Overview of Idaho’s Health Insurance Exchange
In 2010, the federal healthcare law—the Affordable Care Act—was passed, giving states the opportunity to build health insurance marketplaces called exchanges. Your Health Idaho is Idaho’s exchange. Your Health Idaho is offering 146 plans from seven Idaho carriers that will be available to Idahoans. There will be a large selection of plans to choose from, including 61 individual and family plans, 55 small group health plans, 13 individual dental plans, and 17 small group dental plans.
These key providers are offering plans to Idahoans:
- BEST Life and Health Insurance Company
- Blue Cross of Idaho
- BridgeSpan Health Company
- Delta Dental of Idaho
- The Guardian Life Insurance Company of America
- PacificSource Health Plans
- SelectHealth, Inc.
You can get more information about the various health insurance and dental plans available for individuals and small businesses via the “What You Need to Know” section of the Your Health Idaho website.
As of October 1, 2013, you can begin shopping for a plan. Open enrollment lasts until March 1, 2014. Plans become effective on January 1, 2014. Idahoans can also get more assistance through the consumer resource center at 1-855-944-3246, or through Consumer Connectors, who include agents, brokers, and In-Person Assisters located across the state.
Per the Affordable Care Act, all plans must offer the following essential services:
- Ambulatory patient services (doctor visits)
- Emergency services
- Maternity and newborn care
- Mental health and substance use disorder services, including behavioral health treatment
- Prescription drugs
- Rehabilitative and habilitative services and devices (Habilitative services are for people with disabilities who need speech, occupational, or physical therapy.)
- Laboratory services
- Preventive and wellness services and chronic disease management
- Pediatric services, including oral and vision care
There will be four basic plans available with varying levels of coverage: Bronze (60 percent of expenses paid by plan), Silver (70 percent), Gold (80 percent), and Platinum (90 percent). Lower percentage plans will have lower premiums, but higher out-of-pocket costs. There will also be a catastrophic plan with a high deductible available for folks under the age of 30. Additionally, depending on your income level, you may qualify for Medicaid, tax credits, or a subsidy to help offset the costs of coverage.
Parents living at or below 24 percent of the federal poverty level (also known as FPL, which is $11,490 a year in wages for one person and $23,550 a year in wages for a family of four), and pregnant women living at or below 133 percent of the FPL, will qualify for Medicaid in Idaho based on eligibility standards that take effect January 1, 2014.
Tax credits are based on the Silver Plan, so individuals can easily determine what their additional out-of-pocket costs will be if they elect a higher or lower plan compared to Silver.
The monthly premium range for a 31-year-old in Idaho will range from a low of $159.80 per month to a high of $334.00 per month. The monthly premium for a family of four ranges from a low of $527.52 per month to a high of $1,110 per month. Visit this page for a table comparing the general costs of the different health plans being offered to Idahoans, or peruse the full “Health Insurance Plan & Rate Information” booklet that lists all the rates for all plans, ages, and locales as of October 29, 2013.
Many people will want to know how much of a subsidy they qualify for, but the real question is how much will you pay? Once you figure out what the maximum healthcare percentage is for your income, then you know that's the most you'll have to pay for a Silver Plan. For example, if your income is $32,500 a year (283 percent of the poverty level), the most you’ll have to pay for health insurance is nine percent of your income, which amounts to $2,926 annually, or $244 monthly. The challenge is to compare the costs of Bronze, Silver, Gold, and Platinum, and decide which plan offers the best value for you. 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.
Additionally, starting in 2015, new federal financial protection will include a maximum out-of-pocket cost of $6,350 for individuals and $12,700 for families. This financial protection will dramatically reduce the chances of bankruptcy due to medical bills not covered by insurance.
Idahoans who login to YourHealthIdaho.org and enter some basic information on their family size and annual income will be able to determine what level of financial assistance they may be eligible for. Prices displayed for plans on Your Health Idaho will reflect the level of financial assistance that an individual or family may be eligible for. A Premium Assistance Estimator on the official Your Health Idaho website provides more information and a link out to the aforementioned calculator from the Kaiser Family Foundation.