Idaho Health Insurance

 

Health insurance in Idaho

● Idaho enrolls through Your Health Idaho, a state-run health insurance marketplace.

● The open enrollment period for 2021 health plans is from November 1 to December 15, 2020. Idaho residents with eligible events can sign up or make changes to the plan outside of open enrollment.

● Short-term health insurance plans can be sold in Idaho with initial plan terms of up to 364 days.

● Five insurers will offer plans in the Idaho exchange for 2021, compared to four in 2020.

● The average premium increase for 2020 was 6% in the Idaho individual marketplace; for 2021, insurers have proposed an average increase of just 1%.

● About 89,000 subscribers to the 2020 coverage through the Idaho exchange.

● Enrollment in Medicaid expansion began in Idaho on November 1, 2019, with coverage starting January 1, 2020.

This page is dedicated to helping consumers quickly find health insurance resources in the state of Idaho. Here you will find information about the many types of health insurance coverage available. You can find the basics of the Idaho health insurance marketplace and the upcoming open enrollment period; a brief overview of Medicaid expansion in Idaho; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for Idaho residents.

Idaho's health insurance marketplaceplace

Idaho's state health insurance marketplace is called Your Health Idaho. The exchange serves people who buy their own health insurance in the individual marketplace, small businesses, and some populations that are eligible for Medicaid in Idaho. People who purchase individual marketplace coverage include early retirees who are not yet eligible for Medicaid, the self-employed, and people who are employed in a small business that does not provide health benefits.

Idaho was initially the only state to create its own state-run health insurance marketplace, but also rejected Medicaid expansion. But Medicaid expansion is on track in Idaho on January 1, 2020 - six years after it began in states that accepted it as soon as it was available - thanks to an election initiative that voters approved in the 2018 election. Enrollment in the state's newly expanded Medicaid program began on November 1, 2019. Nearly 88,000 people had enrolled in Medicaid under Idaho's new eligibility guidelines by September 2020.

Five health insurance companies will offer one-on-one/family coverage for 2021 through Your Health Idaho. This includes the four offering plans in 2020 - Blue Cross of Idaho, Mountain Health CO-OP, Pacific Source and Select Health - as well as Regence BlueShield of Idaho. Regence offers individual marketplace coverage in the state in May 2020, but only outside of the exchange (enrollment is quite low, at just 1,200 people). Regence joins the exchange for 2021, bringing the total number of participating exchange insurers to five. [Regence is also joining the exchange in Washington for 2021, having previously offered off-exchange coverage.]

The average rate increase approved for Idaho health insurance marketplace individual plans was 6% for 2020. For 2021, the five insurers proposed an overall average rate increase of about 1%.

During the open enrollment period for 2020 health plans, more than 89,000 people enrolled in private individual medical insurance policies through Your Health Idaho. That was about 14,000 fewer than the previous year, mainly because of Idaho's implementation of Medicaid coverage expansion. In 2019 and previous years, people with a household income of at least 100% of the poverty level were eligible for grants to purchase private plans in the health insurance marketplace. But as of 2020, people with an income of up to 138% of the poverty level are instead eligible for Medicaid plans, with the result that fewer people have enrolled in private individual health insurance plans.

Idaho open enrollment period and dates

Open enrollment for 2021 coverage in Your Health Idaho runs from November 1, 2020 to December 15, 2020. Most fully state-run exchanges tend to extend open enrollment periods each year, but Your Health Idaho is the exception to that rule and rarely offers any kind of extension.

The open enrollment period is an opportunity for people to recently enroll in a major individual marketplace medical plan or renew or modify an existing plan for next year. It's also time to update your financial and household information with the exchange, so that your financial assistance is accurate for 2021. It's important to carefully consider all the plan options available each year during open enrollment, as insurers' benefits, premiums, and service areas can change from year to year.

Outside the open enrollment period, individual/family coverage can only be purchased if a person experiences a qualifying event. This is true both on the stock exchange and outside the exchange.

Medicaid expansion in Idaho

Idaho lawmakers have rejected Medicaid expansion for several years, but voters in Idaho have approved an election initiative to expand Medicaid in the 2018 election. As a result, the expansion of Medicaid coverage in Idaho is on January 1, 2020. By September 2020, enrollment in Idaho's expanded Medicaid plans had exceeded 87,000 people.

Eligibility for Medicaid in Idaho now extends to all non-elderly adults with a family income of up to 138% of the poverty level.

Before 2020, an estimated 119,000 Idaho residents are in the coverage gap - not eligible for subsidies in the exchange and also not eligible for Medicaid coverage. But there is no longer a coverage gap in Idaho after the end of 2019.

Short-term health insurance in Idaho

Idaho allows two types of short-term health insurance coverage, which have different regulations. Normal short-term health insurance plans in the state are not renewable and cannot have terms of more than six months. But the state has allowed the creation of new short-term "enhanced" health insurance plans available starting in 2020 with longer terms and much stronger benefits and consumer protections.

How did Obamacare help Idaho?

The uninsured rate in Idaho fell 6.1 percentage points to 10.1% between 2013 and 2016, according to U.S. Census data. Nationally, the uninsured rate fell to 8.6% over the same period of time, but started a little lower than in Idaho, with 14.5% of the national population uninsured in 2013, compared to 16.2% of Idaho's population.

By 2018, the uninsured rate in Idaho had returned to 11.1% (nationally, there was uninsured rate increase from 2017 to 2018), but is expected to fall sharply in 2020, when Medicaid expansion takes place.

The state exchange, Your Health Idaho, has been called a "state-based adoption model [of an exchange]" for its below-average budget, lean organizational structure, and strong financial controls.

As of December 2020, more than 72,000 people had private coverage through Your Health Idaho. All have coverage for the ACA's essential health benefits. And 86% of them receive premium subsidies that keep their monthly premium costs at an affordable level. 30% of subscribers also receive cost-sharing reductions, which reduce out-of-pocket (deductible, coinsurance, and copays) costs to make them more affordable.

Idaho and the Affordable Care Act

Idaho is a solidly "red" state, and many politicians and residents strongly oppose the Affordable Care Act. At the federal level, both Idaho senators voted against the ACA in 2010, as did one of two representatives. Walt Minnick (D) was the only "yes" in Idaho; Raúl Labrador later replaced him in the U.S. House, serving until 2019 when Russ Fulcher became the representative of Idaho's 1st Congressional District. Like Labrador, Fulcher opposes the ACA.

Idaho is one of the only Republican-controlled states that has implemented a state-run marketplace. Former Governor Butch Otter, while criticizing the ACA, advocated a state-run marketplace as a better option than the federally subsidized marketplace. Legislation authorizing state-run exchange, which is called Your Health Idaho, was passed and signed into law in 2013.

With not enough time to get all functions up and running before the ACA's open enrollment period, Idaho residents used HealthCare.gov to sign up for coverage in 2014.

In the fall of 2014, in time for open enrollment for 2015 coverage, Your Health Idaho completed its successful transition to a state-run exchange and began operating regardless of the marketplace. Health Idaho has continued to be a fully state-run exchange, using its own registration platform, since 2015.

Does Idaho have a high-risk pool?

Prior to individual reforms to the ACA health insurance marketplace, coverage was underwritten by the medical reference point in nearly every state, including Idaho.  People with pre-existing conditions were often unable to purchase private plans or could only get policies that excluded their pre-existing conditions or applied increased premiums to them because of their health history.

The Idaho Individual High-Risk Reinsurance Pool (HRP) was created in 2001 to offer people an alternative means of getting coverage if they were unable to purchase a private plan because of their medical history. In 2010, there were 1,565 members in the Idaho HRP. 

Idaho's HRP had a fairly unique design, as every insurer in the state was required to participate and had to offer five standardized HRP plans. If a person asked for individual marketplace coverage and the insurer's subscription had determined that the applicant would be at high risk, they would be able to choose from the five HRP plans offered by that insurer, with premiums limited to no more than 150% of the premiums charged to healthy subscribers in non-HRP plans.

One of the main reforms introduced by the ACA is the guarantee of individual coverage; medical history is no longer taken into account when submitting an application. Therefore, the need for high-risk pools has largely disappeared, and Idaho's risk pool stopped enrolling new members at the end of 2013. But the plan has not yet finished coverage for existing members; may voluntarily switch to the exchange, unless otherwise notified by the HRP.

Medicare coverage and enrollment in Idaho

As of August 2020, there were 346,684 Idaho residents enrolled in Medicare plans. Most are eligible based on their age, but 14% of Medicare beneficiaries in Idaho are under 65 and are eligible for Medicare due to a disability.

Idaho Health Insurance Resources

● Your Health Idaho - The state marketplace that serves as a shopping platform for health coverage and the only place residents can get premium subsidies and cost-sharing reductions in Idaho.

● Idaho Department of Insurance — Licenses and regulates health insurance companies, agents, and brokers; can provide assistance to consumers with health insurance problems.

● Idaho Senior Health Insurance Benefits Advisors (SHIBA) - Local consulting, information and education for Medicare beneficiaries and their caregivers.

● Medicare Rights Center - A national service (website and call center) that provides assistance with Medicare-related questions.

● Idaho Medicaid - Provides health benefits for low-income Idaho residents.