Insurance coverage

How to Get Marketplace Health Insurance Coverage in Idaho

In Spanish | Most Idaho residents are eligible to purchase health insurance through Your Idaho Healththe states Affordable Care Act (ACA) Marketduring open registration, which begins November 1.

If you experience a qualifying life event – ​​such as the birth of a child, moving house, marriage, divorce, or loss of your employer-provided health insurance – you may be able to purchase or change your coverage outside of registration open. And you may be able to save money on premiums with expanded federal tax credits available through 2022.

Most people already enrolled in ACA market plans have seen their premiums drop because the US bailout increased tax credits for insurance premiums and increased the number of households that qualify. Every household that pays more than 8.5% of their family income is now eligible for federal tax credits to help them pay for health insurance. Before the new law, these tax credits were only available to people up to 400% of the federal poverty level (about $51,000 for one person).

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The average American with a market plan can save $50 a month with the new assistance, according to the federal government. As of now, this additional federal financial assistance will only be available until the end of 2022.

Who is eligible?

  • Most Idaho residents, including non-U.S. citizens on work or student visas, are eligible to purchase health insurance through Your Health Idaho, but will need to wait until open enrollment begins. in November if they do not experience an eligible life event before that date. .
  • Idahoans who experience a qualifying life event have 60 days to enroll in a Your Health Idaho plan. Qualifying life events include birth or adoption, loss of employer-provided coverage, marriage or divorce, moving and certain others. special circumstances. Members of federally recognized societies Native American and Alaska Native Tribes can sign up or switch plans once a month.

Low-income households can also get free or low-cost coverage through Medicaid, which allows year-round enrollment. Fill out an application via the Idaho Department of Health and Wellness to see if you or someone in your household is eligible.

When can I register?

Open enrollment for Your Health Idaho plans begins November 1. But if you meet a qualifying life event, you have 60 days from that event to register.

How do I register?

First, create an account with Your Health Idaho or call customer service at 855-944-3246. Your social security number, date of birth, and a valid email address will be required when you sign up for an account.

Claim tax credits and other cost savings through the Idaho Department of Health and Wellness website or by calling 877-​456-1233. Use Your Health Idaho’s Tax Credit Estimator to see if you are eligible. If you or other members of your household are eligible, the information you submitted to the health department when creating your account will automatically be transferred to Your Health Idaho.

From there, you can purchase insurance online, over the phone, by mail, or through a local enrollment expert.

  • By Phone: Call the Your Health Idaho Helpline at 855-944-3246.
  • By mail: Call 855-944-3246 to request a paper application, which you can return by mail.
  • Through a local registration expert: Set up a call or meeting with a local certified agent or brokerwho can help you browse your options and choose the plan that’s right for you.

Once you are approved for a plan, you will need to pay your first monthly premium to your insurance provider for your coverage to begin.

What is covered and how much will it cost?

Coverage and cost depends on where you live, the type of plan you choose, your estimated household income, your age and disability status and that of your family.

If you qualify for Medicaid, you may be eligible for free or low-cost coverage and you may not have to worry about premiums or copayments, depending on your income level.

All Your Health Idaho plans cover 10 “essential” benefitsincluding:

  • Emergencies and hospitalization
  • Pregnancy, maternity and newborn care
  • Mental health services (including counselling)
  • Chronic Disease Management and Pediatric Care

Insurance companies cannot deny coverage due to pre-existing conditions. When you apply, you can identify your medical needs and choose a plan that’s financially right for you and your family.

All Idaho plans cover basic dental services for children, including cleanings and examinations. But adults who want dental coverage must add it to their policy. Deductibles and disbursements vary from plan to plan; enrolling in a family plan can reduce costs.

What about federal premium assistance?

Every eligible household that pays insurance premiums greater than 8.5% of its annual income is eligible for federal insurance premium tax credits through 2022.

For example, a 64-year-old single taxfiler earning $51,000 a year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.

Are there other financial aids?

Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help pay for expenses such as deductibles and co-payments. You must sign up for a Silver level plan to get this support. Your Health Idaho estimates that more than 80% of those currently enrolled are eligible for financial aid. In 2020, 1 in 3 people paid $0 per month for coverage.

What packages are available?

Your Health Idaho plans are organized into three categories:

  • Bronze planes have the lowest monthly premiums, the highest deductibles and copayments, and cover approximately 60% of healthcare costs. They are designed to help you in the event of serious illness or injury.
  • Silver Plans have moderate monthly premiums, deductibles and copayments. They cover 70% of childcare costs. These are the only plans eligible for cost-share grants.
  • Gold Packages have higher monthly premiums, lower deductibles and co-payments, and cover about 80% of care costs.

Idaho residents age 29 and younger can also apply for a catastrophic plan that offers low premiums but limited coverage. You can compare estimated plan costs using Your Health Idaho website.

What if I already have health insurance?

If you are already covered by your employer or directly by an insurer, but qualify for lower premiums, you can upgrade to Your Health Idaho during open enrollment. But you might not be eligible for tax credits if you opt out of your employer’s plan, unless those premiums exceed a certain portion of your household income. Premiums should be more than 9.83% of your household income for single coverage or more than 8.27% for family coverage to qualify for tax credits.

If you have coverage under the Consolidated Omnibus Budget Reconciliation Act (COBRA) of 1985 because you were laid off from a job or reduced your hours of work, you may be able to switch to a Your Health Idaho plan. Try to apply and select your plan before your COBRA coverage ends to ensure there is no gap in coverage. If you are unsure about whether to quit COBRA, you can seek free advice from a local insurance agent or broker.

Will I need a new doctor?

It depends. Major insurers, including Blue Cross of Idaho and Select Health, offer Your Health Idaho plans, but not all doctors accept them. You can talk to your doctor to find out if a certain doctor or practice will accept a market plan.

Will my family members be eligible for the same health plan as me?

It depends. You can register as a family. But in some cases, certain family members may also be eligible for certain grants or other programs, depending on age, income and disability, or caregiver status. These families may choose to register separately. Family members can still see the same doctor or go to the same doctor’s office, depending on the types of insurance plans accepted.

This guide was updated on February 18 with more information on open registration.

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