COVERAGE BASICS
Your Health Idaho—the only place for Idahoans to lower their health insurance costs with a tax credit
Your Health Idaho is Idaho’s health insurance marketplace, where Idahoans can compare and find affordable, quality health insurance coverage from well-known medical and dental carriers. It is also the only place you can apply for and receive a tax credit to help lower your monthly health insurance premiums.
Who is eligible for coverage?
Idahoans who are:
- Not offered or do not have affordable employer-sponsored coverage
- Under the age of 65
- Over the age of 65 but not eligible for Medicare
- Not eligible for Medicaid/CHIP or any other federal health insurance program
- Not incarcerated
Additionally:
- You must be a U.S. citizen, national, or lawfully present You must live in the U.S. and have a primary residence in Idaho
How is Your Health Idaho more affordable?
As the state’s official health insurance marketplace, Your Health Idaho is the only place where Idahoans can apply for and receive a tax credit. This tax credit acts like an instant discount by lowering the cost of your monthly health insurance premium. Idahoans may also receive additional savings through Cost-Sharing Reductions, which reduces out-of-pocket costs for things like co-pays and prescriptions, when enrolled in a Silver plan.
Minimum Essential Health Benefits
All plans offered through Your Health Idaho comply with state and federal requirements by covering ten essential health benefits, including:
Doctor Visits
Hospitalization
Emergency Services
Mental Health & Substance Abuse Services
Rehabilitative & Habilitative Services
Maternity &
Newborn Care
Laboratory Tests
Prescription Medicine
Preventive Wellness & Screenings
Pediatric Care
*While these essential benefits are covered, it doesn’t necessarily mean they are free. Fees such as deductibles and co-pays may still apply. See your specific plan or contact your carrier for details.
Plan Coverage Levels
There are five tiers of coverage available through Your Health Idaho: Platinum, Gold, Silver, Bronze, and Catastrophic.
The names of these tiers do not reflect the quality or amount of care you receive. Instead, they indicate the percentage of costs that you pay compared to what the health insurance carrier covers. All plans cover the ten Essential Health Benefits listed above.
Bronze Plan
Medical Costs Paid by Health Plan : 60%
Medical Costs Paid by Individual: 40%
Silver Plan
Medical Costs Paid by Health Plan : 70%
Medical Costs Paid by Individual: 30%
Gold Plan
Medical Costs Paid by Health Plan : 80%
Medical Costs Paid by Individual: 20%
Platinum Plan
Medical Costs Paid by Health Plan : 90%
Medical Costs Paid by Individual: 10%
- Bronze plans generally have the lowest monthly premiums but come with the highest out-of-pocket costs when receiving medical services.
- Silver plans offer moderate premiums and out-of-pocket costs.
- Gold plans have a higher monthly premium but typically require lower out-of-pocket expenses for medical services.
- Platinum plans usually have the highest monthly premiums but pay the most when you get medical coverage
You must be enrolled in a Silver plan to qualify for Cost-Sharing Reductions, which lowers out-of-pocket costs.
Idahoans under 30 or who qualify for a hardship exemption may want to consider catastrophic coverage. Catastrophic plans provide protection in worst-case scenarios, like serious accidents. They have low monthly premiums but the highest deductibles and out-of-pocket costs of all tier levels.
Health Insurance Plan Quality Ratings
Health plans offered through Your Health Idaho may have an overall quality rating based on member experience, medical care, and health plan administration. Plans are rated on a scale from one to five stars, with five indicating the highest quality.
The Centers for Medicare and Medicaid Services (CMS) assigns these ratings based on data provided by insurance carriers from the previous year. As a result, some plans — such as those that are new or have low enrollment — may not have available ratings and display as “Not Available”. It is important to note that a lack of rating does not indicate that the plan is low quality.
Common Insurance Terms
Advance Premium Tax Credit (APTC)
A tax credit that is applied to monthly health insurance premiums to lower the cost of coverage. The tax credit amount will depend on income level, household size, and other factors.
Premium
The amount you pay for your health insurance every month.
In addition to your premium, you usually have to pay other costs, including a deductible, co-payments, and co-insurance when using your insurance.
Cost-Sharing Reductions
A discount that lowers the amount you pay out-of-pocket for things including deductibles, co-insurance, and co-payments. To qualify for a Cost-Sharing Reductions your income must be within a certain range of the Federal Poverty Level and you must be enrolled in a Silver Tier Plan.
Additional Coverage
Vision Coverage
Your Health Idaho offers access to quality vision care benefits through our partnership with VSP®.
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Small Business
Your Health Idaho’s Small Business Health Options Program (SHOP) helps small businesses and nonprofit organizations provide health insurance to their employees. With SHOP, you can choose from high-quality health insurance plans that meet the needs of your business and employees.
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Tribal Members
Members of federally recognized Tribes and Alaska Native Claims Settlement Act (ANCSA) Corporation shareholders can enroll or change plans once per month through Your Health Idaho. These members are also eligible for enhanced Cost-Sharing Reductions based on income.
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