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Individual Medical Plans

Health benefit plans purchased for new coverage starting January 1, 2014 or later are fully ACA-compliant (Affordable Care Act compliant). ACA-compliant plans will have an associated “metal level” of Bronze, Silver, Gold, Platinum, or Catastrophic, and they offer at least the Essential Health Benefits package.

The Department of Insurance received the preliminary 2016 health plan information on May 1 and proceeded to review the proposed plan documents and rates for compliance with Idaho and Federal regulations. The Department of Insurance does not have the authority to disapprove or establish insurance rates, but it does have the authority to deem rate increases submitted by insurance companies as unreasonable. After the review and negotiation process, the carriers have submitted their final rate increase information. While the Department is disappointed with the large increases of some carriers, the Department did not find the final rate increases to be unreasonable.

The carrier specific rate increases shown below are composites. The premium increase for an individual or family may vary greatly, based on the geographic area, choice of plan, changes in enrollees or ages, eligibility for the advanced premium tax credit, and other factors.

<-- Return to Rate Review Main Menu Detailed Rate Increase Information by Geographic Area -->
2014 Jan-Apr 2015
Insurance Company Preliminary Final Paid Claims Premium Paid Claims Premium
Blue Cross of Idaho Health Service, Inc. 24%23% 221,100,000 188,700,000 77,000,000 77,900,000
BridgeSpan Health Company 7%7% 2,500,000 1,400,000 1,200,000 900,000
Mountain Health CO-OP 25%26% 53,100,000 41,200,000 16,500,000 15,700,000
PacificSource Health Plans, Inc. -8%-8% 10,900,000 6,400,000 1,700,000 900,000
Regence BlueShield of Idaho 10%10% 1,500,000 1,300,000 1,800,000 1,100,000
SelectHealth 15%14% 99,500,000 55,000,000 37,200,000 25,700,000

Each insurance company that submits a rate increase of 10 percent or greater must also submit a consumer-oriented explanation, which is available by clicking on the name of the insurance company above. A key driver of all the increases is the level of health claims paid compared to the premium collected in the prior year.

The table above shows the level of claims paid and premium collected by each insurance company for ACA-compliant health benefit plans during 2014 and during the first four months of 2015. Please note that Mountain Health CO-OP did not sell medical plans in Idaho until 2015, therefore their Montana claims and premium are shown for 2014. In addition to paid claims, the premium should cover the administrative costs, insurance fees, and taxes. The ACA restricts administrative costs to no more than 20 percent of the premium. Larger rate increases may be needed when the prior year's premium is not sufficient to pay for the health claims and administrative costs and fees. Please see an individual company's explanation by clicking on the company name above for more information about a specific rate increase.

Detailed Rate Increase Information by Geographic Area

The average rate increases shown above may not be representative of the rate increases in any one geographic area or specific health plan. The map below shows the 7 geographic rating areas in Idaho. Detailed rate increase information is available for each rating area by clicking on one of the areas below.

(832) (833) (834) (835) (836-7) (838)

The Department of Insurance can be reached for questions regarding this information at (208) 334-4250 or via email. Additional information is also available through Healthcare.gov at the following links: