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Under the Affordable Care Act, residents of Idaho and other states are required by law to have health insurance. Fortunately, it’s very affordable and easily available from Your Health Idaho. The Your Health Idaho website is very user-friendly, so it’s easy to apply for coverage. Most Idahoans will sign up during the open enrollment period, which runs from the first of November through to the end of January.
Choosing a Plan – If you want your health insurance coverage to begin effective the first of January, then you should pick a plan no later than December 15. You can still qualify up until January 31, but if you wait, your coverage may not take effect until February or March.
Plans are identified by “metal levels” – bronze, silver, gold and platinum. Regardless of which plan you choose you’ll be eligible for all the benefits that are considered essential under the Affordable Health Care Act, including doctor visits, hospital and emergency care, maternity and neonatal care, rehabilitation, mental health and substance abuse services, and more. The differences isn’t in the services available – it’s in what you pay. For instance, if you choose a bronze plan, whenever you need care, your insurer will pay 60% of the costs. You’ll pay the remaining 40%. With a platinum plan, your insurer will pay 90% of the costs, and you’ll pay 10%. Of course, you will pay higher premiums for a platinum plan, and lower premiums for a bronze plan. Your out-of-pocket costs will be lower for a platinum plan, and higher for a bronze plan. You get the idea.
Depending on your household income, the number of people in your household, and where you live, you could qualify for tax credits that will lower the cost of your monthly premiums. Most people find that the Silver plan, where you pay 30% of your health care costs and your insurer picks up the remaining 70%, offers the best savings.
Insurance Coverage is Not Optional
Insurance coverage offers you the peace of mind of knowing that if you or anyone in your household becomes ill or is injured, you won’t be on the hook for horrendous medical expenses. But if you’re thinking that you might just like to take your chances, think again. Under the Affordable Care Act, you are required by law to have health insurance. If you don’t have it, the IRS can penalize you, and the penalties are usually more onerous than the cost of insurance in the first place. Unless you qualify for an exemption, you must have health insurance. And given the tax credits that are available to most households that can offset the cost of a health insurance plan, it simply makes no sense to even try to get by without insurance. It’s the law, and besides, it’s to your benefit. To find out more about the potential benefit, and to learn how to apply, visit https://www.yourhealthidaho.org/.
Your Health Idaho Plans & Networks
Under the auspices of Your Health Idaho, residents of the state have access to over 160 health insurance plans that are designed to offer affordable insurance to individuals and families. These plans are offered by eight different insurance companies, and comprise 76 individual health options, 13 dental plans for individuals, and 17 dental plans for small groups.
Given the range of options, there is no excuse for Idahoans not to carry health insurance. Besides, carrying health insurance is required by law under the Affordable Care Act.
Plans – In order to make it easy to comparison shop and choose the right insurance plan, health insurance plans are grouped by what is known as “metal levels” – bronze, silver, gold and platinum. You will receive the same benefits under whichever plan you choose – the only difference is in how much you will pay out-of-pocket, and how much your insurance company will cover.
Here’s how it works. With a bronze plan, you will pay 40% of your costs when you seek medical care, and your insurance company will cover 60%. Under the silver plan, you pay 30% and your insurer pays 70%. With the gold plan, you pay 20% and the insurance company pays 80%. Finally, with the platinum plan, you pay only 10%, and the insurance company covers the remaining 90%. Under the bronze plan, your premium costs are low, but your out-of-pocket is higher. With Platinum, you pay high premiums but very little out-of-pocket. And, of course, the silver and gold plans fall somewhere in between the two.
Again, let’s emphasize that there’s no difference in the level of care, just in the percentage of costs that will be covered by you and your insurer. Every package, regardless of metal level, covers basic, essential services like hospitalization, pediatric and maternity care, emergency care, prescription drugs, mental health and substance abuse services, rehabilitation, and lab services.
If you’re not convinced that you should have health insurance, think about this – it’s the law. If you don’t have a health insurance plan, you will be subject to a penalty imposed by the IRS when you file your federal income tax. Given that there are tax credits and other cost-sharing measures provided that will enable you to have health insurance at low cost, and given that when you take advantage of these incentives the cost of insurance is usually less than the penalty, it just doesn’t make sense not to have health insurance.
With tax credits, you can dramatically reduce what you pay in insurance premiums. In fact, depending on your level of income, the size of your household, and where you live, you could end up paying little or even nothing for your health insurance. Then, of course, there’s the peace of mind of knowing that if you or anyone in your family is injured or ill, you won’t be on the hook for huge medical bills.
To find out more about available health insurance plans under Your Health Idaho, and to learn about tax credits that can reduce or even eliminate the cost of your monthly premiums, visit https://www.yourhealthidaho.org/ and sign up for an account. Then apply for the plan that best suits you and your family. You’ll sleep better knowing that your health care needs are taken care of and the IRS isn’t going to come knocking.
Your Health Idaho Financial Assistance
Under federal law, most American citizens are required to have health insurance. There are exemptions, for instance in cases of extreme financial hardship, for non-citizens, for American Indians and Alaska Natives who qualify for Indian Health Services, and for people who are incarcerated. Generally speaking, though, you do have to have insurance.
There is assistance available that can reduce the cost of your health care insurance, making it affordable for virtually anyone of any income level. Cost-sharing reductions are also available that work to reduce your out-of-pocket expenses.
The APTC (advance payments of premium tax credits) works to lower the cost your insurance premiums that you pay monthly for insurance plans purchased through Your Health Idaho. The amount of the tax credit you qualify for will depend on your combined household income, the number of people in your household, and where you live. Your Health Idaho and the Department of Health and Welfare operate together in order to determine your eligibility for tax credits.
Assuming that you qualify for a tax credit, you can decide how much of your credit you want to use toward lowering the cost of your premiums per month, up to a maximum. Alternatively, you can elect not to use any of the credit as a monthly advance, and instead claim the full amount when you file your federal income tax return. If you owe taxes, the unused credit will reduce the amount that you owe the IRS, and if you don’t owe any taxes, it will be given to you in the form of a refund.
If you were eligible for a higher credit than you actually received, the difference will be applied to your tax return. However, if you were eligible for a lower credit than what you actually received, you will need to pay back the difference when you file your taxes.
Even if you have never filed a tax return, you can still qualify for a credit. Keep in mind, though that if you apply for and receive a tax credit in 2016, then you will have to file a 2016 tax return. If you fail to file a tax return, you may be unable to receive future tax credits.
A cost-sharing reduction works to reduce the amount that you have to pay out of your own pocket for deductibles, co-payments and co-insurance. You are eligible for a cost-sharing reduction if you purchase your health insurance through Your Health Idaho, you select your health insurance plan from the Silver options, and your combined household income does not exceed a certain level.
A co-payment is a fixed amount that you pay when you see the doctor, or when you have a prescription filled that is covered under your health insurance plan. Generally speaking, you make this payment at the time you receive the services. This is a part of your out-of-pocket expenses, and is separate from your deductibles and premiums.
No-Cost Health Care
If you are an American Indian or an Alaska Native, and your income is between one hundred and three hundred percent of the FPL (Federal Poverty Level), you will not have to pay co-pays. Additionally, the other cost-sharing reductions and tax credits that are available to you could actually reduce the cost of your health insurance to nothing.
Tax Credit Estimator
If you would like to get an estimate of the amount of tax credit you may be eligible for, Your Health Idaho offers a convenient tax credit estimator tool. You can find it at https://Idahohix.YourHealthIdaho.org/hix/Preeligibility#/.
Your Health Idaho Tax Information
If you are enrolled in a health plan under Your Health Idaho, you may qualify for tax credits that can greatly reduce the cost of your monthly insurance premiums. Tax credits are based on what you anticipate your income will be for the coming year, and you can use them when you seek medical care to offset the cost of your out-of-pocket expenses. Alternatively, you can choose not to use your tax credits when you see the doctor, and instead use them when you file your income tax at the end of the year. If you owe income tax, your tax credits can lower the amount that you pay. If you don’t owe income tax, then the credits that you didn’t use work to give you a bigger refund.
What You Should Expect
If you are enrolled in a health insurance plan through Your Health Idaho, then in early February, you should expect to receive a Form 1095-A. This is also known as the Health Insurance Marketplace Statement. You will receive a copy, and a copy will also be sent to the IRS.
It is important that you don’t lose your Form 1095-A, since it contains information that is important when it comes to filing your income tax. It verifies, among other things, the number of moths that you had health insurance throughout the year, how much you paid in monthly premiums, any cost-sharing reductions or tax credits you received, and how many members of your household are enrolled in your health insurance plan.
Note that Form 1095-A will contain only information for members of your household who were enrolled under Your Health Idaho. It won’t include anyone who obtained insurance through Medicare, Medicaid, or CHIP (Children’s Health Insurance Program).
Using Form 1095-A
On this form, you will report any tax credits that you received over the previous year. If you did get tax credits, then you will also have to complete Form 8962 in order to determine if the amount of tax credits you received were accurate. Form 1095-A contains all the information that you need in order to complete Form 8962.
It is possible that you will receive more than one Form 1095-A. For instance, if you changed health plans, changed your benefit level, or if not every member of your household was covered under the same plan, you will likely get additional forms. However, even with more than one Form 1095-A, you will only have to fill out one Form 8962.
If you believe, for any reason, that the information contained in your Form 1095-A is not accurate, please contact Your Health Idaho immediately. You can reach them at 1-855-944-3246.
Keep in mind that Your Health Idaho simply provides you with your Form 1095-A. Your Health Idaho cannot assist you with tax preparation. However, you do not need to be afraid of the IRS. They actually want you to get all the deductions to which you are entitled, so if you are having problems filing your taxes, or if you have questions related to your income tax return, visit the IRS website at http://file.gov.com/file/index.html. You’ll find a wealth of information about how to prepare and file your income tax return, as well as helpful tips on how to get all the deductions you qualify for.
Your Health Idaho Small Business
Small Business Insurance and Tax Credit – So, you operate a small business in the State of Idaho. Lucky you. You know how hard it is to find great employees, and how much harder it is to keep them. The fact is, though, that most employees don’t consider high wages to be the biggest thing when they’re evaluating they’re satisfaction. They’re more likely to want to be respected – to feel that they’re valued.
One of the ways you can do that is to make sure that they have access to affordable health care insurance. It can work in a huge way to offset the above-average wages you may not be able to offer, and it might not even cost you all that much.
Your Health Idaho offers affordable health insurance to employers under SHOP (Small Business Health Options Program). It’s a way of helping small businesses and not-for-profit operations to offer affordable health insurance benefits to their workers. You can enroll directly through Your Health Idaho, or if you prefer, you can deal with the certified insurance agent or broker that you’ve been accustomed to working with.
How to Enroll
First, you’ll have to fill out an application and send it to Your Heath Idaho. Unfortunately, online enrollment is not available right now (maybe in the future), so you’ll have to do it on paper. You can download a paper application by going to https://www.yourhealthidaho.org/. Then, fill it out and mail it to Your Health Idaho at PO Box 943, Boise, Idaho 83701.
Once your application has been approved, you simply have to select the plan that you prefer, and enroll. Plans are available through BEST Life and Health, Blue Cross, Dentegra, Mountain Health Co-op, Pacific Source Health Plans, SelectHealth and Willamette Dental.
Advantages – When you offer health insurance through SHOP, you can control the type of coverage that you want to offer, and the amount that you will pay to offset your employees’ premium costs. You can also choose your level of insurance. You can even choose from different plan levels and benefits, and leave it up to your employees to let you know which plans they feel will work best for them. In addition to basic health care coverage, you can also select a dental plan. Healthy workers are happy workers, so keep this in mind when you’re considering the type and level of benefits to offer.
If you are operating a small business that employs 24 or fewer employees, you could qualify for tax credits that will offset premium costs by up to 50%. In addition, you can deduct the rest of the premiums when you file your tax return. These tax credits are only available if you purchase coverage through SHOP.
When you consider the difficulty of finding really good employees, and trying to make sure that they’re content in your operation to the point where they won’t leave you for someone who’s offering nothing more than higher wages, one of the best ways of ensuring loyalty is to provide really good benefits. A quality, affordable health insurance plan goes a long way. If you’d like to learn more about enrollment and tax credits for small business under Your Health Idaho, visit https://www.yourhealthidaho.org/ and investigate the options that are available for small businesses.
Your Health Idaho for Tribal Members
Under Your Health Idaho, citizens of the state can qualify for affordable health insurance. If you are an American Indian or an Alaska Native, you can actually get even more significant savings, up to no health care expenses at all, depending on your income.
If you are an American Indian or an Alaska Native, and your income is anywhere between one hundred and three hundred percent of the FPL (Federal Poverty Level), you will not have to pay out-of-pocket expenses like deductibles, co-pays and co-insurance if you buy your health insurance through Your Health Idaho. If you are below 100 percent or above 300 percent, you will be eligible for limited cost sharing.
As an American Indian or an Alaska Native, you can also enroll outside of the open enrollment period that runs from the first of November until the end of January. You can actually enroll in any month throughout the year, and if you are a member of a tribe that is federally recognized, you can also change your health insurance plan at any time. You don’t have to worry about open enrollment.
As an American Indian or Alaska Native, you are also exempt from the tax penalty that non-natives have to pay if they fail to enroll in a health insurance plan under Your Health Idaho. You will, however, have to file an exemption proving your American Indian or Alaska Native status.
If you are a member of a federally recognized tribe, and you are enrolled in a health insurance plan through Your Health Idaho, you can continue to receive services under tribal health or urban Indian programs, as well as under IHS (Indian Health Services). If you also are enrolled under Your Health Idaho, though, you will have to inform your IHS so that they will be able to bill Your Health Idaho accordingly.
If you are a descendant of an American Indian or an Alaska Native, you can receive benefits just the same as if you were actually an enrolled tribe member. You will, however, only be able to enroll during the open enrollment period from November 1 through January 31.
Everyone who receives coverage under Your Health Idaho has to provide information regarding their income and household size. In this regard, you are not exempt, and you will also have to report any income that you receive under Indian trust land, culturally significant items, and natural resources.
IHS and Your Health Idaho
If you are wondering why you should have coverage under Your Health Idaho even if you are covered under IHS, the answer is simply this – you can get more coverage for more services from more providers. That gives you more options.
Some Idahoan tribes employ counsellors who can help you to find out which tribes participate in Your Health Idaho insurance plans. Your tribal health clinic can provide you with more information. Your Health Idaho meets three times a year with representatives of recognized tribes in order to collaborate in providing health care insurance options
American Indians and Alaska Natives do not have to enroll in insurance plans through Your Health Idaho. However, if they do, they can benefit from increased savings.
Unique Aspects of Your Health Idaho
Your Health Idaho was established following Congress’s passing of the Affordable Care Act in 2010, requiring all states to make available health insurance marketplaces where consumers could find affordable health insurance coverage. Idaho is one of a handful of states that elected to develop its own marketplace, as opposed to having it run by the federal government. In fact, Idaho was the first state to transition away from the federal government.
As an independent entity, Your Health Idaho is governed by a board of eighteen Idahoans, including doctors, insurance agents and brokers, legislators, business owners, and non-profit administrators. Additionally, the Department of Health and Welfare and the Department of Insurance directors participate as non-voting board members. Your Health Idaho is governed by an 18-member board of Idahoans, which includes brokers and agents, physicians, business owners, legislators and non-profit representatives. The directors of the Department of Insurance and the Department of Health and Welfare are also part of the board as non-voting members.
Many states require residents to complete a full enrollment before they can shop for insurance. Idaho does not require your name or your social insurance number in order to permit you compare insurance plans that are available for the coming year.
One of the Top 5 States for Sign-Ups
Idaho is fourth in the United States in terms of the per capita number of residents who chose health insurance plans. Only Maine, Georgia and Florida surpassed Idaho. Through Your Health Idaho, tens of thousands of citizens have been able to obtain affordable health insurance plans.
Your Health Idaho boasts one of the lowest operating costs of any health benefit exchange in the United States, and remains committed to operating in the most cost-effective manner possible. The exchange is moving closer and closer to financial sustainability, and is relying less on federal grant money.
Most of the operating costs are obtained through assessment fees charged to health insurance providers who sell plans through Your Health Idaho. Recently, the fee was increased from 1.5% to 1.99%. This means that Your Health Idaho is building cash reserves that will make the state-run marketplace sustainable going into the future. It also means that Your Health Idaho customers do not have to pay any fees in addition to their monthly insurance premiums.
Additionally, Your Health Idaho’s assessment fee is considerably lower than the 3.5% assessment fee that is imposed by HealthCare.gov on insurance plans that they make available. This lower assessment fee has saved Idahoans nearly six million dollars to date, and resulted in a wide range of choices offered by different providers. There is expected to be a slight increase in assessment fees in 2016, but even allowing for the increase, Idahoans will still save millions annually.
Your Health Idaho is unique in terms of its independence and its steady movement away from federal funding, as well as the composition of its Board of Directors, with members from various walks of life. The marketplace also has one of the highest levels of enrollment in the country, so most Idahoans are benefiting from low-cost health insurance. And finally, the assessment fees levied by Your Health Idaho on its health plan providers are considerably lower than those set by other states, or by the federal government, resulting in even greater savings for Idahoans.
The following is a brief summary of what you need to know about Your Health Idaho. For more information, visit the Your Health Idaho website at https://www.YourHealthIdaho.org/.
Your Health Idaho Mandate
Your Health Idaho is a state-based health insurance benefit exchange dedicated to providing individuals, families, and business that employ 50 or fewer employees with a source for quality, affordable health insurance plans. Your Health Idaho was established in 2013, and is governed by a board of directors consisting of 19 representatives from various sectors.
Your Health Idaho Consumers
Essentially, any Idahoan who does not have health insurance, or who does have insurance but wants to change their coverage, can purchase insurance through Your Health Idaho. Consumers must be residents of the United States, with a primary residence in the State of Idaho, and must be considered a resident of both the country and the state for income tax purposes. Non-citizens are eligible if they intend to be lawfully present in the United States for the whole period of time during which they wish to have health insurance coverage. Persons who are incarcerated cannot purchase health insurance coverage through Your Health Idaho.
Applying for Coverage
To apply for coverage, go to https://www.YourHealthIdaho.org/ and create an account. Then, shop for the plan that is right for you and your family. The open enrollment period runs from November 1 until the end of January, but you may be able to purchase insurance outside of that period if you have had a significant life change. Then, you may qualify for special enrollment. Some examples of significant life changes include a sudden reduction in income (loss of a job), marriage, divorce, having a child, or a death in your household.
Depending on your level of income and the size of your household, you may qualify for assistance in the form of tax credits or cost-sharing reductions. A tax credit reduces the amount that you will pay your insurance company for monthly premiums. Tax credits can be taken in advance to a maximum amount per month, or left unused and claimed when you file your federal income tax return. Cost-sharing reductions lower your out-of-pocket expenses that you are responsible for when you receive care. Cost-sharing reductions can reduce your deductibles, co-pays and co-insurance.
Help With Applying
In order to reduce the confusion that can often go hand-in-hand with choosing insurance, Your Health Idaho makes certified insurance agents and brokers, as well as trained enrollment counselors, available to you. By entering your ZIP code, you can even be put in touch with a representative in your own community.
An enrollment counselor can assist you with the mechanics of applying for an insurance plan and speak with you in general terms about the options that are available, but under the regulations set by the Idaho Department of Insurance, only a certified broker or agent can offer recommendations as to which plan you should purchase. Regardless of who you receive help from, there is no cost for the service.
If you would like to learn more about the benefits and services available to you under Your Health Idaho, visit their website. You can also get information via telephone by calling 1-855-944-3246 to speak with a Your Health Idaho representative.
Pros & Cons of Your Health Idaho
Idahoans who are shopping for affordable health insurance plans will generally find the Your Health Idaho website easy to use. Of course there are a few areas that are less than perfect, but overall, using the website is a pleasurable experience.
Visuals – Your Health Idaho’s website has a very attractive appearance, with great use of color and an un-cluttered, logically arranged layout. The graphics are uncomplicated and intuitive – for instance, a piggy bank to show you where to get information about saving money on your insurance plan, an envelope to click on to get information about the notices you will receive in the mail from Your Health Idaho, a magnifying glass to show you where to find help, and so on. The typefaces used are clear and readable.
Navigation – Generally speaking, navigation is easy, with menu bars and drop-down menus taking you where you need to be. One small criticism is that a few of the pages don’t allow you to go back. That can lead to having several open windows as you go deeper to get the information you need, and at times this can be confusing. This happens when you click on a link that opens a PDF, and since https://www.YourHealthIdaho.org/ is very heavy on PDFs, it happens more often than we’d really like.
The search bar is clearly visible at the top of the page, and that’s a feature we really appreciate. Some states don’t have search bars on their sites, instead requiring the user to scroll through page after page to find what they need. The search function works well, too, pulling up all relevant information. It is not, however, forgiving of spelling errors. For instance, if you type “premum” instead of “premium,” you will not get a Google-like “did you mean…?” response. You’ll just get a message saying that no results were found. So if you want to get the information you need, you’d better know how to spell.
Accessibility of Information – It’s easier to get information from Your Health Idaho without jumping through a whole lot of hoops than it is with a lot of other states, but if you want to be able to browse and compare plans, you’re going to have to provide quite a bit of information. You can browse anonymously, meaning that you don’t have to provide your name, Social Security number, or any address information beyond your ZIP code. Realistically, though, the site is secure, so you might as well just register for an account using all your information – it makes it easier when you’re actually ready to apply for coverage.
Other than that one complaint about accessibility to plan comparisons, you’ll find that the information on the Your Health Idaho website is very easy to access, and also very comprehensive. For instance, if you want to read the minutes of the meeting of the board of directors, you can. You can also read the minutes of all the committee meetings as well, although we can’t imagine why you’d want to! Another feature that we really like is that the site posts opportunities for contractors or vendors who want to do business with Your Health Idaho, along with employment opportunities for people who would like to work for them. The Your Health Idaho site is attractive and nicely laid out, and contains a great deal of information. There are a few minor areas that could use some work, but overall, the site is easy to use and informative.
Whats New for 2016 on Your Health Idaho
2016 promises to be a great year for Your Health Idaho consumers, with access to even more choices in terms of health and dental insurance than they have ever had before. In fact, at their September meeting, the Your Health Idaho board of directors approved 211 different health and dental insurance plans – 13 more than were available in 2015.
According to Pat Kelly, Your Health Idaho’s executive director, this is part of Your Health Idaho’s ongoing commitment to providing Idahoans with a wide variety of choices when it comes to affordable health care insurance.
The options for dental insurance coverage have expanded significantly. Although dental insurance for children has always been a component of any health care plan purchased through Your Health Idaho, adults have not historically been able to avail themselves of dental coverage. That will change in 2016. For the first time, the open enrollment period is allowing adults to purchase dental insurance plans.
Ten insurance carriers will be offering dental insurance through Your Health Idaho. They are:
- BEST Life and Health Insurance Company
- Blue Cross of Idaho
- BridgeSpan Health Company
- Delta Dental of Idaho
- The Guardian Life Insurance Company of America
- Mountain Health Co-Op
- PacificSource Health Plans
- SelectHealth Inc.
- Willamette Dental
Under the dental plans, Your Health Idaho consumers will have access to a range of dental services, including fillings, root canals, cleanings, x-rays, preventative treatment, dentures and more. This is really exciting news for adult Idahoans who may, due to reduced financial circumstances, have been forced to neglect their dental health. Current research indicates that poor dental health can increase the risk of other health issues, including heart attacks and strokes. Access to a quality dental plan can only improve the overall health of Idahoans in general.
Higher Tax Credits
The cost of health insurance plans through Your Health Idaho will increase slightly in 2016. However, the good news is that the tax credits that are available to Idahoans will also increase somewhat. This means that most Idahoans will see little or no increase in the cost of their insurance coverage through Your Health Idaho. As an example, if you enrolled last year in a silver level insurance plan, and your combined household income is anticipated to be the same as it was in 2015, you probably won’t notice a difference. And, of course, shopping around, comparing plans, and perhaps seeking the advice of an insurance agent or broker could help you to save even more money by finding the Your Health Idaho insurance plan that is exactly right for you.
During this open enrollment period, Idahoans will find it easier to preview the various health and dental insurance plans on offer. By providing some information (although you will not be required to give your name or Social Security number) about your income and the size of your household, you will be able to compare the various plans and also get an idea of the amount of tax credit for which you could be eligible.
In 2016, Your Health Idaho will continue to be a useful marketplace where Idaho individuals and families can go to purchase affordable health care insurance, and this year adults will also be able to purchase dental insurance.
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