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Idaho Health Insurance

Idaho Medical Insurance Overview

When compared to other states, Idaho is listed at 14th place with reference to the health of its residents.  Despite a great standing in comparative charts, the state still has room to grow with regard to insurance coverage and health of residents living there.  When the Affordable Care Act came into play, it was hoped that it would improve the scope of health care for residents of the state of Idaho.  The state has a large amount of citizens who don’t have insurance coverage and that forces people to fear the development of a medical issue that would be out of their budgets for treatment.
The following information stands as an overview of the overall health of the residents of the state of Idaho.

Idaho’s Health Care Issues
The state of Idaho is ranked in 17th place among other states in the country when it comes to the health of its residents.  In 2011, Idaho was in 15th place, but has since seen a drop in recent tears.
Strengths of the state include the low prevalence of people suffering from diabetes, the high per capita public health funding and the low incidence of Salmonella.  Weaknesses in the state include its high levels of air pollution, the low availability of doctors serving as Primary Care Physicians and the low rate of kids who have received their necessary vaccinations.

Understanding the Uninsured Population of Idaho
According to the United Health Foundation’s website, eleven percent of people living in Idaho do not have insurance coverage.  The counties in the state with the worst percentages of uninsured residents are Clark and Owyhee counties which show a 32 percent rate of uninsured people.  In these areas, there are usually no medical centers for treatment and the population consists of some of the poorest people in the state as a whole.  The problem with creating a far-reaching health insurance marketplace is getting those people covered who live in these remote, poorer areas.

Below are some statistics offered by the Henry J. Kaiser Family Foundation:

  • The lowest rate of uninsured people is comprised of poor adults who earn 100% or lower than the Federal Poverty Level (FPL).
  • 51% of employers offer group coverage, leaving many people unable to find benefits.
  • Kids living in Idaho have an insurance rate that matches that of the country in its entirety.

Group Health Plans
Employers in the state of Idaho who offer insurance under group health plans is quite low, but 51 percent have employer-sponsored options.  Despite the amount of companies not offering benefits, this remains the best option for people looking to get coverage.  If you cannot obtain a group policy, check with a local trade union to gauge whether or not you would qualify for benefits.  If you wish to know the eligibility requirements for your company’s group health insurance plan, talk with a person in the Human Resources department at your place of employment.

Under a group plan, you will be required to pay a portion of the premiums for coverage, but the money will be automatically deducted from your pay when it comes due.  The Department of Insurance is responsible for regulating private insurance companies that operate in Idaho.

Signing Up
Before contemplating joining a group health plan, there are a variety of things to keep in mind.  There are different levels of coverage depending on what you wish to pay for premiums.  You will want to familiarize yourself with the plans available before committing to enrolling into the group plan.

When thinking about signing up for group insurance coverage, there are things that you want to consider.  These include cost of premiums, how much coverage you need and if the cost of the premiums will fit into your budget.  First, familiarize yourself with the group plan’s options while contemplating the costs you will have to pay on a monthly basis.

Your company’s Human Resources department will have all of the necessary information and paperwork on the company’s group policy.  Consider the following points prior to your enrollment in a group plan offered by your workplace:

  • Are the monthly premiums affordable?
  • Are you responsible for covering a spouse or dependents?  If so, mention them during the enrollment process to ensure they receive the same coverage as you.
  • Do you have a pre-existing condition that will require a lot of medical care?  If so, you will want to plan out your future medical needs and get a level of coverage that will give you the coverage you need at an affordable rate.

Pre-Existing Condition Exclusion Periods
When enrolling into a group health plan, you may have to wait for an exclusion period to pass before your benefits are available for use.  In Idaho, this period can last up to a year’s time if you have a pre-existing medical condition.  Additionally, insurance providers can look back into your medical records for a period of six months to see if you have any pre-existing conditions.  Exclusion periods do not apply to dependents under the age of 19 regardless of the presence of a pre-existing condition.

Affiliation or Waiting Periods
Affiliation periods apply when you first enroll into your group health insurance plan and must pass before your benefits are available to you.  This time frame does not last longer than two months, with the exception of late enrollees, which can wait for three months for benefits to become active.

Individual Health Plans
In the state of Idaho, eight percent of the residents are covered by individual insurance policies.  These plans might be the only option available to those residents who are unemployed, self-employed or employed through a company that doesn’t offer health benefits.  The restrictions placed on providers of individual policies are considered lax when compared to those placed on other plan types.  Because of the risk involved in offering insurance to one person as opposed to a group, the provider can charge more for premiums and deductibles.  Individual insurance coverage can be obtained for a healthy person in the state of Idaho for as low as $33 per month.

Continuation Coverage
If you lose your insurance coverage for any reason like divorce or job loss, depending on the size of the company you may be able to get COBRA coverage.  COBRA is the Consolidated Omnibus Budget Reconciliation Act and it offers temporary insurance coverage for up to 18 months.  Once you have exhausted your benefits through COBRA, you may be able to get continuation coverage through HIPAA.  Conversion plans are also available that keep you insured with the same provider and typically, the same level of coverage.

Idaho Health Benefit Exchange
Idaho’s insurance marketplace is available online at and is a state-run benefits exchange.  The state was provided with a $1 million grant for use in the creation and implementation of the insurance marketplace.  This provides Idahoans with the opportunity to find different coverage options for their situations with the focus on affordability.

Idaho State Insurance Programs
Idaho has a lot of state-funded options for insurance benefits for those people who earn less than average wages.  Eligibility for the various program options available are strictly dependent on income, age, sex and the presence of pre-existing medical conditions.

Provided below is a list of the available programs to residents that are funded by the state:

High Risk Reinsurance Pool Plans (HRP)
For those who have chronic or pre-existing medical conditions, the state of Idaho has the HRP plans.  This program covers prescription medications, preventive medical care, therapy and a great deal more.  Monthly premiums for this type of coverage can cost between $128 and $1,943 per month.

Pre-Existing Condition Insurance Plan (PCIP)
If you have had any issues with obtaining insurance coverage because of a pre-existing condition, you can apply for coverage under PCIP.  If you show proof that you have been turned down for insurance coverage, you can enjoy benefits like primary care, specialty care, and hospital care along with prescription medications.  For this type of coverage, you can expect to pay anywhere between $133 and $571 per month.

Medicaid is a popular option for insurance benefits for low income adults, children and families.  Therapy is covered along with mental health services, x-rays, medical transportation and labs.  You may be able to get this coverage free of charge, but in the worst case scenario, you may have to pay a small amount of premiums.

Idaho Health Plan
If your income is too high to qualify for Medicaid coverage, this program will insure your dependent children with a small monthly fee attached.

Women’s Health Check
This program endeavors to save the lives of women in Idaho by offering breast and pelvic exams along with mammograms.  Eligibility depends on the income level of the applicant and if a diagnosis of cancer is given, the woman can receive Medicaid covered treatment.

Emergency Medicaid
For those in need of emergency treatment for cancers of the cervix or breast or kidney dialysis, the Emergency Medicaid program offers coverage options depending on your income, age and disability status.

Medicare and the Medicare Prescription Drug Program
Medicare is available to those who suffer from end-stage renal disease, are disabled or for people who have worked in a Medicare-covered job that are over the age of 65.  Medicare has four different plans available and each offer a wide array of services to those who qualify.

Indian Health Services
IHS offers Indian residents or women who are pregnant with a qualifying child the ability to obtain medical services like prenatal, postnatal care and other various procedures.

VA Medical Benefits Package
This program is only for veterans who have been honorably discharged from any branch of the United States military after an enlistment period of 24 months consecutively.  Full benefits are available to those who qualify.

Partnership for Prescription Assistance
The Partnership for Prescription Assistance is a free program that guides consumers toward programs that help out with the costs of prescription medications.  There are 475 programs available, so you can get connected to an organization that is likely offer help.

Women Infants Children (WIC)
WIC is a program that aims to provide healthy foods to pregnant women, infants and children under the age of five.  The program is managed by the USDA Food and Nutrition Service and also offers educational resources to women regarding infant care and breastfeeding.

National Association of Mental Illness (NAMI) Helpline
The NAMI helpline is an organization that offers resources and treatment options to those members of the public who suffer from various mental illnesses.  Volunteers staff the helpline and consultations are offered for free.

HIPPA and Conversion Health Plans
When HIPAA was first enacted into law, it only provided safeguards for how medical professionals used and dispensed consumers’ private medical information.  Now, with the introduction of the Affordable Care Act, HIPAA’s provisions have been expanded to include regulations imposed upon insurance companies.  HIPAA now governs how insurance companies treat those who have pre-existing conditions, how much you pay for insurance coverage and the ability for individual insurance companies to deny coverage based on various factors.  Also limited are look back periods, exclusion and affiliation periods.  COBRA coverage is also managed under HIPAA to allow consumers to retain insurance benefits in the event of a job loss or other means of losing insurance coverage.