IdahoIdaho law lets insured patients count some cash payments toward plan limits
Starting January 1, 2027, patients with health plans who negotiate a lower price for a covered service can get credit toward their deductible and yearly out-of-pocket limit by sending proof and bills to their carrier.
What it does
Patients who pay out of pocket for a covered service can have the full amount count toward their deductible and yearly out-of-pocket limit if they negotiate below the plan's allowed amount and send required records.
Health carriers cannot stop providers from offering covered patients a discounted cash price. Providers must accept that payment as full payment and cannot bill for the remaining balance.
Argument forPatients who negotiate a lower price could get credit for what they paid toward their deductible and yearly out-of-pocket limit.
Argument againstPatients may have to gather bills and proof of payment to get credit, which could make the process harder.
More detail
A health carrier must count the full amount a covered person paid toward the plan deductible and yearly out-of-pocket limit. This applies to covered people with health benefit plans who pay out of pocket for medically necessary services covered by their plans. The service must be medically necessary and covered by the person's plan, and the negotiated price must be below the plan's allowed amount. The person must send the carrier the final bill, provider details, negotiated cost, proof of payment, and proof that the provider will not bill the carrier. The amount counts toward the in-network or out-of-network limits based on the provider. It cannot exceed the person's total out-of-pocket amount for the plan period or carry over to a new plan period. This rule excludes specified limited or supplemental insurance, Medicaid, Medicare supplemental policies, workers' compensation, certain auto coverage, most long-term care policies, and qualifying short-term insurance. It does not waive plan rules for prior approval, medical necessity, or review of services. This rule takes effect January 1, 2027. Credit applies during the plan period and does not carry over when a new plan period begins.
A health carrier may not stop a provider from offering a covered person the option to pay the provider's discounted cash price. The provider must accept that payment as full payment and cannot bill the patient or carrier for the remaining balance. These rules cover health carriers, health care providers, and people covered by a health benefit plan. For a hospital that has a discounted cash price, that price has the meaning set by the cited federal rule. It does not include free care or amounts offered under a hospital's financial assistance policy. These rules take effect January 1, 2027.
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Where it stands
- Introduced
- Passed 1st Chamber
- Passed 2nd Chamber
- To Governor
- Became Law
Looking ahead
No hearings or votes scheduled.
History
- 2026
- Apr 2Reported Signed by Governor Brad Little on April 2, 2026 Session Law Chapter 275 Effective: 01/01/2027Became Law
- Apr 1Delivered to Governor at 12:50 p.m. on April 1, 2026To Governor
- Apr 1Returned Signed by the President; Ordered Transmitted to GovernorMinor
- Mar 31Signed by President; returned to HouseMajor
- Mar 31Received from the House enrolled/signed by SpeakerMajor
- Mar 31Reported Enrolled; Signed by Speaker; Transmitted to SenateMajor
- Mar 31Returned from Senate Passed; to JRA for EnrollingMinor
- Mar 30Read third time in full – PASSED - 29-5-1AYES – Adams, Anthon, Bernt, Bjerke(Bjerke), Blaylock, Burtenshaw, Carlson, Cook, Den Hartog, Foreman, Grow, Guthrie, Harris, Keyser, Lakey, Lenney, Lent, Okuniewicz, Rabe, Ricks, Ruchti, Semmelroth, Shippy, Taylor, Toews, VanOrden, Ward-Engelking, Wintrow, WoodwardNAYS – Hart, Kohl, Nichols, Zito, ZuiderveldAbsent and excused – GallowayFloor Sponsor - CookTitle apvd - to HousePassed 2nd Chamber
- Vote recorded Read third time in full –. Result: pass.Upper
- Mar 25Read second time; filed for Third ReadingMinor
- Mar 24Reported out of Committee with Do Pass Recommendation; Filed for second readingMinor
- Mar 23Introduced, read first time; referred to: Commerce & Human ResourcesMinor
- Mar 23Received from the House passed; filed for first reading
- Mar 20Read Third Time in Full – PASSED - 49-21-0AYES – Beiswenger, Berch, Bingham, Boyle, Bruce, Cannon, Cheatum, Church, Cornilles, Crane(12), Crane(13), Dygert, Egbert, Ehardt, Erickson, Fuhriman, Galaviz, Gannon, Garner, Green, Hall(Stone), Handy, Haws, Healey, Holtzclaw, Manwaring, Mathias, McCann, Mickelsen, Miller, Mitchell, Monks, Nelsen, Palmer, Petzke, Pickett, Pohanka, Raybould, Raymond, Redman, Rubel, Sauter, Shepherd, Shirts, Vander Woude, Veile, Weber, Wheeler, Mr. SpeakerNAYS – Alfieri, Barbieri, Burgoyne, Cayler, Ehlers, Furniss, Harris, Hawkins, Hill, Hostetler, Leavitt, Marmon, Mendive, Price, Rasor, Scott, Skaug, Tanner(13), Tanner(14), Thompson, WisniewskiAbsent – NoneFloor Sponsor - BinghamTitle apvd - to SenatePassed 1st Chamber
- Vote recorded Read Third Time in Full –. Result: pass.Lower
- Mar 19Read second time; Filed for Third ReadingMinor
- Mar 18Reported Printed; Filed for Second Reading
- Mar 18Introduced, read first time, referred to JRA for PrintingIntroduced
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