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Idaho Health Insurance
Health insurance is one type of insurance which you cannot afford to overlook. Indeed, purchasing suitable health insurance coverage for your family is quite expensive, but it also requires a good appraisal of all future risks and its impact on your financial health. In the U.S., more than 47 million people are uninsured and working families constitute a major part of this uninsured population. With the rising health care costs, many of these families close their eyes to the importance of having proper health coverage and get stuck with huge medical bills. For those families who are not covered under their employers’ group plan, many states provide low-cost health insurance programs to them.
In 2008, Idaho was ranked as the 8th healthiest state to live in, climbing seven spots from its 2007 ranking, according to the United Health Foundation's Health Rankings. The state went through a notable change in its health score due to the decrease in the crime rate, infectious diseases as well as in the percentage of children under 18 in poverty. The state of Idaho, having the population of more than one million citizens, has both private-market and public health insurance alternatives. The private-market health insurance comprises of numerous types of health plans including family, Medicare supplemental, short-term, student, group and dental. Additionally, the state and federal government sponsored programs provide inexpensive health coverage to the uninsurable residents of Idaho who meet specific eligibility requirements.
The Idaho Department of Insurance is responsible for regulating all types of insurance sold in the state of Idaho including health insurance policies offered by private-market health insurers or public health coverage programs. However, despite the state’s strong public health funding, approximately 14.7% of the population remains uninsured. According to the Censor Bureau’s 2007 and 2008 Current Population Survey, approximately 40.0% of Idaho citizens continue to survive without any kind of health insurance and are under the above 200% FPL category.
Choosing a health plan for your family can be quite challenging. Therefore, your best interests lie in consulting with a licensed health insurance agent/broker to maximize on the benefits of the appropriate health insurance alternatives.
Individual/Family Health Insurance
Below is the guidelines for applying for and obtaining individual health insurance in the state of Idaho. These regulations apply to all insurance companies offering individual or family health insurance in Idaho:
| Medical Underwriting | Yes |
Pre-Existing Condition Exclusion Period | 12 months |
Look Back Period | 6 months |
Look Back Standard | Prudent Person Standard |
Mandatory Benefits | Cancer screening for women including breast cancer screening, direct access to OB/GYNs, OB/GYNs as primary care providers, maternity care |
Market Rate Restrictions | Yes |
Guaranteed Issue Options | Yes |
Small Group Health Insurance
Below is the guidelines for small group health insurance in the state of Idaho. These regulations apply to all insurance companies offering small group health insurance in Idaho:
| Small Group Size | 2-50 |
Employee Qualifications | Two employees must work for at least 6 months out of the year, and work 20 hours per week for coverage |
Guaranteed Issue | Yes |
Premium Rating Factors | Rate Bands |
Rate Adjustment Factors | 50% |
Look-Back Period | 6 months |
Pre-existing condition exclusionary period | 12 months |
Mandatory Benefits | Same as individual |
State Cobra Variations for Small Groups
Below are the COBRA guidelines for small groups in the state of Idaho. For employer groups of more than 20 employees, refer to the federal COBRA guidelines:
| Mini-Cobra Option | No |
Eligible Group Sizes | NA |
Extension of Benefits Period - Standard | NA |
Extension of Benefits Period - Disabled | NA |
Maximum Premium Increase | NA |
State Legislation Reference | NA |
Additional Notes | NA |
State Sponsored Health Insurance Programs
There are several state sponsored health insurance programs in the State of Idaho to assist those without insurance in obtaining adequate coverage.
High-Risk Pools
Some states offer special state sponsored health insurance plans for qualified persons that are not eligible for individual health insurance due to pre-existing medical conditions. The guidelines for enrollment in these programs vary by state. The high-risk pool in the State of Idaho is summarized in the chart below:
| Plan Name | Idaho Individual High Risk Reinsurance Pool Plans (IIHRRP) |
Website | |
Phone Number | 800-721-3272 |
HIPPA Eligibility Required? | Yes |
Available Carriers | Contact IIHRRP |
Pre-Existing Condition Waiting Period | 12 months |
Enrollment Periods | Open |
Premium Limits | Set by High Risk Pool |
Lifetime Maximum Benefit | $500,000 |
Special Notes | Not eligible for coverage under a group health plan, Medicaid, or |
Children’s Health Insurance Program
Through shared funding from the federal government, the State of Idaho provides health insurance for uninsured children that meet certain eligibility guidelines. A summary of this program is outlined in the chart below:
| Program Name | Children’s Access Card |
Website | |
Phone Number | 800-926-2588 |
Apply Online | No |
Age Limits | Under 19 |
Insurance Carrier |
|
Length of Coverage | Subject to Annual Reviews |
Residency Requirements | Idaho residents, legal immigrants |
Other Eligibility Requirements | Must be ineligible for no-cost Medicaid or employer-based coverage |
Pre-Existing Condition Exclusions | No |
Cost | Depending on the family income, this coverage may be free or cost up to $15.00 per child per month. Parents are responsible for paying any deductibles/co-pays. |
Medicaid
Medicaid is a state program partially funded through the federal government. Qualification guidelines, as well as the types of people that are eligible, will vary by state. The chart below provides a summary of the Medicaid programs in the State of Idaho:
| Governing Agency | Idaho Department of Health & Welfare |
Website | http://www.healthandwelfare.idaho.gov/site/3629/default.aspx |
Phone Number | 866-326-2485 |
Residency Requirements | Idaho residents, legal immigrants |
Federal Poverty Line Income Limits | Children Age 0-19 income at or below 185% of the FPL (copayments vary depending on the families qualifying income) |
Additional Resources
Idaho Health Care Options Matrix™ Guide
Provided by the Foundation for Health Coverage Education, the guide is a quick reference guide prepared by the non-profit Foundation for Health Coverage Education that outlines Idaho’s public and private health care choices for individuals and groups with various demographic profiles.
Family Health Insurance Guide by HealthInsuranceFinders.com
The guide created by HealthInsuranceFinders.com provides useful information regarding health insurance coverage such as individual/family health insurance, group health insurance, separate child health insurance and state-sponsored programs that are available for low to middle income families.
Idaho: At-A-Glance
Provides exclusive health data of the Hawaii state. Statehealthfacts.org, a project of the Henry J. Kaiser Family Foundation, is designed to provide free, up-to-date, and easy-to-use health data on all 50 states.
