Obamacare in Idaho

Health Insurance Marketplace in Idaho

If you live in Idaho, Your Health Idaho is the Health Insurance Marketplace to serve you. Instead of HealthCare.gov, you’ll use the Your Health Idaho website to apply for coverage, compare plans, and enroll. Visit Your Health Idaho now to learn more.

Choosing the Right Health Insurance Plan

The new Montana health insurance company that opened last year is expanding into Idaho this year, and will start selling coverage there on November 15, 2014.

There are a number of different tiers of plans available on the Idaho Health Insurance Exchange. Plans range from bare bones “bronze” plans which cover 60% of pocket medical costs to “platinum” plans which have greater coverage but come with higher premiums. In general higher premiums mean lower out-of-pocket costs and a wider insurer network of doctors and hospitals.The plans are as listed below:

NOTE: All cost sharing is of out of pocket costs. Please see ObamaCare health benefits for services that are covered at no out of pocket charge on all plans. The maximum out-of-pocket costs for any Marketplace plan for 2014 are $6,350 for an individual plan and $12,700 for a family plan.

Bronze Plan: The bronze plan is the lowest cost plan available. It has the lowest premiums and in exchange has the lowest actuarial value. The actuarial value of a bronze plan is 60%. This means that 60% of medical costs are paid for by the insurance company, leaving the other 40% to be paid by you.

Silver Plan: The Silver plan is the second lowest cost plan, it has an actuarial value of 70%. This means that 70% of medical costs are paid for by the insurance company, leaving the other 30% to be paid by you. The Silver plan is the standard choice for most reasonably healthy families who historically use medical services.

Gold Plan: The Gold plan is the second most expensive plan, it has an actuarial value of 80%. This means that 80% of medical costs are paid for by the insurance company, leaving the other 20% to be paid by you.

Platinum Plan: The Platinum plan is the plan with the highest premiums offered on the insurance exchange. The Platinum plan as an actuarial value of 90%. This means that 90% of medical costs are paid for by the insurance company, leaving the other 10% to be paid by you. This plan is suggested to those with high incomes and those in poor health. Although coverage is more expensive up front the 90% coverage of costs will help those who use medical services frequently.

Idaho health insurers don’t have to offer every tier of plan, but within the Idaho health insurance exchange, all health insurance companies must offer at least one silver plan and one gold plan to consumers.

Catastrophic plans – which have very high deductibles and essentially provide protection from worst-case scenarios, like a serious accident or extended illness — are available to people under 30 years old and to people who have hardship exemptions from the fee that most people without health coverage must pay.

Expanded Medicaid

Idaho has not chosen to expand its Medicaid program at this time. Read “What if my state isn’t expanding Medicaid?” to learn more. You can find out whether you qualify for Medicaid under Idaho’s current rules 2 ways: Contact your state Medicaid agency right now or fill out an application for coverage in the Health Insurance Marketplace.

Information for:

Individuals and Families

Small businesses

If you need more detailed analysis, identification of issues, solutions, and implementation of your health insurance plan please let us know with the form below and we’ll get right back to you.

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Accountable Care Organizations in Idaho

ACOs are profit-driven health innovators primarily serving Medicare patients who are financially rewarded by the government and private insurance companies for delivering medical services that lead to better health outcomes for less money.

• IHC Health Services (Intermountain Health Care) ID  – Health Care Innovation Award
• St. Luke’s Regional Medical Center, Ltd. ID – Health Care Innovation Award
• Trustees Of Dartmouth College ID – Health Care Innovation Award
• University Of North Texas Health Science Center ID – Health Care Innovation Award
• State of Idaho ID – State Innovation Models Initiative: Model Design Awards

Health care facilities where Innovation Models are being tested

• Adams County Health Center, Inc. Council, ID – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Family Medicine Health Center Boise, ID – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Health West Inc. Pocatello, ID – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Terry Reilly – Nampa Clinic Nampa, ID – Federally Qualified Health Center Advanced Primary Care Practice Demonstration
• Kaniksu Health Services – Comanche Street Clinic Bonners Ferry, ID – Federally Qualified Health Center Advanced Primary Care Practice Demonstration

The Insurance Exchange/Marketplace

What has been done, not been done, or left up to the federal government to do.

Establishing the Exchange in Idaho

On December 11, 2012, Governor C.L. Otter (R) announced Idaho’s commitment to the establishment of a state-based health insurance exchange and on March 28, 2013 signed into law legislation (HB248) creating the Idaho Health Insurance Exchange.¹²

While the Governor had previously signed an Executive Order blocking the implementation of health reform in Idaho, he remained favorable towards exploring the creation of a state-run health insurance exchange.³⁴ Following the Supreme Court’s decision to uphold the Affordable Care Act (ACA) in June 2012, Governor Otter stated that Idaho would work towards a market-based solution and research whether and how to implement an exchange. He announced the creation of new work groups to collect data on the Exchange and Medicaid expansion.⁵  The Exchange workgroup was be led by the Idaho Insurance Department and representatives of key stakeholders have been appointed by the Governor including: insurers, physicians, brokers, business owners, advocacy groups, researchers and a trade association.⁶ In October 2012, the Exchange work group issued findings recommending the state pursue a state-based exchange.⁷

Throughout 2011, the Idaho Department of Insurance and the Department of Health and Welfare moved forward with exchange planning, creating the Idaho Health Insurance Exchange Project. The Exchange Project organized various work groups as well as stakeholder meetings with business owners, medical providers, insurers, Idaho Tribes, consumer advocates and the general public. The Governance work group was responsible for the initial drafting of the establishment legislation presented to the Health Care Task Force.⁸ The work group passed a motion in June 2011, to implement a state-run exchange over a federally-run one and approved seeking additional federal funding for exchange implementation in the state; however, the Exchange Project suspended its website in early 2012.

In April 2011, the Governor signed into law a measure prohibiting abortion coverage in the state’s health insurance exchange except in cases of life endangerment of the pregnant woman, rape or incest (SB 1115).⁹

Structure: The legislation defines Idaho’s Exchange as a quasi-governmental organization, specifically an “independent body corporate and politic.”

Governance: The Idaho Health Insurance Exchange is governed by a nineteen-member board, including two non-voting ex officio members (or their designees): the Director of the Department of Insurance and the Director of the Department of Health and Welfare. The Governor appoints fourteen members of the board, the Speaker of the House appoints a member of the House of Representatives, the President pro tempore appoints a member of the Senate, and minority leadership appoints a member of the legislature representing the minority party. Members appointed by the Governor serve four-year terms. The legislation specifies that the Board should collectively offer expertise in health benefits administration, health care finance, health plan purchasing, health care delivery system administration, public health, and health policy issues related to small business and individual markets and the uninsured. A majority of the board may not collectively represent health carriers and producers.

Members of the Board, persons within the member’s household, or any entity with which the member is associated cannot benefit financially from any action taken by the Board. Members must fully disclose conflicts of interest and abstain from voting on issues in which there is a conflict of interest.

Current appointed Board members are:

• Stephen Weeg, formerly of Health West
• Mark Estess, AARP
• Karen Vauk, Idaho Food Bank
• Dave Self, Pacific Source
• Scott Kreiling, Regence Blue Shield of Idaho
• Zelda Geyer-Sylvia, Blue Cross of Idaho
• B. Hyatt Erstad, Erstad and Co.
• Tom Shores, Shores Insurance
• Frank Chan, Applied Computing
• Jeff Agenbroad, Since 86, Inc.
• Kevin Settles, Bardenay Restaurant and Distillery
• Fernando Veloz, MS Administrative Services
• John Livingston, M.D.
• Margaret Henbest, R.N., Idaho Alliance of Leaders in Nursing
• Senator Jim Rice
• Representative Kelley Packer
• Representative John Rusche

The Board first met in April 2013 and established six subcommittees: information technology, finance, governance, operations, outreach and education, and the Small Business Health Options Program Exchange.  Also in April 2013, the Board hired an Executive Director.

Contracting with Plans: The legislation specifies that the Exchange will function as a clearinghouse; all carriers, health benefit plans, and stand-alone dental plans will be allowed to participate in the Exchange as long as they are in compliance with state and Exchange law.

In March 2013, the Department of Insurance (DOI) established a process for reviewing and accepting submissions of Qualified Health Plans (QHPs) to be sold through the Exchange. Carriers must file through the System for Electronic Rate and Form Filing (SERFF) and may begin submitting filings for Exchange products on April 1, 2013. The submission deadline is May 31, 2013. Carriers should notify DOI as to how many distinct plans at each metal level they intend to file as well as whether each plan will be sold both inside and outside the Exchange.¹⁰ Carriers are required to offer at least one silver and one gold plan in each market in which they want to participate. They must also offer a silver metal level plan that reflects cost-sharing reductions and two plans for Native Americans at all metal levels.¹¹

The DOI received approval from the Centers for Medicare and Medicaid Services (CMS) to define Idaho’s geographic rating areas based on three-digit zip codes rather than the federal default. As a result, Idaho will be divided into seven geographic rating areas. Idaho’s age and tobacco rating ratios will comply with the federal default. The DOI plans to use network adequacy standards similar to the standards established by the Department of Health and Human Services for federally-facilitated exchanges.¹²

Small Business Health Options Program (SHOP) Exchange: The DOI will not merge the small group and individual markets into a single risk pool. The Board has the authority to set a minimum participation requirement but has not yet established such a requirement.¹¹

Essential Health Benefits (EHB): The ACA requires that all non-grandfathered individual and small-group plans sold in a state, including those offered through the Exchange, cover certain defined health benefits. Since Idaho has not put forward a recommendation, the state’s benchmark EHB plan will default to the largest small-group plan in the state, Blue Cross Blue Shield of Idaho- Preferred Blue PPO.

Exchange Funding

The Idaho Department of Insurance received a $1 million federal Exchange Planning grant in September 2010. In November 2011, the Department of Health and Welfare, in collaboration with the Department of Insurance, received a $20.3 million federal Level One Establishment grant for the procurement and development of exchange and Medicaid information technology systems.¹³ The Joint Finance-Appropriations Committee approved spending $4 million in funding to ready the state’s Medicaid system for integration with an exchange; however, the Legislature did not approve spending the Level One grant funding.¹⁴¹⁵

Expansion of Medicaid

From 2014 to 2017, the federal government will pay for 100% of the difference between a state’s current Medicaid eligibility level and the ACA minimum. Federal contributions to the expansion will drop to 95% in 2017 and remain at 90% after 2020, according to the ACA.

As the ACA was originally written, states would lose all Medicaid funding if they refused to expand their program to the ACA minimum.

However, the Supreme Court in June 2012 ruled that the federal government could not withhold Medicaid funding for states that chose not to expand their programs. The decision effectively allowed state officials to opt out of the expansion, and some have said they will do just that.

Idaho is not participating in Medicaid expansion.

Next Steps

On January 3, 2013, Idaho received conditional approval from the U.S Department of Health and Human Services (HHS) to establish a state-based exchange. Final approval is contingent upon the state complying with future guidelines and regulations, demonstrating legal authority for all state-based Exchange functions, and developing a revised implementation timeline.¹⁶

For additional information on Idaho’s exchange planning click here.

Provided by the Henry J. Kaiser Family Foundation