Frequently asked questions about health insurance
coverage options in Idaho
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.
Learn more about the Idaho health insurance marketplace.
Your Health Idaho was the last state to announce a COVID-related enrollment period in early 2021. Idaho’s special enrollment period initially ran from March 1 – March 31, 2021, but was subsequently extended through April 30 and expanded to include anyone eligible to use the exchange (as opposed to only uninsured residents). A qualifying event is not necessary during this window, but will once again be necessary after the end of April, until open enrollment starts again in November.
The extended enrollment window gives Idaho residents an opportunity to take advantage of the American Rescue Plan’s additional premium subsidies. This applies to people who are currently uninsured, as well as those who have a plan through the exchange and would like to change their coverage (although this is limited to switching to another plan offered by the same insurer the enrollee already uses). It also applies to people who are enrolled off-exchange (directly through an insurer) because they weren’t previously eligible for premium subsidies, since the “subsidy cliff” has been eliminated for 2021 and 2022. And some Idaho residents who have enrolled in enhanced short-term plans might find that an ACA-compliant plan will now fit their budget; the enrollment window that continues through April 30 is an opportunity to make that switch.
Open enrollment for 2021 coverage in Your Health Idaho was scheduled to run from November 1 through December 15, 2020, following the same schedule that Idaho has used for the last several years (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, although they do give people an extra week each year to finish their plan selection, as long as they started the process by December 15). But for 2021 health plans, the exchange announced a last-minute extension, allowing people to enroll as late as December 31, 2020.
Five health insurance companies offer individual/family coverage for 2021 through Your Health Idaho. This includes the four that offered plans in 2020 – Blue Cross of Idaho, Mountain Health CO-OP, PacificSource, and Select Health – as well as Regence BlueShield of Idaho.
Regence offered individual market coverage in the state as of 2020, but only outside the exchange (enrollment was fairly low, at just 1,200 people). Regence joined the exchange for 2021, bringing the total number of participating exchange insurers to five. (Regence also joined the exchange in Washington for 2021, as well as the exchange in Oregon, after previously offering off-exchange coverage.)
Enrollment in private individual market plans dropped significantly in 2020, due in large part to the expansion of Medicaid — people with income between 100 and 138 percent of the poverty level had previously been eligible for premium subsidies for private plans, but became eligible for Medicaid instead as of 2020. Enrollment dropped again in 2021, with about 69,000 people signing up for coverage during the open enrollment period.
This decline came despite the exchange’s extension of the open enrollment window through December 31 (instead of December 15; Idaho’s exchange rarely extends open enrollment). The decline is linked to more people enrolling in Medicaid and the fact that the Medicaid program (nationwide) is not conducting eligibility redeterminations or terminating coverage during the COVID emergency period. But Idaho’s drop in private plan enrollment for 2021 was much more significant than most states’.
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 dropped slightly in 2019, to 10.8 percent (nationwide, there was another small uptick in the uninsured rate in 2019), and it’s likely that it dropped sharply in 2020, thanks to the implementation of Medicaid expansion.
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 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.
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 January 2021, enrollment in Idaho’s expanded Medicaid plans had surpassed 100,000 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.
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.
As of December 2020, there were 351,859 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.
- 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.
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.