Health Insurance in Idaho

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


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


Guaranteed Issue Options


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


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


Premium Rating Factors

Rate Bands

Rate Adjustment Factors


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


Eligible Group Sizes


Extension of Benefits Period – Standard


Extension of Benefits Period – Disabled


Maximum Premium Increase


State Legislation Reference


Additional Notes


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 (5IIHRRP)



Phone Number


HIPPA Eligibility Required?


Available Carriers

Contact IIHRRP

Pre-Existing Condition Waiting Period

12 months

Enrollment Periods


Premium Limits

Set by High Risk Pool

Lifetime Maximum Benefit


Special Notes

Not eligible for coverage under a group health plan, Medicaid, or

Medicare, and do not have other health insurance coverage.

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



Phone Number


Apply Online


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



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 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



Phone Number


Residency Requirements

Idaho residents, legal immigrants

Federal Poverty Line Income Limits

Children Age 0-19 income at or below 185% of the FPL (5copayments vary depending on the families qualifying income)

Pregnant Women: 133% FPL

Adults: 25% FPL

Supplemental Security Income Recipients: 74% FPL

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

The guide created by 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., 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.