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.
Open enrollment for 2022 health plans begins November 1, 2021 in Idaho, although Your Health Idaho will have plans available for window shopping as of October 1.
The open enrollment period is scheduled to end December 15, 2021 (with plan selections allowed until December 22 for people who apply by the 15th).
In states that use HealthCare.gov (the federally-run exchange), HHS has extended the open enrollment period to continue through January 15. But the new guidelines clarify that states that run their own exchanges (like Idaho) can have an earlier deadline, as long as it’s no earlier than December 15. So Idaho can continue to use the December 15 deadline if they choose to do so.
Your Health Idaho offered a COVID/American Rescue Plan enrollment window in 2021, but it ended much earlier than the windows that were offered in other states — Idaho residents had until April 30, 2021 to sign up for coverage without needing a qualifying event.
For 2021 enrollments and plan changes, a qualifying event is now necessary. But as is always the case, qualifying events will not be needed during the open enrollment period that begins November 1.
Five health insurance companies will offer individual/family coverage for 2022 through Your Health Idaho.
These are the same five insurers that offer plans in 2021:
- Blue Cross of Idaho
- Mountain Health CO-OP
- Select Health
- 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.)
For 2022 coverage, the five insurers that offer plans through Your Health Idaho have proposed an overall average rate decrease of 2%.
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% 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% of the national population uninsured in 2013, versus 16.2% of Idaho’s population.
By 2018, the uninsured rate in Idaho had inched back up to 11.1 % (nationwide, there was an increase in the uninsured rate from 2017 to 2018), but it dropped slightly in 2019, to 10.8% (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 early 2021, more than 66,000 people had private coverage through Your Health Idaho (and that was before the American Rescue Plan made subsidies larger and more widely available, driving a sharp increase in enrollments during Your Health Idaho’s COVID-related enrollment window in the spring of 2021).
All of the exchange’s enrollees have coverage for the ACA’s essential health benefits. And 82% of them were receiving premium subsidies that keep their monthly premium costs at an affordable level (again, before the ARP made subsidies more widely available later in 2021).
Twenty-six 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 August 2021, enrollment in Idaho’s expanded Medicaid plans had surpassed 111,000 people.
Eligibility for Medicaid in Idaho now extends to all non-elderly adults with household income up to 138% 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 June 2021, there were 357,870 Idaho residents enrolled in Medicare plans. Most are eligible based on their age, but 13% 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.