Idaho residents have seen a lot of changes since the Affordable Care Act started in 2010. The cost of health care continues to be a challenge for many families. But a little research goes a long way toward finding the most affordable health insurance for you and your family in the Gem State.
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The Best Health Insurance in Idaho
What is Health Insurance?
Health insurance is coverage that pays for a part or the entire cost of your health care. Every month you must pay your insurance provider a premium to keep your plan. Then you’ll be covered if you have a routine or emergency medical visit. Expect your health insurance company to pay for that expense.
Most plans have a deductible that you must meet before the insurance company pays your costs. A deductible is a fixed amount you pay; the insurance company picks up the rest of the tab. After reaching your deductible, you’ll only be required to pay the coinsurance costs on most plans.
Let’s say your health insurance covers 80% of a $1,000 procedure. You would be responsible to pick up the remaining $200. A general principle of insurance is the higher your deductible, the lower your premium, and vice versa.
Average Cost of Health Insurance in Idaho
The average individual health plan premium starts at $231 per month. The average family plan premium starts at $814 per month. But your specific amount will vary and depends on several factors like your family size, your location and your plan.
Types of Health Coverage
Many kinds of health insurance plans are available in Idaho. The plan you choose determines your monthly cost and whether you need a referral to see a specialist. A rule that applies to all the plans is that more freedom means a higher price.
Here are 5 common types of plans:
- Health maintenance organization (HMO) plan: HMO plans require you to have a primary care physician who will refer you to a specialist. You must stay in-network to have coverage. HMOs are often the most affordable type of plan, but you sacrifice the freedom of choosing any provider you want.
- Preferred provider organization (PPO) plan: PPO plans offer you a network of providers but allow you to go out of network. You’ll pay more if you choose an out-of-network provider, but at least the choice is available. It’s because of this flexibility that PPO plans are pricier than HMO plans.
- Point of service plan (POS) plan: POS plans are like a blend between an HMO and a PPO. This plan lets you pay less if you use providers that belong to the network. Like an HMO plan, a POS plan requires you to have a referral from your primary care physician to see a specialist. Like a PPO plan, you can choose out-of-network doctors for an extra cost. POS plans try to give you more freedom and keep the prices less expensive than a PPO.
- Catastrophic plan: Catastrophic plans require you to be under the age of 30 to qualify. The benefits of the plan are low premiums and free preventive care, even if you haven’t met your deductible. Catastrophic plans require you to see only in-network doctors. You’ll have high deductibles and you’ll only get 3 primary care visits before the deductible applies.
- High deductible health plan (HDHP): With or without a health savings account, HDHP plans are like catastrophic plans and have high deductibles to lower your monthly cost. But you don’t have to be under age 30. This policy can work with an HMO, PPO or POS. The health savings account allows you to pay for eligible medical expenses and care with tax-free money.
Know that not every health insurance company offers all plans. Some providers have only 1 type, while others may offer all 5. It’s a smart idea to speak with your plan’s representative before you lock in your final choice.
What Does Health Insurance Cover?
The Affordable Care Act (ACA) has standardized the health insurance industry. The ACA requires every permanent health insurance plan to include its 10 essential benefits:
- Ambulatory patient services: This is outpatient care you get outside of a hospital.
- Emergency services: In an emergency, you can visit the closest hospital and your health insurance provider must cover you. The company cannot charge you more if the hospital is out of network.
- Hospitalization: The health insurance plan must include coverage for overnight stays or surgeries.
- Pregnancy maternity and newborn care: This supplies care both before and after birth.
- Mental health and substance use disorder services: The health insurance provider covers behavioral health treatment, including counseling and psychotherapy.
- Prescription drugs: This covers prescription drugs. You can find an approved list on the health insurance company’s website or plan information. If you need a specific drug, first consult the company to make sure it’s covered before you enroll.
- Rehabilitative and habilitative services and devices: These services and devices help people with injuries, disabilities or chronic conditions recover or gain physical and mental skills.
- Laboratory services: The plan supplies coverage for tests such as imaging and bloodwork.
- Preventive and wellness services: The health insurance provider must cover medical screenings such as cholesterol screenings or diabetes screenings and recommended vaccinations.
- Pediatric services: This includes vision and dental care for children. Adults need supplemental coverage for these services.
What Does Health Insurance Not Cover?
Most health insurance providers do not cover the following:
- Vision and dental coverages: Your health insurance plan will not include these services. But you can often add these services with a supplemental plan.
- Weight loss surgery: Is someone in your family considering bariatric surgery? Some plans cover it, but the vast majority don’t because it’s not federally mandated. You’ll want to contact your plan representative if this is a concern.
- Cosmetic surgery: Cosmetic surgery is not covered because it’s not medically necessary. The only exception may be for cases where there is a medical reason, such as a child’s birth defect.
- Travel vaccinations: The health insurance provider will cover medically necessary treatments. Vaccinations needed for international travel are not covered.
- Male birth control: Plans don’t cover vasectomies and barrier methods; however female birth control is an essential benefit.
- Fertility treatments: It’s not a required essential benefit. Plans vary and may supply coverage, although it’s rare.
Your treatment or therapy will only be covered if it’s medically necessary or related to an essential benefit. There is an appeal process for exceptional cases. If you’re concerned about specific coverage, then please contact the health insurance company to learn more.
Best Health Insurance Providers in Idaho
Here are some of the best health insurance providers for inexpensive plans in the Gem State.
1. Select Health
Select Health has helped Idahoans for 36 years. The company offers HMO plans with many ways to save through its plan types:
- Traditional plans: This is your classic HMO plan.
- HSA plans: Lets you use your HSA for eligible medical-related expenses.
- Benchmark plans: Benchmark plans are cheaper than traditional plans because they only cover the state’s essential health benefits.
- Catastrophic plans: Offer a way to save money if you’re under 30. These plans feature high deductibles and low premiums.
- Transition plans: This is a short term option for people who are changing jobs or missed the open enrollment period.
Select Health focuses on wellness with free preventive care, like gym membership reimbursements, on most plans.
2. Blue Cross of Idaho
Blue Cross of Idaho has served the state since 1945. It’s a separate company from Regence Blue Shield of Idaho.
It offers 8 HMO plans, and 1 of its policies allows you to use an HSA. There’s also a catastrophic plan for those under 30. They even offer short term insurance if you missed open enrollment or switched jobs.
You’ll also get discounts on gym memberships, childproofing products, hearing aids, contact lenses, laser correction surgery, acupuncture and massage therapy with the Blue Extras program.
PacificSource has over 40,000 individual plan members. The company has a 4-state network that allows you to see doctors in Idaho, Montana, Oregon and Washington.
PacificSource has 9 different offerings with customization for health savings accounts and catastrophic plans. You must check your county to know which options are available.
You’ll get free preventive care and select prescription drugs. The company lets you add dental for you and your children, and PacificSource covers vision for members up to age 18.
PacificSource has a strong customer service focus and boasts you can speak to a live person on the phone in 30 seconds or less.
4. Regence Blue Shield of Idaho
Regence Blue Shield has over 161,000 members and over 10,000 network providers in the Gem State.
You can expect free preventive care for services such as annual physicals and vaccinations. Choose among the company’s POS plans. You can opt for an HDHP with an HSA if you’re looking for a low monthly premium.
Don’t want to drive to the doctor? No problem. The company has MD Live, so you can talk with a doctor on video or the phone, which is handy while traveling. Regence Blue Shield even has coverage for prescription home delivery.
If you’re looking for everything under one roof, you can add dental and vision coverage, too.
Finding Affordable Coverage
Many Idaho families are trying to figure out how to get health insurance that fits their finances. After making a list and looking at provider features, you’re on your way to finding the best insurance policy for you and your family.
It’s a smart tactic to get multiple quotes and speak to a representative with questions. If a particular coverage is crucial to you or family members, bring that up in your conversations. Remember to read your plan options before you lock in your choice.