2017 Idaho Individual and Family Plans

The information on this page is for plans beginning January 1, 2017.  

Medical Plans

All plans are available direct with PacificSource and through YourHealthIdaho.org.

Medical policy samples by plan and network: 


Plan

Deductible*

Out-of-pocket limit*

Co-pay for office visits

Co-insurance after deductible

SBCs
by Network
Summaries
by Network
Bronze HSA 6550 $6,550  $6,550  No charge No charge SmartAlliance / BrightPath SmartAlliance / BrightPath
Bronze HSA 6550 (0)*** $0 $0 No charge No charge SmartAlliance / BrightPath SmartAlliance / BrightPath
Bronze HSA 6550 (AI)***  $6,550 $6,550 No charge No charge SmartAlliance / BrightPath SmartAlliance / BrightPath
Silver HSA 3000 $3,000 $5,000 No charge 25% PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Silver HSA 3000 (0)*** $0 $0 No charge No charge PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Silver HSA 3000 (AI)*** $3,000 $5,000 No charge 25% PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Silver HSA 3000 (73)** $1,800 $5,000 No charge 25% PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Silver HSA 3000 (87)** $750 $1,500 No charge 20% PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Silver HSA 3000 (94)** $250 $600 No charge 20% PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Gold 1500 $1,500 $3,000 No charge 20% PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Gold 1500 (0)*** $0 $0 No charge No charge PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Gold 1500 (AI)*** $1,500 $3,000 No charge 20% PacificSource / SmartAlliance / BrightPath PacificSource / SmartAlliance / BrightPath
Catastrophic $7,150  $7,150  No charge+ No charge SmartAlliance / BrightPath SmartAlliance / BrightPath

*Deductible and out-of-pocket limit amounts shown above are the costs for individuals. Amounts for families are twice the individual amounts.

**This is a cost-sharing plan. Cost-sharing plans are only available to those who qualify financially and enroll through YourHealthIdaho.org.

***The Affordable Care Act (ACA) has special provisions for members of federally recognized American Indian tribes that purchase healthcare coverage through the Marketplace, including zero-cost health services for those whose income is at or below 300 percent of the Federal Poverty Level. Please note that even with a zero cost-sharing plan, out-of-network providers can bill for the amount over the network rate.

+The first three primary care practitioner (PCP) office and home visits office visits combined are paid at 100 percent. After that, PCP office visits are subject to deductible and co-insurance.

 

Dental Plans


Dental Advantage 0/20/50 Sample policy  
Kids Dental Advantage 0/20/50 Sample policy  

 

Rates


2017 Idaho Individual and Family Plan Rates

 

Network Availability (Medical)


Network availability varies depending on geographic location.

PacificSource Network (PSN)

 

Availability: If an individual or family lives in one of the following counties, they can choose a plan on the PacificSource Network (PSN): 

  • Adams
  • Bannock
  • Bear Lake
  • Benewah
  • Bingham
  • Bonner
  • Bonneville
  • Boundary
  • Butte
  • Caribou
 
  • Cassia
  • Clark
  • Clearwater
  • Custer
  • Franklin
  • Fremont
  • Idaho
  • Jefferson
  • Kootenai
 
  • Latah
  • Lemhi
  • Lewis
  • Madison
  • Nez Perce
  • Oneida
  • Power
  • Shoshone
  • Teton
 

Notable features: The PacificSource Network (PSN) includes the broadest access to in-network providers and facilities, such as hospitals and urgent care centers. Plans on the PacificSource Network will typically cost more because members will have more providers to choose from. Please note that not all plans are available on the PacificSource Network. See the medical plans listed above for details.

 

SmartAlliance Network

 

Availability: If an individual or family lives in one of the following counties, they can choose a plan on the SmartAlliance Network:

  • Ada
  • Boise
  • Canyon
  • Gem
 
  • Owyhee
  • Payette
  • Washington
 

Notable features: The SmartAlliance Network is designed to give members a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care at a lower cost. This network includes coverage with Saint Alphonsus providers and facilities, as well as other local healthcare providers.

 

BrightPath Network

 

Availability: If an individual or family lives in one of the following counties, they can choose a plan on the BrightPath Network:

  • Ada
  • Blaine
  • Boise
  • Camas
  • Canyon
  • Elmore
 
  • Gem
  • Gooding
  • Jerome
  • Lincoln
  • Minidoka
  • Owyhee
 
  • Payette
  • Twin Falls
  • Valley
  • Washington
 

Notable features: The BrightPath Network is designed to give members a coordinated-care experience through select provider groups and facilities. This level of provider collaboration means great care at a lower cost. This network includes coverage with St. Luke's providers and facilities, as well as other local healthcare providers.