Choosing a coverage level
Health insurance plans are categorized into five tiers: Catastrophic, Bronze, Silver, Gold, and Platinum. These tiers represent different levels of coverage and cost-sharing.
Are you and your family mostly healthy, or do you have ongoing medical needs? Consider your health needs when choosing.
Think about expected healthcare costs, like medications, doctor visits, or surgeries.
Account for doctor visits and chronic conditions. The right coverage tier depends on your situation.
Balance premium costs (based on factors like age and tax credits) with out-of-pocket expenses for an informed choice.
Read more about choosing a coverage level.
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No frills plan designed for emergencies, but includes many $0 preventive services.
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Typically has the lowest monthly premiums but the highest out-of-pocket costs.
Covers about 60% of your healthcare costs.
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Offers moderate monthly premiums and moderate out-of-pocket costs.
Covers about 70% of your healthcare costs.
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High coverage for frequent doctor visits. Generally has higher monthly premiums but lower out-of-pocket costs.
Covers about 80% of your healthcare costs.
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Maximum coverage possible. Has the highest monthly premiums but the lowest out-of-pocket costs.
Covers about 90% of your healthcare costs.
Consider the Provider Network
Provider Networks are doctors, hospitals, and other healthcare facilities who have contracts with Mountain Health Co-Op to provide services at lower negotiated rates. These rates are known as In-Network rates.
If more than one network is available for your location consider your medical history and travel preferences.
For example, if you have an existing relationship with a Primary Care Provider or a specialist, find out if they are in the network you’re considering joining.
Partnership with St. Alphonsus Regional Medical Center.
Counties: Ada, Boise, Canyon, Gem, Owyhee, Payette, and Washington
Partnership with St. Luke Medical Center.
Counties: Ada, Adams, Blaine, Boise, Camas, Canyon, Cassia, Elmore, Gem, Gooding, Jerome, Lincoln, Minidoka, Owyhee, Payette, Twin Falls, Valley, and Washington
Available in every other country not listed for Access and Link
Limited in some regions due to St. Luke’s and St. Alphonsus Networks.
Engage plans are a standard Point of Service plan featuring a wide range of in-network providers.
Our Access Care plans are a Point of Service plan.
Plus plans are designed to support the relationship with your primary care provider. This means the plan keeps your co-pay lower by providing the option to visit Tier 1 providers, who are available through participating Community Health Centers.
Our Connected Care plans are designed to allow freedom of choice while working to reduce your out-of-pocket costs.
Our High Plains plans are designed to emphasize preventive healthcare with a cost-efficient network of providers.
Understand plan costs
Weigh the trade-offs of a low monthly premium with higher out-of-pocket costs versus higher premiums with lower out-of-pocket costs.
Current treatments, meds, and significant upcoming life changes such as pregnancy, retiring, or elective surgery should factor into your decision.
Remember:
We offer plan perks to help lower overall costs.
Get paid up to $210 to see doctors and pay $0 for thousands of medications. Learn more...
Monthly Premium Costs
Your premiums are calculated based on individual circumstances, such as age, location, and plan type.
Tax credits may lower your monthly premium and are calculated via your state’s marketplace.
Review Plan Documents
Carefully review each plans’ documents. The Outline of Coverage and Summary of Benefits contain complete cost and coverage details.
The amount you must pay out-of-pocket before your insurance coverage starts. The percentage of cost covered after deductible is met is determined by coinsurance.
A percentage of the cost you share with the company after meeting the deductible.
e.g. If your plan says “Coinsurance: 80%,” you’ll be responsible for the remaining 20%.
The most you’ll pay for covered services in a plan year.
Fixed fees you pay for specific services (e.g., $20 for a doctor’s visit).
Low-cost, generic medications that are considered the most affordable option for treating a particular medical condition.
Purchase your health plan
Plans are typically purchased during the annual Open Enrollment Period, which varies by state and takes place towards the end of the year. Plans purchased during Open Enrollment take effect the following year.
You may purchase directly from us or through your state’s marketplace.
Example
A plan purchased during Open Enrollment on November 15, 2023 becomes effective January 1, 2024.
Special Enrollment Periods
You may qualify for a Special Enrollment Period after certain life events, such as getting married, having a baby, losing employer coverage, or moving to a new area.
This Special Enrollment Period will last 60 days from when the life event occured.
Answer a few questions to see which plans are available in your area and view estimated tax credits.
This pricing is a quote.
If you have questions or need advice, you can call us 855-485-7080
Create an account to submit complete details about each person on your plan.
Eligible tax credits or subsidies can be chosen during this step.
You’re now ready to make a final choice and enroll.
Pay your first premium by the due date to activate your coverage.
Learn how to maximize your coverage
Get paid up to $210 to stay healthy, find $0 medications, access hundreds of preventive care services, and more. All without having to meet your deductible.
Understand what’s covered to take advantage of your plan’s perks.
Get advice choosing a plan that fits.
Talk to an advisor: 855-485-7080
