As the Open Enrollment Period for enrolling in a qualified health insurance plans kicks off for 2020, I thought it would be a good time to review some basics on how health insurance in Idaho works these days.
Open Enrollment Period
If you do not currently have a health insurance plan you have until December 16th to get signed up, or else you will most likely have to wait for 2021. If you already have a health insurance plan, the deadline to switch to a different plan is the same day, December 16th.
Who Qualifies for a premium tax credit?
APTC, or Advanced Premium Tax Credit is when your health insurance premiums are significantly reduced based on your income. Anyone who isn’t offered coverage from work and has income between 138% and 400% of the federal poverty line(FPL) based on their family size may qualify for the premium tax credit. If spouses and children are offered coverage from work they are not eligible for APTC. The 2018 federal poverty line for a family of 1 is $12,490 and goes up by $4,420 for each additional person in the family. 1. So a family of 4 can make as much as $103,000 and still qualify for a premium tax credit by being under 400% of the FPL. In many cases if you qualify for APTC, you can get a high deductible health plan for Free. If you make below 138% of the FPL, you can qualify for Medicaid.
Options for Coverage in Idaho
Options are pretty slim in most states, including Idaho. There are 4 health insurance carriers (Mountain Health Co-op, Blue Cross, Select Health, and Pacific Source) offering individual and family coverage both on and off the Idaho Exchange(must get coverage on exchange to get APTC) , and 1 more that offers individual coverage outside the exchange only (Regence). But then when you talk about price increases and deductibles that keep going up, there are really no “affordable” options for most people. With that being said, whatever your current situation is you might be able to save money by looking into all your options. The prices vary so much with each company each year that it is usually not in your best interest to stick with the same company year over year.
For example, I helped a family save hundreds of dollars a month by switching them from being a spouse and children on a school district employer health plan, to a family plan off the exchange with Regence, separate from their employer. Coverage for the actual employee is usually a very good price, but if your employer offers coverage for your spouse and children, it is usually more expensive then what you could get separate from your employer.
Another option to possibly consider, is the new “Enhanced Short Term” plans available through Blue Cross. These plans can be renewed up to 3 years and in general are quite a bit cheaper than the on exchange plans. These policies go through underwriting, so your price is based on your health history. You cannot use APTC to get these plans, but if you do not qualify for a tax credit, this is a more affordable option.
If you need help with your health insurance I am a licensed agent and work with the Idaho health insurance companies both on and off the exchange.
By Jimmy Hancock
1. “Federal Poverty Level (FPL) – HealthCare.gov Glossary.” HealthCare.gov, www.healthcare.gov/glossary/federal-poverty-level-fpl/.