Shop. Compare. Choose. Your Health Idaho and You.

Shop. Compare. Choose.

Your Health Idaho and You

Your Health Idaho

The Idaho legislature voted to create a state-based health insurance marketplace to prevent federal involvement in Idaho.

Why are we here?

Today that state operated exchange is known as Your Health Idaho.

Through Your Health Idaho, Idahoans are able to Shop, Compare and Choose the right plan that fits their health needs and their budget.

Your Health Idaho

By Idahoans for Idahoans

Who?

What it means for you.

Americans over the age of 18, living in Idaho, will be eligible to buy insurance on Your Health Idaho.

Some exceptions to buying a plan include:

1. Individuals under the age of 26 who are covered on their parents plan

2. Those over the age of 65 and qualify for Medicare3. Those who are currently covered by an insurance plan4. Those members of a federally recognized tribe

Who needs Your Health Idaho?

Who needs Your Health Idaho?

Small businesses with up to 50 employees are eligible to buy a plan that best fits their budget.

The MarketplaceShop. Compare. Choose.

SHOP. COMPARE. CHOOSE.

1. Competitive plans2. Apples-to-apples comparisons 3. Affordability4. Idahoans for Idahoans

Idaho’s Marketplace

Health Insurance Plan Options

Total of 146 plans from 7 Idaho Insurance companies are

competitively prices and designed for Idahoans.

Marketplace: Shop

Make easy apples-to-apples comparisons of health insurance options available.

Marketplace: Compare

All plans MUST cover these services:• Free preventative care• Coverage for prescription drugs• Emergency care• Hospitalization• Doctor’s visits• Maternity and newborn care• Mental health and substance use disorders• Rehabilitative and habilitative• Laboratory services• Preventative and wellnessAnd many other health care services


No matter which plan you choose, you will get the same set of essential benefits.


Metal Level Paid by Health Plan

Paid by Consumer

Bronze 60% 40%

Silver 70% 30%

Gold 80% 20%

Platinum 90% 10%

Metal Levels and Premiums

Advanced Premium Tax Credit

Your Health Idaho is where you may receive a

tax credit to lower the cost of your monthly

premium.

Marketplace: Choose

Marketplace: Choose

Who is eligible for an Advanced Premium Tax Credit or Cost Sharing Option?

Advance Premium Tax Credit Income Qualifications

Family Size Income Range

Individuals $11,490-45,960

2 people $15,510-62,040

3 people $19,530-78,120

4 people $23,550-94,200

Cost-Sharing Reduction Income Qualifications

Family Size Income Range

Individuals $11,490-$28,725

2 people $15,510-$38,775

3 people $19,530-$48,825

4 people $23,550-$58,875

Estimated Savings for an Individual

Estimated Premium Assistance for an IndividualAge 26

Annual Income: $13,000

Estimated Monthly Premium on Mid-Range Silver Plan $185

Monthly advanced premium tax credit estimate $159

Estimated lower monthly premium cost with advanced premium tax credit applied $26

Estimated Savings for an Individual

Estimated Premium Assistance for an IndividualAge 61


Estimated Monthly Premium on Mid-Range Silver Plan $507


Estimated lower monthly premium cost with advanced premium tax credit applied $65

Estimated Savings for Family of Three

Single Parent, Age 35 & two children under 20 $ 37,000 annual income

Estimated Monthly Premium on Mid-Range Silver Plan

$450



$180

Estimated Savings for a Family of Four

Estimated Premium Assistance for Family of FourTwo Adults age 40 & Two Children under 20



$690


Estimated lower monthly premium cost with advanced premium tax credit applied $ 280

Marketplace: Individuals

$11,490 $22,980$34,470

ADVANCE PREMIUM TAX CREDITS

$45,960

Advance Premium Tax Credits (APTC) are for individuals with income between $11,490 and $45,960

COST-SHARING REDUCTIONS

Cost-Sharing Reductions (CSR) are available for individuals with income $11,490-$28,725 that purchase a silver plan.

Eligibility for Cost-Savings for individuals (Age 19-64) on Plans Sold on Your Health Idaho

Annual Income

Marketplace: Family of Four

$23,550 $47,100$70,650

ADVANCE PREMIUM TAX CREDITS

$94,200

Advance Premium Tax Credits (APTC) are for a family of four with an between $23,550 and $94,200

COST-SHARING REDUCTIONS

Cost-Sharing Reductions (CSR) are available for individuals with income $23,550-$58,875 that purchase a silver plan.

Eligibility for Cost-Savings for a family of four (Ages 19-64) on Plans Sold on Your Health Idaho

Annual Income

Timeline

Important dates to remember.

December 15, 2013: Enrollment deadline for coverage starting Jan 1, 2014

March 31, 2014:End of open enrollment for 2014

October 15, 2014:Beginning of open enrollment for 2015

“This is a marathon,

not a sprint.”– Amy Dowd,

Executive Director, Your Health Idaho

Timeline: Individuals and Families

Getting Started

What you need to know.

What you need to get started:

1. Estimated 2014 income2. Current insurance information3. Your Social Security Number

for all applying4. Zip code5. Dates of birth

What you need

Apply

Getting a plan right for you.

Resources: Website

View Plans and Rates

Resources: Website

Tax Credit Calculator

YHI Calculator

Resources: Website

Resources: Applications

By phoneYou can complete the entire application process from beginning to end with information you provide over the phone.

1-800-318-2596

Apply Over Phone

Applying Online

Applying Online

Getting Help

Finding an expert.

Resources: Consumer Connectors

Consumer Connectors

Consumer Connectors

Consumer Connectors

In-Person Assisters:

• Employees or volunteers from non-profit entities around Idaho• Trained and cleared through national background checks• Can help you understand available options• They are NOT able to make recommendations

Our Partners:Idaho Primary Care Association

Mountain States GroupPublic Health Districts

Idaho Association of CountiesIdaho Hospital Association

Community Action Partnership of Idaho

Consumer Connectors

Agents and Brokers

• Licensed and regulated by Idaho’s Department of Insurance• Typically get payments or commissions from health insurance

companies for enrolling people• Some agents and brokers can sell plans from specific health

insurers

As opposed to IPAs, agents and brokers CAN make recommendations and advise on which plan to buy

Additional Help

Your Health Idaho website• www.YourHealthIdaho.org

Consumer Resource Center• 855-YH-Idaho (855-944-3246)

Questions?

Graph/ Chart Goes Here

Additional—If needed

Local Control

1. Plan Management

Under the Federally Facilitated Marketplace (FFM):

Federal government reviews & regulates plans

Idaho’s State-based Marketplace Your Health Idaho (YHI)2013-2014

The Idaho Department of Insurance (DOI) reviewed and the YHI board approved qualified health plans.

Idaho’s State-based Marketplace Your Health Idaho (YHI)2015 and beyond

The Idaho Department of Insurance maintains full regulatory authority.

2. Consumer Assistance Program


Federal government designs & operates program.

Limited role for agents/brokers


Idaho maintains the primary and integral role for agents and brokers, in selling health insurance

Our assistance program is based in Idaho.


Idaho maintains the primary role for agents and brokers.

Idaho builds program that meets Idaho’s unique needs.

Local Control

3. Assessment Fee


Federal government sets fee at 3.5% for 2014.

Assessment fee revenue paid to federal government


Idaho sets lower fee of 1.5% for 2014 which will be adjusted in future.

Assessment fee revenue stays in Idaho.

Lower fee saves money, e.g. $2.9 M savings in 2014 if 50k enroll


Aim to keep Idaho’s assessment fee below federal fee.

Assessment fee revenue stays in Idaho

Local Control

4. Governance and Funding


Federal government governs Idaho’s marketplace and spends some of Idaho’s assessment fee revenues out-of-state.


19-member board of Idahoans governs marketplace & decides how to spend assessment fee & grants.

Federal grants used in-state which created local jobs, plus work for Idaho-based vendors and businesses.

Funding of marketplace this year is from federal grants, no state funds are used to fund marketplace.


Idaho’s marketplace will be sustainable by 2016, no state funds used to fund marketplace.

Assessment fee revenues that stay in Idaho create local jobs & work for Idaho businesses

Local Control

5. Technology Solution


The federal government facilitates & operates its own technology solution


Governor Otter successfully negotiated to borrow existing technology while Idaho develops its own without a fee for 2014 only.


Idaho controlled technology solution designed to meet Idaho’s unique needs will be implemented.

Local Control

Local Control

6. Agent and Broker Regulation


Federal government sets qualifications and approves agents and brokers to sell marketplace products


For 2014 only, the federal government set qualifications and approved Idaho licensed agents and brokers to sell marketplace products


Idaho will approve licensed agents and brokers to sell marketplace products in coordination with Idaho Dept. of Insurance

Shop. Compare. Choose. Your Health Idaho and You.

Documents

health idaho

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estimated monthly premium

health needs

health planpaid

premium assistance

idaho legislature

marketplace shop