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Your Health Idaho Overview

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Overview

Your Health Idaho is a marketplace which provides a new way to get health insurance coverage for Idahoans who are not offered affordable health insurance through an employer. Idaho citizens can compare different health insurance options (Qualified Health Plans or QHPs) on the basis of price, quality and other factors. Some individuals and families will be able to get help in paying for coverage.

Starting October 1, 2013, and running through March 31, 2014, you will be able to apply through Your Health Idaho in a variety of ways, including online at www.yourhealthidaho.org, through an agent or broker (producer), in person or via a call center to:

  • Find a QHP that meets your needs
  • See if you qualify for an advance tax credit to help pay for health insurance premiums
  • Determine if you qualify for reduced cost-sharing (out-of-pocket costs other than premiums) for services
  • Determine eligibility for Medicaid or the Children’s Health Insurance Program (CHIP)

General Provisions

Essential Health Benefits

Pre-Existing Conditions – Health insurance plans sold on Your Health Idaho cannot deny enrollment due to health status or a pre-existing condition. Because of this, if you were denied health insurance or were eligible only through a High Risk Pool, you will be able to enroll in a health plan through the marketplace.

Levels of Coverage – Generally, QHPs must meet a certain “metal” level of coverage. The level of coverage refers to the percentage of health care, in addition to a monthly premium, that the individual enrolled in the plan pays, as opposed to what the plan pays.

In general, the greater the percentage of cost covered by the insurer, the higher the monthly premium will be. Therefore, a Platinum plan will typically have a higher monthly premium, while a Bronze plan will have a lower premium.

Applying for Coverage

Single, Streamlined Application – You can complete a single application to receive assistance in selecting a health insurance plan that is right for you, to apply for assistance in paying for health insurance and to determine if you are eligible for Medicaid or CHIP.

Advance Premium Tax Credits – If your income is between 100% and 400% of the Federal Poverty Line (FPL), you will be eligible to receive an advance tax credit to help pay health insurance premiums if your employer does not offer affordable health insurance and if you are not eligible for Medicaid or CHIP.

The amount of the tax credit varies according to your household income.

Cost-Sharing – Generally, you will be eligible for reduced cost-sharing (out-of-pocket expenses to the consumer other than premiums such as co-pays and deductibles) if your household income is 250% FPL or less.

Enrollment Periods

  • Initial Enrollment period – beginning October 1, 2013 and ending March 31, 2014.
  • Annual Enrollment period – begins each year on October 15th and ends December 7th.
  • Special Enrollment periods – under certain circumstances, you may enroll outside of the initial or annual enrollment periods. Special enrollment may be allowed due to reasons such as loss of health insurance coverage, gaining a new family member or a permanent move.

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