Idaho Rate Review Individual
This is the summary page for 2022.
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 2020. 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 Statewide Rate Increase||-1%||-3%||-2%||0%||-2%||$416,480,000||$513,270,000|
|Insurance Company||Bronze||Silver||Gold||Catastrophic||Overall||Paid Claims||Premium|
|Blue Cross of Idaho Health Service||-1%||-5%||-1%||-1%||-2%||$139,340,000||$203,650,000|
|Mountain Health CO-OP||-1%||3%||0%||5%||1%||$66,480,000||$81,330,000|
|PacificSource Health Plans||0%||-4%||1%||0%||0%||$7,940,000||$5,870,000|
|Regence BlueShield of Idaho||0%||3%||-2%||n/a||2%||$6,460,000||$10,340,000|