If you or members of your family are enrolled in employer-sponsored health insurance that is deemed unaffordable* or are going without insurance because it is unaffordable, you may be eligible for affordable health coverage through Your Health Idaho, the state’s health insurance exchange. You could qualify for assistance such as a tax credit that acts like an instant discount to lower your monthly health insurance premiums or cost-sharing reductions which lower out-of-pocket costs for things like co-pays and prescriptions.
To be able to enroll in coverage outside of Your Health Idaho’s annual open enrollment period each fall, you would need to qualify for a Special Enrollment Period (SEP). There are three circumstances under which you can qualify for an SEP:
- If you are currently enrolled in, or could qualify for, employer-sponsored health coverage and it is during your (or a spouse’s) employer’s open enrollment period.
- AND The cost of the annual premium you pay (or would have to pay) for employer-sponsored coverage in 2023 is more than 9.12 percent of your total annual household income.
- You experience a Qualifying Life Event (QLE) such as marriage or divorce, having a baby, or losing employer-sponsored coverage.
For most QLEs, a consumer has 60 days from the date of an event to enroll in coverage. This means a consumer must report their change, provide documentation, and select and enroll in a plan by the end of the 60 day period.
If you are currently enrolled in an employer-sponsored health plan and are considering not renewing coverage through your employer, we strongly recommend that you create an account and go through the application process first. This will confirm whether your employer-sponsored coverage is considered unaffordable and whether you will be eligible for a tax credit and coverage through the exchange.
*An affordability determination is made by creating an account at yourhealthidaho.org and filling out an application. Submitting an application does not commit you to purchasing insurance. It only allows a determination to be made as to your eligibility for tax credits and cost sharing reductions. Affordability will be determined separately for:
- Employee-only coverage
- Coverage for an employee plus dependents
If employee-only coverage is found to be affordable, a spouse and/or dependents may still qualify for an SEP and be eligible for a tax credit and enroll in coverage through the exchange.
If you have questions, or would like more information, contact Your Health Idaho at 855-944-3246, submit a support request online, or chat with a customer advocate.