Obamacare, officially known as the Affordable Care Act (ACA), was signed into effect nationwide in 2010 and enforcement officially started in 2014. The intent of Obamacare was to increase access to healthcare through expanding Medicaid programs, protecting consumers from being discriminated against due to pre-existing health conditions, opening a regulated Marketplace to shop for cost-efficient health insurance options, and requiring all U.S. citizens to have minimum health insurance coverage.
Obamacare's Effect on Idaho Health Insurance
The state of Idaho has experienced a small drop in the uninsured rate to 15.2%. Like many states that opted to not expand their Medicaid programs, Idaho has not been able to offer coverage to many residents that live in the space between poverty and middle class. The National Health Interview Survey determined the uninsured national average to be 9.1% and with a plan for more investment in Medicaid, Idaho would be more likely to experience an equivalent drop.
What Idaho Residents Should Know About Obamacare in Idaho
The Pros and Cons of Idaho Obamacare
Idaho has been successful in implementing a well-run state exchange that controls expenses and is user-friendly. Obamacare in Idaho has also successfully eliminated denial of care based on pre-existing conditions and has disabled Idaho companies from charging a higher premium based on race or gender.
There have been criticisms of Obamacare in Idaho that while access to health insurance coverage has increased, many carriers are struggling financially to offer coverage to the patient population. This has caused some health insurance companies to leave the market or propose rate increases up to 30%. In addition, there has been a notable struggle in getting re-enrollments, especially for the healthy young adult population who would rather pay the fine for not having coverage than be responsible for monthly health insurance premiums they cannot afford.
Obamacare Health Plan Categories and How Much You Will Pay
When shopping in the Idaho Obamacare Marketplace, there are four primary health plan categories you can choose from: bronze, silver, gold, and platinum. The categories determine the percentage of healthcare costs that the plan will pay for over a course of a year. The remaining percentage is what you will be expected to pay.
These percentage differences greatly impact how much you may expect to pay for care. Think about it this way, if the bronze plan pays for 60% of a benefit, then as the patient, you can expect to pay for the remainder 40%. While this plan will cost you less monthly, it leaves you financially responsible for a larger dollar amount than a platinum plan, which pays for 90% of a benefit.
Here are the different kinds of Obamacare plans as well as the average amount of healthcare services each plan pays for:
- Bronze plan - 60%]
- Silver plan - 70%
- Gold plan - 80%
- Platinum plan - 90%
How do I sign up for Obamacare in Idaho?
The Idaho Obamacare Marketplace and exchange can be accessed through the Your Health Idaho website or by calling (800) 318-2596.
What are the Obamacare Marketplace and exchange?
The Marketplace is a central location to shop for insurance options and enroll for selected coverage. In the case of Obamacare, Idaho utilizes a State-Facilitated Marketplace (SFM), which means that the State of Idaho operates and manages the Marketplace where health insurance plans are offered.
Do I need to use an exchange?
To access public health insurance, you will need to go through Your Health Idaho. The only exception to personally using the exchange to sign up for Obamacare in Idaho is if you are able to seek help from an Idaho-certified counselor or a private insurance agent who can discuss your options and select a plan, on your behalf, through the exchange.
How do I use an exchange?
You can use the exchange one of four ways:
- Visit Your Health Idaho
- Use the telephone support assistance available by calling (800) 318-2596
- Find a local certified counselor
- Seek help from a private insurance agent
What does it mean to be on-exchange or off-exchange?
On-exchange generally refers to purchasing health insurance coverage from the Obamacare Idaho Marketplace, while off-exchange normally refers to purchasing health insurance coverage from a private company.
When is the Obamacare enrollment deadline and what do I do if I missed it?
The Obamacare open enrollment period for 2017 in Idaho is from November 1, 2016 until January 31, 2017. If you miss enrollment, you would need to qualify for a special enrollment period due to a qualifying life event or purchase short term individual private insurance to avoid a penalty.
What is the Obamacare penalty if I don't buy health insurance?
If you do not buy Obamacare or other qualifying health coverage (also referred to as “minimum essential coverage”) you will be subject to a tax penalty for each month you go without coverage. This fee should be paid when you file your federal tax return. In some special cases, there are exemptions to this penalty.
The Obamacare penalty for 2016 is either 1) 2.5% of your household income, with a maximum of the price of a Bronze plan sold through the Marketplace, or 2) $695 per adult and $347.50 per child under 18 years of age with a maximum of $2,085. You will pay whichever of the two options is higher.
The Obamacare penalty for 2017 is fairly similar to 2016 with the percentage fee of 2.5% remaining the same, however, the flat fee will be adjusted for inflation.
What if I cannot afford Obamacare?
If you can’t afford to pay for Obamacare coverage, you may be able to qualify for a government subsidy. For more information on government subsidies, visit Your Health Idaho website.
What are the alternatives to Obamacare in Idaho?
Any health insurance coverage that meets the minimum essential coverage, as set forth in the Affordable Care Act, can be used, whether this coverage is received through an employer, private insurance company, or purchased through a private exchange.
There are several alternatives available when selecting coverage. You can select one of the available alternatives on the Marketplace, purchase one of the many options available on the private exchange, or see if you are eligible for subsidized programs through Idaho’s Medicaid program.