance plans from a broker or an insurance agent if you don’t want to buy an ACA through Your Health Idaho. All insurance plans sold must adhere to the ACA’s coverage requirements, whether they are sold on or off the exchange. Plans must cover mental health care, pre-existing conditions, and other important benefits in Idaho. Off-exchange plans, however, do not provide CSRs or tax credits.
Types of coverage: 49% of Idahoans have employer-sponsored health insurance. Low-income adults and kids on Medicaid (15.6%) and seniors and people with disabilities on Medicare (15%) make up the following two most prominent groups in Idaho health insurance. 8.6% of Idahoans have non-group insurance. 10.5% of people lack insurance, while the military covers 1.4%.
How do I sign up for the Health Insurance in Idaho Marketplace?
Your Health Idaho is the name of the state-run health insurance exchange in Idaho. Your Health Idaho offers more than a place to buy individual insurance policies. It is a central location where you can review Idaho’s low-cost health insurance options, including both on- and off-exchange plans. If you want to buy an Affordable Care Act plan, talk to enrollment counselors; if you want an off-exchange insurance plan, talk to an insurance broker or agent.
Your Health Idaho will inquire about your interest in an ACA plan to ascertain whether you qualify for notable tax credits or CSRs. These include inquiries about the number of people in your household, your tobacco use, and their ages. You can browse plans after completing the registration process until you find one that works for your family and your budget.
Your Health Idaho features ACA plans from five companies:
- Health Service Blue Cross of Idaho, Inc.
- Idaho’s Molina Healthcare
- Mountain Health Cooperative
- Plans from PacificSource Health
- Idaho’s Regence BlueShield, Inc.
How do I sign up for individual and family health insurance in Idaho?
There are a few crucial factors to consider when looking for individual healthcare coverage in Idaho, whether for oneself or several people. These factors consist of:
- Medical requirements
- Preferred type of plan
- Premium accessibility
- Deductibles for individuals versus families
- Individual insurance in Idaho
Your general health will influence the price of insurance that you purchase for yourself. You should probably pick a plan with a low monthly premium and high deductibles if you don’t need much medical attention.
The deductibles can add up if you visit a doctor or specialist frequently and require frequent prescriptions. Your best option is a plan with a higher monthly premium but lower deductibles. You can manage your out-of-pocket costs by doing this.
There are various types of plans from which you can select:
HMO Plan: If you don’t need prescription medication or frequent doctor or specialist visits, an HMO plan is the best option. It has higher deductibles and lower monthly premiums. The most affordable options are HMO plans. With an HMO plan, there are limitations, though. You are limited to using the HMO plan’s in-network healthcare providers, must designate a primary care physician, and must obtain a referral to see a specialist.
PPO Plan: If you frequently visit doctors or other specialists, a Preferred Provider Organization (PPO) plan is a better option. A PPO plan will provide you with more flexibility but will cost more. No primary care physician is required, you are not restricted to in-network providers, and you never need a referral to see a specialist.
POS Plan: A Point of Service Plan (POS) combines HMO and PPO features. You can use out-of-network healthcare providers, but you must first obtain a referral if you want to see a specialist.
Also, check out the EPO healthcare plan.
Family medical or health insurance in Idaho
When looking for an affordable family insurance plan, you must balance your spending power and your family’s medical requirements. While you might be in good health, your spouse might suffer from a long-term illness like heart disease or hypertension. Similar to how one of your kids might require routine medical attention for a mental health issue or asthma.
A healthy family might feel at ease selecting an HMO plan. If someone in your family has a chronic medical condition, a PPO or POS plan may give you the healthcare coverage in Idaho you require to see specialists.
Many family plans have both an individual, and a family deductible should be considered. Each person covered by the plan is subject to an individual deductible, whereas the family deductible applies to the entire family. It’s possible to reach the family deductible before everyone on the plan has got their individual deductibles if one of your family members requires hospitalization or expensive surgery.
What is the cost of health insurance in Idaho?
Insurance plans in Your Health Idaho are categorized into four metal tiers: Bronze, Silver, Gold, and Platinum. You won’t receive insufficient medical care if you choose a Bronze plan over a Gold plan. All the plans offered by Your Health Idaho provide necessary and affordable health insurance; however, the amount of coinsurance your responsibility varies between plans. The metal tiers provide a basic understanding of how each plan handles your coverage costs.
- Bronze plans have low monthly premiums but high deductibles and coinsurance fees of 40%, making them ideal for reasonably healthy people looking for affordable health insurance in Idaho. Bronze plans are a great way to reduce costs if you don’t frequently need medical attention. In Idaho, CSRs and premium tax credits are commonly offered with Bronze plans, further reducing costs. Before considering any potential credits or benefits, Idaho’s most affordable Bronze plan costs $323 per month.
- Silver plans are for people who need reasonable, routine medical care. Although the monthly premiums for silver plans are higher, they have lower deductibles and a coinsurance payment of only 30%. Tax credits and CSRs from silver plans may be available to individuals and families who qualify. Before any tax credits or benefits, Idaho’s least expensive Silver plan costs $452 per month.
- Gold and Platinum plans are for people with chronic health conditions who must frequently see a doctor or specialist and fill many prescriptions. These plans have the lowest coinsurance and deductibles at 10% for a Platinum plan and 20% for a Gold plan, respectively. However, you’ll have to pay a high monthly premium. Idaho’s most inexpensive Gold plan costs $480 per month.
Is there affordable health insurance in Idaho?
Medicaid and the Children’s Health Insurance Program are two options for low-income individuals and families in Idaho (CHIP). 759,800 people signed up for Medicare or CHIP in 2021.
- Idaho Medicaid
- Medicaid eligibility requirements in Idaho are as follows:
- An inhabitant of the state
- A citizen, legal permanent resident, or foreign national
- You must have a low income (Medicaid income limit) and need health care or insurance assistance.
Furthermore, you must fall under one of the following categories:
- Adults who make less than or equal to 138% of the federal poverty level (FPL)
- Pregnant women of any age with incomes of at least 130% of the federal poverty level
- A female patient with breast or cervix cancer whose income is at or below 200% of the federal poverty level
- Be blind or disabled.
- Must be at least 65 and have the required income.
The Idaho Medicaid program for adults is divided into two plans to meet the various medical requirements of those enrolled:
- The basic plan offers wellness, prevention, and general health benefits for people without specific medical needs. It covers doctor visits, hospital stays, prescription drugs, yearly physicals, and vaccinations.
- Adults with special medical needs or disabilities are the target audience for the enhanced plan. Everything from the basic plan is included, but it also comes with extra benefits. To join the enhanced plan, it would help if you had a recommendation from your doctor.
Each of the groups above that apply for Medicaid in Idaho is subject to income and resource caps. Regular Medicaid has a resource ceiling of $2,000 for individuals and $3,000 for couples. The amount rises to $4,000 per couple if a couple is requesting home health care or nursing home care.
Children in Idaho who are covered by CHIP fall into one of three categories:
- Children whose family income is less than 190% of the federal poverty line
- Children with special needs
- Children with needs for behavioral health
Children whose families are eligible for CHIP get yearly checkups, dental and vision care, ambulance services, home health care, durable medical equipment, immunizations, lab tests, prescriptions, x-rays, orthotics/prosthetics, and other services.
Medicaid and CHIP applications are available through Your Health Idaho.
What are Medicare options available to seniors and people with disabilities in Idaho?
Medicare is a government funded health insurance program for people over 65 and people with disabilities that is paid for by the federal government. It has four parts called A, B, C, and D.
Original Medicare is the basic version of the program that is under federal administration. There are two parts to it: Part A (inpatient care) and Part B. (preventive care and outpatient medical services). Prescription drugs are not covered, but hospital care, preventative care, durable medical equipment, and other medical services are all paid for. The Medicare Part D supplemental plans assist with prescription drug costs.
Private health insurance companies market and sell Medicare Advantage Plans in Idaho. Even though they must provide at least the same coverage as Original Medicare, Medicare Advantage Plans frequently offer additional services like prescription drug coverage, dental care, and vision insurance.
If Original Medicare is what you opt for, you can buy supplemental plans to increase your coverage. Medicare Part D covers prescription drugs, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare expenses.
Individuals under the age of 65 must be covered by companies selling Medicare Supplement Insurance/Medigap plans in Idaho. Additionally, the state caps premiums at 150% of what businesses charge people 65 and older.
To get Medicare, you must be 65 years old or have a disability that meets certain requirements. A disorder that makes you eligible for at least 24 months of benefits from the Railroad Retirement Board or the Social Security Disability Insurance program is called a “qualifying disability.” If you have Lou Gehrig’s disease or end-stage renal disease, you might be able to qualify more quickly.
If you start getting money from Social Security or the Railroad Retirement Board at least four months before you turn 65, Medicare will sign you up automatically. Otherwise, you must submit an online application or contact your neighborhood Social Security office. Medicare enrollment is available during the following times:
Initial enrollment: You have a three-month window before turning 65 and a three-month window following that age to enroll. During this time, you can enroll if you have never had Medicare. You could alter your plan even if you enrolled in Medicare when you were younger.
General enrollment: Select this enrollment window if you missed the first one. January 1 through March 31 is the general enrollment period for Medicare. You can select Part D, Medigap, Medicare Advantage, or Original Medicare.
Medicare Advantage Open Enrollment: Medicare Part C, also known as Medicare Advantage, can be modified between January 1 and March 31.
Open enrollment Period: During open enrollment, which runs from October 15 to December 7, you can enroll, change plans, or cancel your coverage.
Special enrollment periods: You may be eligible for a special enrollment period if you lose your coverage or your eligibility changes outside of the regular enrollment periods.
Resources for Medicare
Senior Health Insurance Benefits Advisors (SHIBA) in Idaho offer free, unbiased, and private health insurance advice to beneficiaries, families, or caregivers about Medicare options. This covers all types of Medicare plans, such as Original Medicare, Medicare Advantage, Medigap, Part D One, and others.
The qualified and licensed counselors at SHIBA can be reached by phone, email, remote communication, and (if necessary) in-person meetings. Never will a counselor try to sell you a strategy.
Are there options for temporary health insurance plans in Idaho?
You might discover that ACA plans are more expensive than short-term health insurance plans.
Traditional short-term health insurance policies in Idaho have a 12-month maximum coverage period and are nonrenewable. The duration of enhanced short-term plans is 36 months, renewable once. Standard short-term insurance plans do not cover pre-existing conditions, but enhanced plans have a 12-month waiting period before providing pre-existing condition coverage. However, if you had prior coverage, this time frame might be shortened or eliminated (such as coverage through an employer).
These improved short-term insurance plans include the same benefits as ACA-compliant ones. For instance, the first three children under 21 who are covered by a family plan pay no premiums and receive free preventive care. These plans also cover prescription drugs, maternity care, and mental health services. The fact that out-of-pocket expenses are limited to $50,000 is a drawback, though.
Insurance FAQs for Idaho
Is health insurance a requirement in Idaho?
Even though the ACA initially imposed a tax penalty on those Americans who did not have health insurance, the penalty was eliminated by legislation in 2018 and subsequent federal court decisions. Idaho does not require health insurance, unlike some other states.
Do I have to make use of Idaho’s Health Insurance Marketplace?
No, you cannot purchase health insurance in Idaho through an insurance broker or agent. However, you are ineligible for premium assistance.
What non-traditional medical insurance plans, such as cost-sharing, are offered in Idaho?
In Idaho, cost-sharing plans with a religious component are most prevalent. These plans’ participants split the cost of their medical care. If you wish to enroll in a health cost-sharing insurance plan, you are not required to be a member of a specific or general religion.
These insurance plans, however, might not cover pre-existing conditions and other necessary benefits since they are not required to adhere to ACA requirements. Make sure the faith-based plan you’re considering covers the health issues that your family faces.
If I have an HSA or FSA, do I still need health insurance in Idaho?
An HSA/FSA is brilliant, even if you have insurance. These accounts are designed to pay for minor medical expenses such as copays, deductibles, and vision and dental work after insurance has paid its share of the bill.
Do I still need short-term disability coverage if I have health insurance in Idaho?
Health insurance and short-term disability coverage are two distinct concepts. If you get hurt, short-term disability insurance can help with household costs. All that health insurance covers are medical expenses. Consider short-term disability insurance if your line of work exposes you to a risk of injury.
Do I still need long-term disability coverage if I have health insurance in Idaho?
It’s a good idea to have long-term disability insurance if you have a job that has the potential to be dangerous. When you’re hurt, it will assist with covering your expenses like utilities, mortgage payments, or groceries. Your health insurance covers only the medical costs.
Visit our website NewHealthInsurance.com to learn more.