Idaho Health Insurance: 2021 Coverage Guide

Fran
Fran Majidi
November 3, 2020

If you live in Idaho and are shopping for an individual or family plan this year, do it right by comparing prices with SmartFinancial. There are a few steps you should take before you choose a plan, and we’ll guide you through the process. Do remember that you may only enroll in a health plan during the open enrollment unless you are eligible for the Special Enrollment Period due to a qualifying event.

When Is Open Enrollment in Idaho?

November 1, 2020 - December 15, 2020. The coverage begins in January 2021.

How to Get Health Insurance in Idaho

Figuring out what ballpark your healthcare costs will fall into is a good place to start. You can estimate what your needs will be based on the previous year. Having this information will help you decide which type of coverage is right for you, and which level tier suits will be most economical. The biggest mistake people make is looking at the monthly cost alone. What about the deductible? Or the copays and prescription drug costs?

One thing you can do to ensure that you’re paying the lowest price is to compare health insurance companies and health insurance quotes. After you submit a form with SmartFinancial, you’ll get several health insurance rates and an agent to help answer your questions about the plans you’re considering.

What Types of Health Insurance Are Available in Idaho?

HMOs, EPOs, PPOs and POS plans are most commonly purchased in Idaho. Most people buy silver tier coverage, which covers 70% of costs. However, you can buy a lower tier bronze plan, which covers 60% or a gold plan which covers 80% of all costs. A higher tier plan will cost more each month, but it’ll cover more medical visits and procedures.

Does Health Insurance Cover Pre-existing Conditions?

According to the Affordable Care Act, it is illegal for marketplace health plans to deny you coverage based on pre-existing conditions.

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Do I Qualify for a Special Enrollment Period?

Common reasons people qualify for a special enrollment period:

  • Lost or quit a job. You may have also changed jobs but weren’t offered health insurance or you may have started your own business.
  • Turned 26. If you were on your parents’ health insurance plan but turned 26 it’s time to buy your own plan.
  • Moved out of a coverage area. You may have had a health plan that was only valid in one state but you moved to another. Some health plans only cover certain regions of a state. When you become ineligible, you can buy a new plan.
  • Cobra coverage deadline. If you reached the end of your Cobra extension, you can buy a new health plan.
  • Divorce. If you were married but divorced your spouse and lost coverage, you can buy a new health plan.
  • Marriage. If you recently married, you can add your spouse to your plan (or vice versa) or start a new one altogether.
  • Birth or adoption of a child. You have a year to buy health insurance for that child, any time of the year.
  • Death of spouse or partner. If you shared health insurance with a spouse or partner but that person passed away, you can buy a new plan.
  • Spouse or partner loses coverage. If you shared health coverage with a spouse or partner who loses coverage for any qualifying reason, you are eligible to buy an individual plan or buy coverage with that spouse/partner again.

Is Health Insurance Required in Idaho?

No, unlike California, Massachusetts, New Jersey, Vermont, Rhode Island, and DC, Idaho does not impose a tax penalty for uninsured individuals. However, the majority of folks in Idaho have private insurance. Buying health insurance is necessary to avoid medical bankruptcy.

How Much Is Health Insurance in Idaho?

The average cost of health insurance in Idaho for a 40 year old is about $490 a month. Health insurance costs less when you are young and it steadily increases each year. Tobacco use increases health insurance rates.

How to Save on Health Insurance in Idaho

The best way to save on health insurance in Idaho is to compare rates based on the tier system. Beforehand, you’ll want to estimate your medical costs for the whole year.

Medicare in Idaho

Medicare is health insurance coverage for Americans ages 65 years and older. The government also allows younger people with disabilities to enroll in the program. Individuals with End-Stage Renal Disease (a permanent kidney failure treated with dialysis or a transplant) can also sign up as can some individuals with severe mental health issues. Others who qualify for Medicare disability coverage are individuals with Amyotrophic Lateral Sclerosis (also called Lou Gehrig’s Disease). Most beneficiaries will receive Original Medicare (Parts A and B). Some people buy Medicare Advantage, which includes Part A and B as well as offering vision, dental and prescription drug coverage.

How Many People Are on Medicare in Idaho?

19% of the people of Idaho are covered by Medicare. See if you qualify for Medicare by reading the sections below.

How Much Is Medicare in Idaho?

If you do not qualify for Medicare, you can buy it for $458 a month for Part A in 2020 and a standard monthly premium for Medicare Part B was $144.60 for 2020, or even higher depending on income. Avoid the penalty for late enrollment of Part B by buying it as soon as it’s available to you.

Original Medicare vs Medicare Advantage: What’s the Difference?

Medicare is a government subsidized health plan that is available to qualified Americans age 65 and older. Medicare Advantage is sold through private health insurance companies, but these policies are also regulated by the government. Medicare Advantage plans offer the same benefits as Medicare Parts A and B. Medicare Advantage plans also offer more coverage for dental, vision, hearing and prescription drugs. Medicare Advantage plans have a maximum out-of-pocket limit. For 2020, it was $6,700 but many plans set their maximums at a much lower cost. That is why it’s important to compare companies. People who opt for original Medicare can buy Medicare Supplements to help with out-of-pocket costs. You cannot buy both Medicare Advantage and Medicare Supplements. If you enroll in a Medicare Advantage Plan during open enrollment, you will automatically be disenrolled from original Medicare.

How to Get Medicare Coverage in Idaho

If you’re on social security, you may automatically enroll in Medicare, but you may have to sign up if you do not receive payments already. The easiest way to enroll in Medicare is by working with a knowledgeable insurance agent. Just enter your zip code and answer a few simple questions.

Types of Medicare Plans Available

Original Medicare, Medicare Advantage, Medicare Cost Plans (only offered in certain areas), Demonstration/Pilot Programs (also called Research Studies; only offered in certain areas) and Programs of All-Inclusive Care for the Elderly (PACE).

How Do I Qualify for Medicare?

To qualify for Medicare you must be a citizen of the U.S. or have been a legal resident for at least five years. If you are age 65 or older and you/your spouse have worked for at least 10 years (40 quarters) or you have a disability, Amyotrophic Lateral Sclerosis (ALS) or end-stage renal disease (ESRD), you most likely qualify for Medicare.

How Can I Save on Medicare in Idaho?

You can save on Medicare by signing up for Part B as soon as you’re eligible. People who enroll late must pay a penalty every year. If you’re interested in buying Medicare Advantage, you can shop and compare Medicare plans for the best value.

Idaho State Health System Ranking

Ever wonder how your state stacks up when it comes to quality healthcare? The Commonwealth Fund published a report in 2020 on State Health System Performance. They took into consideration the access to quality care, health outcomes, and disparities in all 50 states. The scores for the Idaho Health System are listed below:

  • Idaho: Overall Ranking: 21 of 51
  • Idaho: Overall Performance: Below U.S. Average
  • Idaho: Access and Affordability: 45
  • Idaho: Prevention and Treatment: 30
  • Idaho: Avoidable Hospital Use and Cost: 5
  • Idaho: Healthy Lives: 16
  • Idaho: Health Care Disparities: 8
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Idaho Health Insurance Coverage

The people of Idaho have different kinds of health insurance while some Idaho residents are not insured at all. See the breakdown below:

  • Private coverage: 50%
  • Medicaid: 18%
  • Medicare: 19%
  • Uninsured: 13%

Report: America's Health Insurance Plans

Idaho Health Insurance Companies

  • Aetna Health of Utah, Inc.
  • Aetna Life Insurance Company (Idaho)
  • Blue Cross of Idaho Health Services, Inc.
  • SelectHealth Inc. (D)
  • PacificSource Health Plans - Idaho
  • Regence BlueShield of Idaho
  • United Healthcare Services, Inc. (Idaho)
  • UnitedHealthcare Insurance Company (Idaho)
  • UnitedHealthcare Military & Veterans Services, LLC
  • Compass Rose Health Plan

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