En español | Most Idaho residents are eligible to buy health insurance through Your Health Idaho, the state’s Affordable Care Act (ACA) marketplace. And you might be able to save money on premiums, thanks to expanded federal tax credits in last March’s coronavirus relief bill. Your Health Idaho’s open enrollment begins in November, but you may still be able to switch to a marketplace plan if you move to the state or to a new county or ZIP code within the state, have a baby, or experience another qualifying life event.
Most people already enrolled in ACA marketplace plans have seen their premiums go down this year, because the recently enacted American Rescue Plan increases tax credits for insurance premiums and expands the number of households who qualify for them. Every household that pays more than 8.5 percent of their household income now qualifies for federal tax credits to help them afford health insurance. Prior to the new law, such tax credits were only available to people making up to 400 percent of the federal poverty level (around $51,000 for one person).
The average American with a marketplace plan can save $50 per month with the new assistance, the federal government says. As of now, this additional federal financial assistance will only be available in 2021 and 2022.
Who is eligible?
- Most Idahoans, including non-U.S. citizens with worker or student visas, are eligible to buy health insurance through Your Health Idaho, but they’ll need to wait until open enrollment begins in November if they don’t experience a qualifying life event before then.
- 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 other special circumstances. Members of federally recognized American Indian and Alaska Native tribes can enroll in or change plans once per month.
Low-income households may also qualify for free or low-cost coverage through Medicaid, which allows for year-round enrollment. Complete an application through the Idaho Department of Health and Welfare to see if you or someone in your household is eligible.
When can I enroll?
Open enrollment for Your Health Idaho plans runs from Nov. 1 through Dec. 15. If you submit an application by Dec. 15, you’ll have until Dec. 22 to choose a plan and enroll. If you experience a qualifying life event, you have 60 days from that event to enroll.
How do I sign up?
First, create an account with Your Health Idaho or call customer service at 855-944-3246. You’ll be asked for your Social Security number, your date of birth and a valid email address when you register for an account.
Apply for tax credits and other cost savings through the Idaho Department of Health and Welfare’s website or by calling 877-456-1233. Use Your Health Idaho’s Tax Credit Estimator to see if you’re eligible. If you or other members of your household qualify, the information you sent to the health department when you created your account will automatically transfer to Your Health Idaho.
From there, you can apply for insurance online, by phone, by mail or through a local enrollment expert.
- Online: Compare plans and enroll on Your Health Idaho’s website. Call 855-944-3246, submit a request online or email email@example.com if you need help enrolling.
- By phone: Call Your Health Idaho’s help line at 855-944-3246.
- By mail: Call 855-944-3246 to request a paper application, which you can return by mail.
- Through a local enrollment expert: Set up a call or a meeting with a local certified agent or broker, who can help you navigate your options and pick the right plan for you.
Once you’re approved for a plan, you’ll 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 depend on where you live, the type of plan you choose, your estimated household income, and the age and disability status of you and your family.
If you qualify for Medicaid, you will be able to get free or low-cost coverage and may not need to worry about premiums or copays, depending on your level of income.
All Your Health Idaho plans cover 10 “essential” benefits, including:
- Emergency services and hospitalization
- Pregnancy, maternity and newborn care
- Mental health services (including counseling)
- Chronic disease management and pediatric care
- Prescription drugs
Insurance companies cannot deny coverage because of preexisting conditions. When you apply, you can identify your medical needs and choose a plan that makes financial sense for you and your family.
All Idaho plans cover basic dental services for children, including cleanings and exams. But adults who want dental coverage must add it to their policy. Deductibles and out-of-pocket costs vary between plans; enrolling in a family plan can cut costs.
What about new federal assistance for premiums?
Every eligible household that pays insurance premiums that exceed 8.5 percent of annual income now qualifies for federal tax credits for insurance premiums.
For example, a single 64-year-old filer earning $51,000 per year could potentially save more than $8,000 with the new tax credits, according to the Kaiser Family Foundation.
Is there any other financial assistance available?
Yes. If you qualify for a premium tax credit, you may also qualify for a cost-sharing reduction that would help you pay for such out-of-pocket expenses as deductibles and copays. You must enroll in a Silver-level plan to get this assistance. Your Health Idaho estimates that more than 80 percent of people who are currently enrolled qualify for financial help. Last year, 1 in 3 paid $0 per month for coverage.
What plans are available?
Your Health Idaho’s plans are organized into three categories:
- Bronze plans have the lowest monthly premiums, the highest deductibles and copays, and cover roughly 60 percent of care costs. They’re designed to help you in case of serious illness or injury.
- Silver plans have moderate monthly premiums, deductibles and copays. They cover 70 percent of care costs. They’re the only plans eligible for cost-sharing subsidies.
- Gold plans have higher monthly premiums, lower deductibles and copays, and cover roughly 80 percent of care costs.
Idaho residents 29 and younger can also apply for a catastrophic plan offering low premiums but limited coverage. You can compare estimated plan costs using Your Health Idaho’s website.
What if I already have health insurance?
If you already have coverage through your employer or directly through an insurance provider but are eligible for lower premiums, you can switch to Your Health Idaho during open enrollment. But you may not qualify for tax credits if you opt out of your employer’s plan — unless those premiums exceed a certain portion of your household income. The premiums would need to be more than 9.83 percent of your household income for individual coverage or more than 8.27 percent for family coverage in order for you to qualify for the tax credits.
If you get coverage through the Consolidated Omnibus Budget Reconciliation Act of 1985 (COBRA) because you were terminated from a job or were put on reduced hours, you may be able to switch to a Your Health Idaho plan. If you’re not sure about whether to switch out of COBRA, you can ask for free advice from a local insurance agent or broker.
Will I need to get a new doctor?
That depends. Major insurance providers, 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 see whether a certain doctor or practice will accept a marketplace plan.
Will my family members qualify for the same health plan that I do?
It depends. You can enroll as a family. But in some cases, some family members may also be eligible for certain subsidies or other programs, depending on age, income and disability, or caregiver status. Such families may choose to enroll separately. Family members may still be able to see the same doctor or go to the same medical practice, depending on the types of insurance plans accepted.