Health insurance in Idaho
- Idaho enrolls through Your Health Idaho, a state-run health insurance marketplace.
- Open enrollment period for 2021 health plans is November 1 – December 15, 2020. Idaho residents with qualifying events can enroll or make plan changes outside of open enrollment.
- Short-term health insurance plans can be sold in Idaho with initial plan terms up to 364 days.
- Five insurers will offer plans in the Idaho exchange for 2021, up from four in 2020.
- The average premium increase for 2020 was 6% in Idaho’s individual marketplace; for 2021, insurers have proposed an average increase of just 1%.
- About 89,000 enrolled in 2020 coverage through the Idaho exchange.
- Medicaid expansion enrollment began in Idaho on November 1, 2019, with coverage effective January 1, 2020.
This page is dedicated to helping consumers quickly find health insurance resources in the state of Idaho. Here, you’ll find information about the many types of health insurance coverage available. You can find the basics of the Idaho health insurance marketplace and upcoming open enrollment period; a brief overview of Medicaid expansion in Idaho; a quick look at short-term health insurance availability in the state; statistics about state-specific Medicare rules; as well as a collection of health insurance resources for Idaho residents.
Idaho’s health insurance marketplace
Idaho’s state-run health insurance marketplace is called Your Health Idaho. The exchange serves people who buy their own health insurance in the individual market, small businesses, and some populations that are eligible for Medicaid in Idaho. People who buy individual market coverage include early retirees who aren’t yet eligible for Medicaid, self-employed individuals, and people who are employed by a small business that doesn’t provide health benefits.
Idaho was initially the only state to create its own state-run health insurance marketplace but also reject Medicaid expansion. But Medicaid expansion took effect in Idaho on January 1, 2020 — six years after it began in states that accepted it as soon as it was available — thanks to a ballot initiative that voters passed in the 2018 election. Enrollment in the state’s newly-expanded Medicaid program began 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 individual/family coverage for 2021 through Your Health Idaho. This includes the four that offer plans in 2020 — Blue Cross of Idaho, Mountain Health CO-OP, PacificSource, and Select Health — as well as Regence BlueShield of Idaho. Regence offers individual market coverage in the state as of 2020, but only outside the exchange (enrollment is fairly low, at just 1,200 people). Regence is joining the exchange for 2021, bringing the total number of participating exchange insurers to five. [Regence is also joining the exchange in Washington for 2021, after previously offering off-exchange coverage.]
The average approved rate increase for Idaho’s individual health insurance marketplace plans was 6 percent for 2020. For 2021, the five insurers have proposed an overall average rate increase of about 1 percent.
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. This was about 14,000 fewer than the year before, primarily due to Idaho’s implementation of Medicaid coverage expansion. In 2019 and prior years, people with household income of at least 100 percent of the poverty level were eligible for subsidies to purchase private plans in the health insurance marketplace. But as of 2020, people with income up to 138 percent of the poverty level are eligible for Medicaid plans instead, resulting in fewer people enrolled in private individual health insurance plans.
Read more about Idaho’s health insurance marketplace.
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 of the fully state-run exchanges tend to extend their open enrollment periods each year, but Your Health Idaho is the exception to that rule, and rarely offers any sort of extension.
The open enrollment period is an opportunity for people to newly enroll in an individual market major medical plan, or to renew or change an existing plan for the coming year. It’s also a time to update household and financial information with the exchange, so that your financial assistance is accurate for 2021. It’s important to carefully consider all of the available plan options each year during open enrollment, as benefits, premiums, and insurers’ service areas can change from one year to the next.
Outside of the open enrollment period, individual/family coverage can only be purchased if a person experiences a qualifying event. This is true both on-exchange and outside the exchange.
Medicaid expansion in Idaho
Idaho lawmakers rejected Medicaid expansion for several years, but voters in Idaho passed a Medicaid expansion ballot initiative in the 2018 election. As a result, Medicaid coverage expansion in Idaho took effect January 1, 2020. By September 2020, enrollment in Idaho’s expanded Medicaid plans had surpassed 87,000 people.
Eligibility for Medicaid in Idaho now extends to all non-elderly adults with household income up to 138 percent of the poverty level.
Prior to 2020, an estimated 119,000 Idaho residents are in the coverage gap — ineligible for subsidies in the exchange and also ineligible for Medicaid coverage. But there is no longer a coverage gap in Idaho after the end of 2019.
Read more about Medicaid coverage expansion in Idaho.
Short-term health insurance in Idaho
Idaho allows two types of short-term health insurance coverage, which have differing regulations. Normal short-term health insurance plans in the state are non-renewable and cannot have terms in excess of six months. But the state allowed for the creation of new “enhanced” short-term health insurance plans that are available as of 2020 with longer terms and much more robust benefits and consumer protections.
Read more about short-term health insurance in Idaho.
How has Obamacare helped Idaho?
The uninsured rate in Idaho dropped 6.1 percentage points to 10.1 percent between 2013 and 2016, according to U.S. Census data. Nationwide, the uninsured rate fell to 8.6 percent in the same time period, but it started out a little lower than Idaho’s, with 14.5 percent of the national population uninsured in 2013, versus 16.2 percent of Idaho’s population.
By 2018, the uninsured rate in Idaho had inched back up to 11.1 percent (nationwide, there was an increase in the uninsured rate from 2017 to 2018), but it’s expected to drop sharply in 2020, when Medicaid expansion takes effect.
The state’s exchange, Your Health Idaho, has been called a “model for state-based adoption [of an exchange]” for its below-average budget, lean organizational structure and strong financial controls.
As of 2020, more than 72,000 people had private coverage through Your Health Idaho. All of them have coverage for the ACA’s essential health benefits. And 86 percent of them are receiving premium subsidies that keep their monthly premium costs at an affordable level. Thirty percent of the enrollees are also receiving cost-sharing reductions, which reduce out-of-pocket costs (deductible, coinsurance, and copays) to make them more affordable.
Idaho and the Affordable Care Act
Idaho is a solidly “red” state, and many politicians and residents staunchly oppose the Affordable Care Act. At the federal level, both Idaho senators voted against the ACA in 2010, as did one of two representatives. Rep. Walt Minnick (D) was the sole “yes” vote from Idaho; Raúl Labrador subsequently replaced him in the U.S. House, serving until 2019 when Russ Fulcher became the Representative from Idaho’s 1st Congressional District. Like Labrador, Fulcher opposes the ACA.
Idaho is one of the only Republican-controlled states that implemented a state-run marketplace. Former Gov. Butch Otter, while critical of the ACA, advocated for a state-run marketplace as a better option than the federally facilitated marketplace. Legislation authorizing the state-run exchange, which is named Your Health Idaho, passed and was signed into law in 2013.
With not enough time to get all functions operational before ACA’s open enrollment period, Idaho residents used HealthCare.gov to sign up for coverage in 2014.
By 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 independently of the federal marketplace. Your Health Idaho has continued to be a fully state-run exchange, utilizing its own enrollment platform, since 2015.
Does Idaho have a high-risk pool?
Before the ACA’s individual health insurance market reforms, coverage was medically underwritten 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 charged them increased premiums because of their healthcare history.
The Idaho Individual High-Risk Reinsurance Pool (HRP) was created in 2001 to give people an alternative means of obtaining coverage if they were unable to purchase a private plan because of their medical history. By 2010, there were 1,565 members in the Idaho HRP.
Idaho’s HRP had a fairly unique design, in that each insurer in the state was required to participate, and had to offer five standardized HRP plans. If a person applied for individual market coverage and the insurer’s underwriting determined that the applicant would be a high risk, they would be able to select from among the five HRP plans offered by that insurer instead, with premiums capped at no more than 150 percent of the premiums charged for healthy enrollees in the non-HRP plans.
One of the primary reforms brought about by the ACA is guaranteed issue individual coverage; medical history is no longer taken into consideration when an application is submitted. Thus the need for high-risk pools has largely disappeared, and the Idaho risk pool stopped enrolling new members at the end of 2013. But the plan has not yet terminated coverage for existing members; they can voluntarily transition to the exchange unless notified otherwise 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 percent of Idaho’s Medicare beneficiaries are under the age of 65 and are eligible for Medicare due to a disability.
You can read more about Medicare enrollment in Idaho, including details about private Medicare plans — Medicare Advantage, Medicare Part D prescription plans, and Medigap — and how the state regulates Medigap policies.
Idaho health insurance resources
- Your Health Idaho — The state-run marketplace that serves as a shopping platform for health coverage and the only place residents can obtain premium subsidies and cost-sharing reductions in Idaho.
- Idaho Department of Insurance — Licenses and regulates health insurance companies, agents, and brokers; can provide consumer assistance with health insurance issues.
- Idaho Senior Health Insurance Benefits Advisors (SHIBA) — Local counseling, information, and education for Medicare beneficiaries and their caregivers.
- Medicare Rights Center — A nationwide service (website and call centers) that provides assistance with Medicare-related questions.
- Idaho Medicaid — Provides healthcare benefits for low-income Idaho residents.
Health reform legislation in Idaho
Scroll to the bottom of this page for a look at state-level legislation related to health care reform in Idaho: