In 2010, the federal healthcare law — the Affordable Care Act (ACA) — was passed. Ultimately, this law gave states the opportunity to build health insurance marketplaces called exchanges. Your Health Idaho is Idaho’s exchange.
It offers 146 plans, including:
- 61 individual and family plans
- 55 small group health plans
- 13 individual dental plans
- 17 small group dental plans
Read on to learn more about the Idaho exchange and how to apply for the health coverage you need.
Your Health Idaho has seven insurance companies offering plans:
- BEST Life and Health Insurance Company
- Blue Cross of Idaho
- Bridge Span Health Company
- Delta Dental of Idaho
- The Guardian Life Insurance Company of America
- Pacific Source Health Plans
- Select Health
All plans must offer the following essential services:
- doctor visits
- chronic disease management
- emergency room visits
- maternity and newborn care
- mental health services
- prescription drugs
- rehabilitative services
- habilitative services and devices (includes speech, occupational, or physical therapy)
- lab services, such as blood work
- preventive and wellness checks
- pediatric care, including oral and vision
- sick visits
- substance abuse treatment
There are four basic plans available through the exchange. These have varying coverage levels. They include:
- bronze (60 percent of expenses paid)
- silver (70 percent)
- gold (80 percent)
- platinum (90 percent)
While the platinum plan may be the most appealing, it also comes with higher premiums. Lower percentage plans will have lower premiums. The downside is higher out-of-pocket costs.
If you’re under the age of 30, there’s also a catastrophic plan available. This has the highest deductible, but the most affordable premiums.
Your ultimate decision should be based on your income versus how often you might need to use the coverage.
The monthly premium range for a 31-year-old in Idaho will range from $159.80 to $334. The monthly premium for a family of four ranges from $527.52 to $1,110. Check the premium ranges tables or the health insurance plan and rate information booklet provided by Your Health Idaho to compare prices.
Once you figure out the maximum healthcare percentage for your income, then you know that's the most you'll have to pay for coverage. For example, if your income is $32,500 a year, the most you’ll have to pay for a silver plan is 9 percent of your income. This amounts to $2,926 annually, or $244 a month.
The challenge is to compare the costs of each plan and decide which offers the best value. A helpful calculator offered by the Kaiser Family Foundation provides an estimate of your subsidy eligibility and how much you should expect to spend on health insurance.
Depending on your income, you may qualify for financial aid to help offset the costs of coverage. This may come in the form of:
- Medicaid coverage
- tax credits
Parents living at or below 24 percent of the federal poverty level (FPL) may qualify for Medicaid in Idaho based on eligibility. Pregnant women at or below 133 percent of the FPL also qualify. The FPL for 2015, according to the Department of Health and Human Services, is:
- $11,770 in individual annual wages
- $15,930 for families of two
- $20,090 for a family of three
- $24,250 for a family of four
As of 2015, the annual maximum out-of-pocket is $6,350 for individuals. It’s $12,700 for families. This financial protection may reduce the chances of bankruptcy due to medical bills not covered by insurance.
Tax credits are based on the silver plan. This helps you determine any extra out-of-pocket costs if you elect a higher or lower plan. The ACA was designed so the silver plan is more affordable for individuals buying their own insurance. This is regardless of how expensive the healthcare rates are where you live.