Choosing a health care plan can be confusing, frustrating and many times, expensive.
Maybe it even looks unaffordable.
“When you think of a family of four making $25,000 to $30,000, they’re struggling to find out whether they’re going to pay the rent and put food on the table, and they’re also saying, ‘Gosh, I wish I had health insurance,’” said Pat Kelly, executive director of Your Health Idaho. “A lot of those people are going without because they think they have to make a decision between food and taking care of their family.”
That’s a decision many don’t need to make, Kelly said during a visit Tuesday to The Press. He said that with a built-in tax credit, a family of four making $25,000 might have to pay nothing for health care coverage.
Your Health Idaho is an online marketplace and resource that gives individuals and families options when choosing the health insurance that’s right for them. Open enrollment begins Nov. 1. If you’re already enrolled and happy with your plan, you need do nothing, Kelly said. You’ll automatically be renewed.
“We provide a service that allows people to make an informed decision,” Kelly said. “We’re here to execute per what the legislation says, which is efficient, local control. Idahoans design the plans, Idahoans review them, Idahoans run our support center. They run all of our operations here. We’re focused on giving consumers tools to make great decisions.”
Established by the Idaho Legislature in 2013, Your Health Idaho is an independent entity overseen by a board of a wide cross section of Idahoans who work to ensure long-term success for their fellow Idahoans.
“It was a very contentious issue with the legislature,” Kelly acknowledged, noting that states were faced with the Affordable Care Act’s mandate to either create their own marketplace or use the federal government’s.
Kelly said Idaho chose wisely.
“Essentially, the governor said, ‘Look, we can do it better. We can do it cheaper and we can keep the feds out of Idaho,’” Kelly said. “And those are really the core tenets of why we exist.”
More than 90,000 Idahoans are enrolled in Your Health Idaho, including 9 percent (7,735) of Kootenai County’s residents. Millions of Idaho dollars have been saved, Kelly said.
“We continue to operate at the lowest cost of any state in the country, and we have saved Idahoans $22 million,” he said, explaining that consumers pay less than the 3.5 percent federal assessment fee when they enroll with the state-based Your Health Idaho.
“Our fee has always been lower,” Kelly said. “That’s real money that stayed in the state.”
The nearly 300 individual medical and dental plans offered in the exchange are also geared at keeping money in consumer pockets. Your Health Idaho is the only place people can get a tax credit to offset insurance premium costs, saving most Idahoans 80 percent on monthly insurance premiums.
"You may be eligible for a tax credit, even if you don’t know it," Kelly said.
Those who are between 100 and 400 percent of the Federal Poverty Level may be eligible for the tax credit, which is the only part of Your Health Idaho that uses federal funds. Funding for Your Health Idaho is self-generated from the low assessment fees.
“Having access to health insurance and having it be comprehensive and affordable, when you have choice, you can find what works for your budget,” Kelly said. “It means that people are able to get the care they need early in that process.”
More than 900 certified Your Health Idaho agents, brokers and enrollment counselors are working in communities throughout the state, including nearly 100 within 50 miles of Coeur d’Alene, about 80 in the Sandpoint area and two in Kingston and Pinehurst.
“When you have a decision about health insurance, you want to talk to someone you trust. It’s a hard decision,” Kelly said. “That network of agents and brokers has absolutely been the cornerstone for our success, also the cornerstone for local control.”
The agents are available to help navigate the website, provide expertise and answer other health care plan-related questions.
Kelly said now is a crucial time for people to ask those questions because even if the Medicaid Expansion Initiative Proposition 2 passes during the election next month, it won’t be implemented until Jan. 1, 2020.
“That is a critical message to get out,” he said. “It is a long way in the future, not to mention how it makes its way through the legislation. Our real fear is that people will hear that it passes and think they’re going on Medicaid tomorrow and drop coverage, and then they’re without any coverage.”
Plans are organized by tier — bronze (paying the least per month but higher out of pocket); silver (somewhere in the middle); and gold (pay a higher premium but less out of pocket) — and can be anonymously perused by clicking “Get Coverage" on www.yourhealthidaho.org.
Enrollment runs from Nov. 1 through Dec. 15. People applying for the tax credit must complete their application by Dec. 15 for coverage to begin Jan. 1, 2019.
"We are here to serve Idahoans," Kelly said.