With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Idaho, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Idaho
Idaho placed 18th in United Health Foundation’s 2014 America’s Health Rankings.1 The state’s strengths include a low incidence of infectious disease, high per capita public health funding, and a low rate of preventable hospitalizations. Challenges Idaho faces include high levels of air pollution, low immunization coverage among teens, and limited availability of primary care physicians. In the past two years, children in poverty and infant mortality decreased while obesity and drug deaths increased.
The U.S. Department of Health and Human Services reported that 76,061 individuals in Idaho selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Idaho enrolled in a marketplace plan increased to 97,079 during the open enrollment period.3
Idaho individual and family health insurance
When Obamacare’s first open enrollment began Oct. 1, 2013, Idaho launched a partnership health insurance exchange with the federal government. For 2015 open enrollment, which began Nov. 15, 2014, Idaho introduced its own state-based health insurance exchange called Your Health Idaho.4
Those who buy health insurance through Idaho’s exchange may be eligible for income-based subsidies, including premium tax credits that may be applied to any metal plan and cost-sharing subsidies that apply to silver plans. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
Idaho residents may also find qualified health plans away from the Obamacare exchanges in the private marketplace on websites such as HealthCare.com. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Your Health Idaho to apply for a health insurance plan.
|Idaho’s health insurance exchange:||yourhealthidaho.org|
|Idaho’s department of insurance:||doi.idaho.gov|
Idaho small group health insurance plans
Small business owners who live in Idaho and have 50 or fewer employees may offer them access to coverage through Your Health Idaho’s Small Business Health Options Program, as well as in the private marketplace. Small businesses that use Idaho’s SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from Idaho’s partnership exchange.
Idaho state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Idaho is among the states without mini-COBRA or state continuation coverage for small groups.
Idaho high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
As of December 2014, Idaho had not expanded its Medicaid to low-income adults without dependents.7 In 2014, a coverage gap was created in states where Medicaid was not expanded. This coverage gap includes those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange.
The information below is specific to Idaho’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Idaho Department of Health and Welfare|
|How to apply online||idalink.idaho.gov|
|Additional application options||healthandwelfare.idaho.gov/Default.aspx?TabId=123|
|Open-enrollment period||Year-round in all states|
|Eligibility requirements8||Based on citizenship/immigration status, income, resources, work requirements, and other household circumstances|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Idaho’s health insurance program for low-income children:
|How to apply online||idalink.idaho.gov|
|Additional application options||healthandwelfare.idaho.gov|
|Eligibility9||To qualify, a child must be under age 19 and live in Idaho, be a U.S. citizen or legal resident, and be within family income guidelines; children cannot be enrolled in a private health insurance plan|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Galewitz, Phil. “Red State Idaho Launches Its Own Obamacare Exchange.” Nov. 12, 2014. http://kaiserhealthnews.org/news/red-state-idaho-launches-its-own-obamacare-exchange/.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Idaho.” http://www.medicaid.gov/Medicaid-CHIP-Program-Information/By-State/idaho.html.
8 Idaho Department of Health and Welfare. “About Medicaid.” http://healthandwelfare.idaho.gov/Default.aspx?TabId=123.
9 Idaho Department of Health and Welfare. “Getting Help to Keep Your Children Healthy.” http://healthandwelfare.idaho.gov/Medical/Medicaid/IdahoHealthPlanforChildren/tabid/219/Default.aspx.