The Patient Protection and Affordable Care Act, often called the Affordable Care Act (ACA), was passed in 2010 and requires health plans to meet specific requirements relating to coverage, eligibility, and cost-sharing to help ensure a minimum level and quality of coverage.
The ACA, in part, created a new type of health plan that expanded health coverage to more Americans. These plans offer health insurance to people who may be uninsured or uninsurable for a variety of reasons, including preexisting conditions, a lack of affordable plan options, or lack of access to a health plan through their employer. The ACA established guidelines for individuals and families, as well as small businesses. (If you are a small business owner and want to learn more about health plan options, explore what we offer to employers with 2-50 employees.)
ACA plans are offered on a federal or state health insurance exchange – or health insurance marketplace. ACA plans in Idaho are offered through the Idaho exchange, Your Health Idaho (YHI).
ACA plans offer health coverage with different deductibles, copays and out-of-pocket maximums. This lets you choose the plan that best fits your needs. ACA plans are also required to include minimum benefits, as well as items and services, in ten general categories.
Here are the 10 essential health benefits covered by ACA plans:
Make sure to compare plans and offerings to find the best fit for you.
ACA plans are broken out into metal levels based on the level of coverage they provide. Here’s how Healthcare.gov defines each metal level.
Bronze plans have the lowest monthly premiums of the metal levels, but costs for healthcare are higher when you need it. Deductibles for Bronze plans can be very high, meaning you may need to pay for most of your healthcare yourself each year before your health plan begins paying for covered services. Annual wellness exams and certain preventive care services are covered at 100%, so you pay nothing out of pocket for these defined services.
You can find information about Blue Cross of Idaho Bronze plans on our ACA plans page.
Silver plans fall in between Bronze and Gold plans. Premiums for Silver plans are higher than Bronze plans, but not as much as Gold plans. But with a higher monthly premium comes a lower deductible, so you’ll pay less out of pocket when you get care with a Silver plan than with a Bronze plan.
Additionally, you can help offset medical costs with a Silver plan if you qualify for cost-sharing reductions (CSRs). CSRs are only available for Sliver plans. CSRs help lower your yearly out-of-pocket medical costs by lowering your deductible, copayments, coinsurance and out-of-pocket maximum. Qualifications for a CSR on a Silver plan are determined by income and family size.
You can see if you qualify for a CSR plan on Idaho's exchange, Your Health Idaho (YHI). All CSR plans must be purchased through YHI.
You can find information on Blue Cross of Idaho Silver plans on our ACA plans page.
Gold plans have higher monthly premiums than Bronze and Silver plans. Even though Gold plans have some of the highest premiums of the metal plans, the deductibles for Gold plans are typically low. This means you’ll pay less out of pocket each year when you use your health insurance for care and treatment.
You can find information about Blue Cross of Idaho Gold plans on our ACA plans page.
Choosing an ACA plan may depend on how much you expect to use your plan. If you think you’ll need to see a doctor often or have a big surgery planned, you may prefer a Silver or Gold plan so that more of your healthcare costs are covered by your plan.
If you don’t need to go to the doctor very often, then a Bronze plan might be a good choice for you. While you may pay more when you need care, you will have a lower monthly premium with a Bronze plan. Think about your healthcare needs to decide which plan will give you the most value.
If you’re curious learn about Blue Cross of Idaho ACA plans, check out our ACA plans page to compare the coverage and benefit options offered by each of our plans to help you narrow down your options.
Catastrophic health plans have low monthly premiums, but very high deductibles. These plans are designed to offer protection for worst-case scenarios and can end up being very costly if you need to get care often. While you’ll pay a lower premium, the high deductible means you will pay for most of your routine care yourself.
Only people younger than age 30 can buy a Catastrophic plan. People 30 years and older can only buy these plans with a hardship exemption or affordability exemption, based on a lack of affordable health coverage through the exchange or through their job.
Tribal plans, which offer benefits specific to certain American Indians and Alaska Natives, are only available through YHI. Visit YHI’s website for more information on health coverage available to American Indians and Alaska Natives.
You can also buy vision or dental coverage through YHI. Vision plans are offered in partnership with the Vision Service Plan (VSP) and YHI. Adults who enroll in a Qualified Health Plan can also enroll in a Qualified Dental Plan.
You can lower the cost of your monthly premium for an ACA plan by using a tax credit. With the American Rescue Plan Act, passed in 2021, all income levels qualify for an advance premium tax credit (APTC) until the end of 2025. You can use the credit to help pay for all or part of your monthly premium.
You may also be eligible for cost-sharing reductions (CSR). As mentioned above, CSRs can help lower your yearly out-of-pocket costs by lowering your deductible, copayments and coinsurance. These savings are only available with Silver plans, but your annual savings in care may be significant.
To find out if you qualify for an APTC or CSR, use YHI’s tax credit estimator. Enter your household income and select Check for Savings to see what you could save. APTCs and CSRs are given based on household income and/or family size.
While the APTC is first used towards your medical plan premium, any leftover amount can be applied to your dental plan premium. You’ll need to first choose a medical plan to apply your APTC towards, then you’ll be able to use any remaining APTC amount towards your dental plan premium.
Visit YHI’s website to shop for an ACA plan, compare plans and find out if you qualify for APTCs or CSRs. To qualify for APTCs or CSRs on a Silver plan, you must apply for a plan through YHI.
Blue Cross of Idaho offers a few different Bronze, Silver and Gold plans, as well as Tribal and Catastrophic plans. We also have Silver copay plans, which allow you to pay a fixed-dollar amount for benefits and services without having to meet a deductible. This gives you a clearer view of your healthcare costs so you can be prepared before you go to the doctor.
In addition to covering the 10 essential health benefits, Blue Cross of Idaho ACA plans have extra services and savings.
Here are some of the additional benefits our ACA plans offer:
We also offer ACA-qualified dental plans for children and adults on the YHI exchange. Visit our website to compare our ACA medical plans and ACA-qualified dental plans and see which one will work for you.
Written by: Blue Cross of Idaho
Posted: June 4, 2024
Blue Cross of Idaho is providing all of the above information for general informational purposes only. All descriptions of coverage are subject to the provisions of our Member Contract or Enrollee Certificate. Please refer to your Member Contract or Enrollee Certificate for a complete description of benefits, exclusions, and other conditions of coverage. To the extent that any of the information provided above is inconsistent with the Member Contract or Enrollee Certificate, the provisions set forth in the Member Contract or Enrollee Certificate will govern in all circumstances.
