Frequently Asked Questions
What are Health Insurance Marketplaces?
How does Idaho Insurance Marketplace differ from the State of Idaho's Public Insurance Exchange?
Will it cost me anything to use your services?
Will my rate be lower if I purchase coverage directly through Idaho's Public Insurance Exchange?
Do I have to buy health insurance through the Exchange or Marketplace?
What are navigators, certified application counselors, and assisters?
Are there penalties if I don't purchase insurance?
What are the metal plans?
What are Essential Health Benefits?
Can I keep my current plan, or will I be forced to buy a new plan?
What is the SHOP exchange?
What is open enrollment?
Can I get free Health Insurance?
How do subsidies work?
How do lower out of pocket cost work and am I eligible?
How does a PPO plan work?
What is the best health insurance plan for me?
What is a deductible?
What is a co-pay?
How do you protect my private information?
What are Health Insurance Marketplaces?
Health Insurance Exchanges or Marketplaces are State-based competitive shopping portals where people and small businesses can shop for and buy private health insurance. Consumers will have the same health plan choices available as members of Congress. The marketplaces are not private insurance companies or government-run health plans.
How does Idaho Insurance Marketplace differ from the State of Idaho's Public Insurance Exchange?
Idaho Insurance Marketplace is a private entity and is unaffiliated with the State of Idaho and their public exchange Your Health Idaho. Consumers can enroll in plans directly through either the state of Idaho's Exchange or through our website at the same price. Here at Idaho Insurance Marketplace we employee licensed brokers and advisors who are available to provide plan recommendations and are certified to assist consumers in enrolling in Idaho's State based Exchange. Only licensed brokers are able to give product recommendations and advice.
Will it cost me anything to use your services?
There is no cost to you for using any of our services.
Will my rate be lower if I purchase coverage directly through Idaho's Public Insurance Exchange?
The rates through the State of Idaho's Exchange are exactly the same as those offered here through Idaho Insurance Marketplace - Guaranteed!
Do I have to buy health insurance through the Exchange or Marketplace?
No. However the only way to qualify for the subsidy is if you purchase insurance through the Marketplace or Exchange. Using Idaho Insurance Maketplace's services allows you to compare plans and rates including subsidies side by side; before going to the state/federal exchange to complete your purchase. We help you through the application process and in applying for those subsidies.
What are navigators, certified application counselors, and assisters?
These are individuals that are intended to provide assistance to individuals applying for medical assistance and/or enrolling on the exchange. They will primarily be regulated by the State of Idaho's exchange. They are NOT licensed brokers and they cannot make product recommendations.
Are there penalties if I don't purchase insurance?
Under the new Patient Protection and Affordable Care Act starting in 2014 the federal government requires most Americans to have qualified health insurance coverage or be forced to pay a penalty. In 2014 the penalty is $95 for adults and $47.50 for children, with a maximum of $285 per family or 1 percent of the family income, whichever is greater.
What are the metal plans?
All marketplace plans are separated into 4 different categories: Bronze, Silver, Gold, and Platinum. Platinum plans are the richest in benefits; Gold plans are the second richest and so on. The metal designation is used to help when comparing plans. As a general guideline Platinum plans cover 90% of medical cost, Gold plans 80%, Silver plans 70% and Bronze 60%. Bronze plans are designed with the lowest monthly premium and highest cost sharing—such as deductibles, coinsurance and or copayments—when health care services are utilized. Platinum plans generally have the highest monthly premium and lower cost sharing responsibility for the patient.
What are Essential Health Benefits?
Health plans offered both inside and outside of the Marketplace, offer a comprehensive package of items and services, known as essential health benefits. Essential health benefits must include items and services within at least the following 10 categories: ambulatory patient services; emergency services; hospitalization; maternity and newborn care; mental health and substance use disorder services, including behavioral health treatment; prescription drugs; rehabilitative and habilitative services and devices; laboratory services; preventive and wellness services; chronic disease management; and pediatric services, including oral and vision care. Insurance policies must cover these benefits in order to be certified and offered in the Health Insurance Marketplace.
Can I keep my current plan, or will I be forced to buy a new plan?
For most people, the answer is that we will have to buy a new metal plan through the Idaho Exchange. When your plan renews in 2014 you will need to move to a new exchange plan, unless your current plan is in a grandfathered status. Grandfathered plans are rare, so most people will need to move to a new plan.
What is the SHOP exchange?
It is the health insurance exchange for small employers (Small Business Health Options Program).
What is open enrollment?
Open enrollment is a specified timeframe in which you can not only buy health insurance products, but you can apply for a subsidy. Some insurance carriers will allow you to buy health insurance outside of open enrollment, but you will not qualify for a subsidy unless you meet 'special enrollment' guidelines such as, your current plan is expiring and will not continue (2014 only), loss of group coverage, marriage, divorce, newborn child and adoption. Specific open enrollment periods are as follows:
Initial open-enrollment period — October 1, 2013, through March 31, 2014.
Annual enrollment period — for benefit years starting on or after January 1, 2015 will be October 15 through December 7 of the preceding year.
Can I get free Health Insurance?
There are a lot of myths in regards to the new health care laws and plans that are offered, the simple answer is no. However you may qualify for a subsidy to assist you with the cost of health insurance premiums. There are several factors which determine the amount of the subsidy you qualify for including your income, age and family size. Some subsidized premiums may be close to $0.
How do subsidies work?
If your household income is between 100% and 400% of the federal poverty level, you likely qualify for a subsidy to help offset the cost of buying an individual health insurance policy.
The subsidy is paid by the federal government directly to the insurance carrier. The premium you pay each month to the insurance carrier is the subsidized premium. You do NOT need to pay the full premium and be reimbursed later.
If your personal or family income falls below 100% of the federal poverty level you may be eligible for Medicaid.
The amount you save depends on your family size and how much money your family earns. In general, people at the following income levels will qualify to save in 2014. The lower your income, the higher your savings will be. (The amounts below are based on 2013 numbers and are likely to be slightly higher in 2014.)
- Up to $45,960 for individuals
- Up to $62,040 for a family of 2
- Up to $78,120 for a family of 3
- Up to $94,200 for a family of 4
- Up to $110,280 for a family of 5
- Up to $126,360 for a family of 6
- Up to $142,440 for a family of 7
- Up to $158,520 for a family of 8
You may also be able to get lower out-of-pocket cost depending on your income and family size. When you apply for lower costs, you'll need to estimate your household income for 2014. For most people, you can use your household's adjusted gross income for this estimate. If you know your 2013 adjusted gross income, use that and take into account any changes you expect in 2014. When you fill out the Marketplace application, a number called "modified adjusted gross income" (MAGI) will be used.
Modified adjusted gross income is generally your household's adjusted gross income plus any tax-exempt Social Security, interest, and foreign income you have. It's used to determine your eligibility for lower costs on Marketplace coverage and for Medicaid and the Children's Health Insurance Program (CHIP).
So what happens if you get a subsidy payment in advance and then your spouse suddenly finds a job, boosting your family's income? You'll need to go through a reconciliation process and pay back some of the subsidy. However, most households will need to repay only a portion of the overestimated subsidy. The amount you have to pay back will be based on how much you earn.
How do lower out of pocket cost work and am I eligible?
When you get coverage through the exchange, you may be able to get lower costs on deductibles, copayments and coinsurance. This will depend on your income. Cost-sharing reduction lowers the amount you have to pay for out-of-pocket costs like deductibles, coinsurance and copayments. These are costs you have to pay when you get care.
This savings is based on your income and family size.
Health insurance companies offering coverage through the Marketplace must lower the amount you pay out of pocket for essential health benefits if your household income is below the following amounts. (Incomes below are based on 2013 numbers. They are likely to be slightly higher in 2014. Amounts are different for each family size, up to 8.)
- Up to $28,725 for individuals
- Up to $38,775 for a family of 2
- Up to $48,825 for a family of 3
- Up to $58,875 for a family of 4
- Up to $68,925 for a family of 5
- Up to $78,975 for a family of 6
- Up to $89,025 for a family of 7
- Up to $99,075 for a family of 8
When you apply for coverage in the Marketplace, you'll learn if you're eligible for these savings on out-of-pocket costs. If you qualify for out-of-pocket savings, you must choose a Silver plan to get the savings.
How does a PPO plan work?
PPO (Preferred Provider Organization) is a network of doctors and hospitals. Although you have the freedom to use any doctor or hospital you receive the greatest benefit by using doctors or hospitals that are a part of the PPO network.
PPO providers are contractually required to provide services to the health insurance plan's members at a discounted rate. You won't be required to pick a primary care physician but will be able to see doctors and specialists within the network at your own discretion.
You will have a deductible to pay before the insurance company starts covering your medical bills. You will also have a co-pay for most services or be required to cover a certain percentage of the total charges for your medical bills.
With a PPO plan, services rendered by an out-of-network provider are typically covered at a lower percentage than services rendered by a network provider.
What is the best health insurance plan for me?
This is a very complicated question. In part because the answer varies so much depending upon your personal circumstances, how long you need coverage, your preferences and other relevant factors. Our professionally trained and licensed agents work closely with you one on one to insure that we place you with the health insurance plan that best suits your needs. For that very reason we send your completed application (with your permission) to ALL of the available insurance carriers in the state of Idaho, something that no other insurance agent or company offers.
What is a deductible?
A "deductible" is a specific dollar amount that your health insurance company requires that you meet (pay out-of-pocket) before your health plan begins to make payments for claims. All insurance plans offer what is called "pre-deductible" benefits. These are benefits that are available without the deductible being met. These benefits always include wellness services and may also include; doctor office co-pays, Rx, accident benefits, chiropractic, vision, lab and X-ray.
What is a co-pay?
A "co-pay" is a specific dollar amount that your health insurance plan requires that you pay for services. For example, your health insurance plan may require a $30 co-payment for an office visit or brand-name prescription drug, after which the insurance company often pays the remainder of the charges.
How do you protect my private information?
At Idaho Insurance Marketplace we take very seriously our responsibility to safeguard your personal history and health information. Every place on our website that gathers personal information is protected via SSL (Secure Socket Layer) and can be verified by clicking on the SSL verification at the start of our online application. All data is stored in the most secure fashion.