The 2010 Patient Protection and Affordable Care Act has changed the manner in which insurance regulations can be handled on a state-by-state basis. Provisions regarding pre-existing conditions, for instance, will have to be revised in light of the new prohibition against excluding children on that basis. (The same protection will extend to adults by 2014.) Additionally, children may now remain as dependent beneficiaries on their parents’ health care coverage through age 26, with no stipulation regarding educational or marital status.
Initially, to comply with federal provisions, states were charged with implementing some form of high-risk insurance pool, followed by the development of required health insurance exchanges.
General Insurance Regulations
Because Idaho has one of the lowest rates in the nation for employment-based health insurance, some 15% of state residents have no health care coverage at all. Insurers are not, however, allowed to deny coverage or to add an exclusion period for pre-existing conditions at present so as long as the applicant has not been without insurance for more than 63 days.
All insurers in the state must offer basic, standard, and catastrophic health insurance policy options. There is an open enrollment period during which anyone can purchase a new policy even if they have not previously been enrolled in another plan.
The Women’s Health Check Program for low-income women provides breast and cervical cancer screenings, and uninsured children may qualify for the Children’s Access Card. This program provides a $100 to $300 monthly benefit for medical care. Other residents who work for small businesses may qualify for the similar Access to Health Insurance program that provides $100 to $500 to be used for health insurance premiums.
Health Insurance Exchange
Idaho legislators are currently studying options to implement the health care exchange required by the Affordable Care Act, with the Idaho Department of Insurance and the Department of Health and Welfare moving forward with the planning.
In April 2011, the Governor signed into law a measure prohibiting abortion coverage through the state’s health insurance exchange except in cases of life endangerment, rape, or incest.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan in Idaho is administered by the U.S. Department of Health and Human Services. Benefits address both primary and specialty care, as well as prescription drugs and hospitalization. Depending on the applicant’s age and the option selected, premiums may range from $133 to $571 with deductibles falling in a range of $1000 to $3000. (A separate deductible may apply for drug coverage.) Total out-of-pocket expenses for care both in and out of the network may not exceed $7000.
All Medicaid eligibility is figured according to a percentage of the Federal Poverty Level. In Idaho, children under the age of 5 qualify at 133% FPL, with those 6-19 at 100%. That same age group may also access the CHIP-funded Medicaid Expansions at 133% FPL.
Pregnant women may qualify for Medicaid at 133% FPL, parents at 25%, all adults working for small businesses at 185% (enrollment capped at 1000), and non-elderly disabled Social Security recipients at 78%.
There are more than 212,000 state residents enrolled in Medicare, with 215,900 accessing prescription drug coverage.