Coverage Basics
Everything you need to know about health insurance through Your Health Idaho
- What's Covered
- Plan Types
- Key Terms
- Dental & Vision
ESSENTIAL COVERAGE
10 Essential Health Benefits
Every plan through Your Health Idaho covers these ten essential categories. Hover over any card to flip it for a quick description.
Ambulatory Service
Ambulatory Service
Outpatient care you get without being admitted to a hospital.
Emergency Services
Emergency Services
Emergency treatment at a hospital.
Hospitalizations
Hospitalizations
In-hospital care, like surgery and overnight stays.
Maternity & Newborn Care
Maternity & Newborn Care
Pregnancy, maternity, and newborn care, before and after birth.
Mental Health
Mental Health
Mental health and substance use disorder services.
Prescription Medicine
Prescription Medicine
Coverage for at least one drug in every USP category and class.
Rehabilitation
Rehabilitation
Services and devices for people with injuries, disabilities, or chronic conditions.
Lab Services
Lab Services
Diagnostic testing to help diagnose, monitor, or treat medical conditions.
Preventive Care
Preventive Care
Preventive and wellness services, and chronic disease management.
Pediatric Services
Pediatric Services
Including oral and vision care for children.
More about the 10 Essential Health Benefits
You can find more information about the 10 Essential Health Benefits on Healthcare.gov, including preventive care benefits for all adults, women, children.
Ready to estimate your tax credit and enroll?
CHOOSE YOUR TIER
Choose Your Plan Type
Plans determine the percentage of costs paid between you and the insurance company.
BRONZE
60%
of costs covered
Lower monthly premium
Higher deductibles
- Good if you need less frequent care
- Lower monthly cost
- Higher out-of-pocket costs
SILVER
Cost-Sharing Reductions Available
70%
of costs covered
Moderate premium
Moderate deductibles
- Opportunity for savings
- Moderate monthly cost
- Moderate out-of-pocket costs
GOLD
80%
of costs covered
Higher premium
Lower deductibles
- Good if you have predictable medical needs
- Higher monthly cost
- Lower out-of-pocket costs
PLATINUM
90%
of costs covered
Highest premium
Lowest deductibles
- Good if you require frequent care
- Highest monthly cost
- Lowest out-of-pocket costs
CATASTROPHIC PLAN
Catastrophic plan coverage is available for Idahoans under the age of 30 or who qualify for a hardship exemption. This plan provides coverage for worst-case scenarios like a serious accident with low monthly premiums but the highest deductibles and out-of-pocket costs. For information on how to apply for a Catastrophic plan, visit our Exemptions page
ADD-ONS
Dental & Vision Coverage
Dental Coverage
Dental insurance helps maintain oral health by preventing small issues from becoming costly problems. Pediatric dental care is considered an Essential Health Benefit.
Vision Coverage
Vision insurance makes regular eye exams, glasses, and contact lenses affordable and helps ensure early detection of eye conditions.
GLOSSARY
Key Insurance Terms
Premium
Monthly amount you pay for your plan.
Deductible
Amount you pay out-of-pocket before insurance kicks in.
Copay
Fixed amount (for example $30) you pay for a covered service.
Coinsurance
Your share of costs after deductible, as a percentage.
Out-of-Pocket Max
Most you'll pay per year. After this, insurance covers 100%.
Tax Credit (APTC)
Federal tax credit that reduces your monthly premium.
Find out how much you could save
80% of Idahoans who enroll receive premium tax credit.
70%
Of enrollees work with an agent
80%
Of Idahoans receive
a tax credit
1 min
Time to get
an estimate