Official Government Website

Idaho Rate Review Small Group

This is the summary page for 2021.

The Department of Insurance receives preliminary health plan information for the following year from insurance carriers by June 1 and reviews the proposed plan documents and rates for compliance with Idaho and federal regulations.The Department of Insurance does not have the authority to set or establish insurance rates, but it does have the authority to deem rate increases submitted by insurance companies as reasonable or unreasonable. After the review and negotiation process, the carriers submit their final rate increase information.The public is invited to provide comments on the rate changes. Please send any comments to Idaho Department of Insurance.

A key driver of increases is generally the level of health claims paid compared to the premium collected. The table below shows the level of claims paid and premium collected by each insurance company for ACA-compliant health benefit plans during 2019. In addition to claims paid, the premium needs to cover the company’s administrative costs, insurance fees, and taxes. Those costs generally consume around 20 percent of the premium. Larger rate increases may be needed when the prior year’s premium is not sufficient to pay for health claims and administrative costs and fees.With its rate increase submission, each insurance company submits a consumer-oriented explanation of the increase, which is available by clicking on the name of the insurance company in the table below.

Each health benefit plan has an associated “metal level” of Bronze, Silver, Gold, or Catastrophic and offers, at a minimum, Idaho's Essential Health Benefits package.The metal level is assigned based on the policyholder's "cost-sharing," which includes any deductibles, coinsurances, copays, and out-of-pocket maximums. A Silver plan usually will have lower cost-sharing than a Bronze plan, and a Gold plan will usually have lower cost -sharing than a Silver plan.However a Gold plan usually has a higher monthly premium than a Silver plan, and a Silver plan usually has a higher monthly premium than a Bronze plan. Policyholders are able to choose which metal level and which plan within that metal level best works for them.

Average 2020 Rate Increases
Prelim.FinalFinalFinalFinalFinal Jan-Dec 2019
Insurance CompanyOverallBronzeSilverGoldPlatinumOverall Paid ClaimsPremium
Blue Cross of Idaho Health Service6%7%7%6%n/a6%$109,160,000$126,780,000
Mountain Health CO-OP-8%-8%-7%-9%n/a-8%$420,000$660,000
National Health Insurance Company10%11%11%10%n/a10%$900,000$900,000
PacificSource Health Plans0%4%2%-1%n/a0%$20,820,000$24,780,000
Regence BlueShield of Idaho5%6%5%5%6%5%$62,610,000$77,240,000
UnitedHealthcare Insurance Company9%9%n/an/an/a9%$2,350,000$2,340,000
Average Statewide Rate Increase6%7%6%6%6%6%$246,100,000$281,720,000
Average 2020 Rate Increases
Blue Cross of Idaho Health Service6%7%7%6%n/a6%
Jan - Dec 2019 Paid Claims$109,160,000
Jan - Dec 2019 Premium$126,780,000
Mountain Health CO-OP-8%-8%-7%-9%n/a-8%
Jan - Dec 2019 Paid Claims$420,000
Jan - Dec 2019 Premium$660,000
National Health Insurance Company10%11%11%10%n/a10%
Jan - Dec 2019 Paid Claims$900,000
Jan - Dec 2019 Premium$900,000
PacificSource Health Plans0%4%2%-1%n/a0%
Jan - Dec 2019 Paid Claims$20,820,000
Jan - Dec 2019 Premium$24,780,000
Regence BlueShield of Idaho5%6%5%5%6%5%
Jan - Dec 2019 Paid Claims$62,610,000
Jan - Dec 2019 Premium$77,240,000
Jan - Dec 2019 Paid Claims$49,830,000
Jan - Dec 2019 Premium$49,020,000
UnitedHealthcare Insurance Company9%9%n/an/an/a9%
Jan - Dec 2019 Paid Claims$2,350,000
Jan - Dec 2019 Premium$2,340,000
Average Statewide Rate Increase6%7%6%6%6%6%
Jan - Dec 2019 Paid Claims$246,100,000
Jan - Dec 2019 Premium$281,720,000

Detailed Rate Increase Information by County

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