COVERAGE BASICS
What is Your Health Idaho?
Welcome to Your Health Idaho, Idaho’s state-based health insurance marketplace. Just like your favorite online store — you can look around, compare prices, and purchase a health insurance plan that best fits your lifestyle and budget.
Who is eligible for coverage?
Idahoans who do not have affordable employer-sponsored coverage, are under the age of 65, or are not eligible for Medicare, and are not eligible for federal programs like Medicaid or Tricare can enroll and may qualify for a tax credit and other cost savings on health insurance through Your Health Idaho.
Is financial assistance available?
Your Health Idaho is the only place where Idahoans can apply for and receive a tax credit that acts like an instant discount by lowering the cost of your monthly health insurance premium. Idahoans can also receive additional savings through Cost-Sharing Reductions when they enroll in a Silver Tier plan, which reduces out-of-pocket costs for things like co-pays and prescriptions.
Minimum Essential Health Benefits
All plans offered through Your Health Idaho meet the high standards of state and federal requirements and are required to cover ten essential health benefits, including:
Doctor Visits
Hospitalization
Emergency Services
Mental Health & Substance Abuse Services
Rehabilitative & Habilitative Services
Maternity &
Newborn Care
Laboratory Tests
Prescription Medicine
Preventive Wellness & Screenings
Pediatric Care
*While these essential benefits are covered, it doesn’t necessarily mean they are free. Cost sharing fees such as deductibles and co-pays may still apply. See your specific plan or contact your carrier for details.
Plan Coverage Levels
Five tiers of coverage are available on Your Health Idaho: Platinum, Gold, Silver, Bronze, and Catastrophic. The tier names do not indicate the quality or amount of care you receive but rather the percentage paid by you versus the health insurance carrier. All plans cover the ten essential health benefits listed above.
Bronze Plan
Medical Costs Paid by Health Plan : 60%
Medical Costs Paid by Individual: 40%
Silver Plan
Medical Costs Paid by Health Plan : 70%
Medical Costs Paid by Individual: 30%
Gold Plan
Medical Costs Paid by Health Plan : 80%
Medical Costs Paid by Individual: 20%
Platinum Plan
Medical Costs Paid by Health Plan : 90%
Medical Costs Paid by Individual: 10%
Bronze plans generally have the lowest monthly premiums but require the highest out-of-pocket costs when you receive medical service. Gold plans have higher monthly premiums, but you will typically pay less out-of-pocket for medical services. Silver plans offer moderate premiums and out-of-pocket costs.
If you qualify for Cost-Sharing Reductions, which lower out-of-pocket costs, you must be enrolled in a silver plan.
If you are under 30 or qualify for a hardship exemption, you may want to consider catastrophic coverage. Catastrophic plans are designed to protect you from worst-case scenarios, like serious accidents. They have low monthly premiums but very high deductibles.
Health Insurance Plan Quality Ratings
Health plans offered through Your Health Idaho may have an overall quality rating based on member experience, medical care, and health plan administration. Plans are given ratings of one through five stars, with five being the highest. The Centers for Medicare and Medicaid Services (CMS) determine the rating based on data provided by Insurance Carriers. Ratings for each year are based on data provided for the previous year, so in some cases — such as when plans are new or have low enrollment — ratings aren’t available and display as Not Available. This doesn’t mean the plans are low quality.
Common Insurance Terms
Advance Premium Tax Credit (APTC)
An Advance Premium Tax Credit acts as an instant discount to cover some or all the monthly costs for health insurance coverage.
Individuals and families qualify for a tax credit based on income level, household size, and other factors.
Premium
The amount you pay for your health insurance every month.
In addition to your premium, you usually have to pay other costs, including a deductible, co-payments, and co-insurance when using your insurance.
Cost-Sharing Reductions
Cost-Sharing Reductions are another way to make coverage more affordable. It helps lower the cost of things like deductibles, co-insurance, co-pays, and out-of-pocket maximums.
To qualify for a Cost-Sharing Reduction, your income must fall within a specific range, and you must be enrolled in a Silver Tier plan.
Additional Coverage
Vision Coverage
With two plans to choose from and hundreds of providers across Idaho, vision coverage from VSP includes a wide range of benefits and services.
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Small Business
Your Health Idaho’s Small Business Health Options Program (SHOP) helps small businesses and nonprofit organizations provide health insurance to their employees. With SHOP, you can choose from high-quality health insurance plans that meet the needs of your business and employees.
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Tribal Members
Members of federally recognized Tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders can enroll or change plans once per month through Your Health Idaho. These members are also eligible for enhanced cost-share reductions based on income.
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