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Idaho Short-Term Health Plans
Idaho health insurance has become more complicated since October 2, 2018 when the Trump administration instructed federal agencies to ease restrictions on healthcare coverage. Prior to 2017, federal regulations had long limited the duration of short-term health plans to just one day shy of a year. The new rules, however, returned to that time frame.
Some states set the maximum period at six months while other states didn’t allow short-term plans at all. Short-term health insurance policies have always been outside of the Affordable Care Act (ACA) as they weren’t major medical plans and didn’t meet federal standards for “minimum essential coverage.”
The Obama administration tightened short-term regulations that took effect in 2017 and limited temporary healthcare insurance plans to 90 days. States that didn’t adopt their own regulations defaulted to federal rules. As a result, since Idaho didn’t limit the duration of temporary policies, it needed to follow federal guidelines.
In addition to the rule changes promoted by the White House, Congress enacted the Tax Cut and Jobs Act, which had revised the ACA. The new law repealed the unpopular “individual mandate” which forced Americans to pay a penalty unless they purchased health insurance, qualified for an exemption, or if they weren’t already covered by their employer or a program such as Medicare or Medicaid.
Idaho Health Insurance – It’s Complicated
The new health insurance regulations complicated matters for residents of Idaho. Policies in Idaho are now subject to the 364-day rule, but it becomes a bit more confusing when talking about extending coverage.
If the health plan is renewable, it’s subject to rules that apply to Idaho’s insurance regulations. The major provision is that the plan be renewable.
See what we mean? It’s complicated.
Idaho’s Department of Insurance Bulletin No. 03-1 makes a distinction between a “health benefit plan” as opposed to short-term coverage. The state of Idaho has determined that short-term medical plans are less than one year in duration and not renewable.
If a policy can be renewed, it doesn’t meet the requirement to be considered a short-duration policy. It then becomes a different type of policy.
Once a policy is renewed, reissued, or extended, it’s determined to be a health benefit plan and is subject to Idaho health insurance law. This includes a requirement that the policy guarantees renewability.
“‘Health benefit plan’ means any hospital or medical policy or certificate, any subscriber contract provided by a hospital or professional service corporation, or health maintenance organization subscriber contract. Health benefit plan does not include policies or certificates of insurance for specific disease, hospital confinement indemnity, accident-only, credit, dental, vision, Medicare supplement, long-term care, or disability income insurance, student health benefits only, coverage issued as a supplement to liability insurance, worker’s compensation or similar insurance, automobile medical payment insurance, or nonrenewable short-term coverage issued for a period of twelve (12) months or less.”
-Idaho Health Insurance Law
Idaho has other considerations regarding preexisting conditions for health benefit plans as well. All in all, some of the new regulations apply, but other portions – such as the maximum 36 months for renewals – don’t apply.
Idaho Short-term Health Plans
So what are your options? At least nine companies offer short-term insurance in the state of Idaho with terms of six or 12 months. Idaho short-term insurance offers deductibles from $1,000 to $10,000 or more per policy.
Coinsurance ranges from 10 percent to 50 percent and above. Policy maximum coverage can be as low as $500,000 or as high as $2 million.
There are also Preferred Provider Organizations or PPOs, meaning that those insurance companies have negotiated pricing for in-network doctors and medical facilities. Out-of-network providers may be seen, but at a higher cost.
Idaho short-term insurance includes indemnity plans. These temporary duration policies basically cover a portion of eligible medical services.
Idaho consumers should refer to the plans for more details and carefully review their benefits and exclusions when evaluating their coverage needs.
The state of Idaho cautions consumers that these temporary policies don’t meet federal guidelines for inclusion in the ACA, popularly known as Obamacare. These plans may refuse applicants based on their health histories and preexisting conditions such as asthma, diabetes, hypertension, stroke, and others.
Also, premiums can be based on health status or gender. While short-term plans may have significantly lower premiums, they can result in higher out-of-pocket costs.
Finally, Idaho short-term health plans cannot be renewed. This means that Idaho residents will need to find new coverage after the end of the term of their policy.
“Consumers need to be sure they understand what they are buying,” says Idaho Department of Insurance Director Dean Cameron. “We encourage Idahoans to visit with a licensed insurance agent to help them decide whether short-term coverage is their best option.”
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