Residents of the Gem State have plenty of options for health care. According to a study by US News, ID has the 18th best health insurance in the nation. That study accounts for access, quality, and overall public health.
Health insurance options in Idaho
According to the Idaho Department of Insurance, residents have several health insurance options:
Employer-provided
- From your employer
- Through your spouse's employer
Individual or family plans
- Through HealthCare.gov
- Directly from a health insurance company
Government-assisted
- Medicare
- Medicaid
Where do most Idaho residents get their health insurance coverage?
| Sources | Percent | ||
|---|---|---|---|
| Employer-Provided | 47% | ||
| Individual or family | 9% | ||
| Medicaid | 17% | ||
| Medicare | 15% | ||
| Military | 2% | ||
| Uninsured | 11% | ||
| Source: Kaiser Family Foundation, Health Insurance Coverage of the Total Population | |||
Eleven percent of ID residents are uninsured, slightly highher than the national average. This is bad news for policyholders, because more uninsured people leads to higher rates for insured people.
Idaho health insurance companies
ID residents have plenty of options when it comes to health insurance providers in their state. These health insurance companies offer both individual and family plans in ID:
- BlueCross of Idaho
- Mountain Health CO-OP
- SelectHealth
- PacificSource
Idaho health insurance costs and rate factors
ID residents spend an average of $6,927 per year on health care, less than the average American. So, what influences your health care prices in Idaho? Prices vary person to person, but are based primarily on these factors:
Health insurance plan type
The more coverage you want, the more you’ll have to pay. Marketplace plans come in metal tiers: bronze, silver, and gold.
So, how much should you expect to pay in the Gem State? These are the average prices for each plan type for a middle-aged ID resident in 2020:
| Bronze | Silver | Gold | |
|---|---|---|---|
| $329 | $512 | $551 | |
| Source: Kaiser Family Foundation, Change in Average Marketplace Premiums by Metal Tier | |||
Premiums for a gold plan cost about 67 percent more than a bronze plan. That comes as no surprise considering gold plans cover 80 percent of medical costs, whereas bronze plans cover 60 percent.
You may qualify for a catastrophic plan, the lowest level of coverage available in your state. Catastrophic plans have low monthly premiums but a yearly deductible of $8,150. These plans essentially exist to prevent medical bankruptcy. They’re not designed to cover preventative, every day care. Because of that deductible, it may save you money to invest in a bronze or silver plan.
Body mass index
According to the CDC, a high body mass can lead to several serious health conditions. That’s why insurance companies will analyze your BMI to determine your risk-level. A higher BMI means higher monthly premiums.
In 2019, ID had a 29 percent obesity rate, the 37th highest rate in the country. Out of the many Idaho residents who used QuoteWizard to compare health insurance plans, 31 percent have a BMI in the obese range.
Tobacco use
Due to the substantial risks from smoking, tobacco users pay more for health insurance. About 14.5 percent of ID residents are smokers, the 12th lowest rate in the country.
Age
According to HealthCare.gov, companies charge older people up to three times more for health care than younger people. State residents who used QuoteWizard to shop for health insurance are, on average, 39 years old.
Location
Where you live plays a large role in how much you’ll pay. That’s because every state has different health care laws, regulations, and providers.
Insurance companies also use community-rating to determine your costs. So, rates are based in part on the combined claims that everyone files. If your state files a high number of claims, your prices could reflect that.
That means your state’s overall health-consciousness your state is also plays a role. According to America’s Health Rankings, ID is the 14th healthiest state in the country. That’s a good sign for policyholders.
Idaho health insurance laws
The Affordable Care Act limits health insurance companies from considering certain factors while pricing your policy.
- Pre-existing conditions: Before the ACA, people with pre-existing conditions paid more for health insurance. Now, the ACA mandates that companies can’t charge you more for a pre-existing condition.
- Gender: Insurance companies aren’t allowed to charge women and men different prices for the same plan. That’s good news, especially since women historically pay more for health care.
- Insurance and medical history: The ACA limits insurance companies from analyzing your medical history and your past insurance coverage. People with previous medical problems or lapses in insurance used to pay a lot more in premiums.
There's a limit to how much you'll pay out-of-pocket for marketplace plans. In 2020, the out-of-pocket maximum is $8,150 for an individual plan and $16,300 for a family plan.
Idaho state law requires insurance companies to offer at least some coverage for the following services:
- Maternity minimum stay
- Mammography coverage
- Breast reconstruction
- Cleft lip and palate
You can find the entire list on cms.gov.
Medicare and Medicaid in Idaho
Medicare and Medicaid are both government-funded health care programs. Medicare covers for seniors, while Medicaid covers low-income families and children.
Medicare
Idaho resident 65 and older qualify for Medicare. There are several coverage options, including parts A, B, C, D, and supplemental coverage plans. You may also qualify for a Medicare Savings Program with these income limits:
- Individual monthly income limit: $1,456
- Married couple monthly income limit: $1,960
Medicaid
Medicaid offers coverage to low-income families and children. These are the state’s Medicaid financial requirements:
| Household Size | Maximum Yearly Income |
|---|---|
| 1 | $16,971 |
| 2 | $22,930 |
| 3 | $28,888 |
| 4 | $34,846 |
| 5 | $40,805 |
| 6 | $46,763 |
| 7 | $52,722 |
| 8 | $58,680 |
Idaho Department of Insurance
- Website:
- Homepage
- Insurance Commissioner:
- Dean L. Cameron
- Insurance Hotline:
- (800) 721 – 3272
- Office Hours:
- Monday - Friday
8:00 am to 5:00 pm
- File a Consumer Insurance Complaint
- Complaint Page
Sources:
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