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 (5IIHRRP)
Website
://www.doi.idaho.gov/Consumer/Health/Info.aspx
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
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
Website
://www.healthandwelfare.idaho.gov
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
://healthandwelfare.idaho.gov/Home.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 (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 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.