Bill Analyses and Ratings

Bill Summary

House Bill 929 adds Section 41-1854 to Idaho Code, establishing new rights and obligations for patients, health insurers, and health care providers regarding cash payments for covered medical services. The bill prohibits health carriers from preventing providers from offering insured patients a discounted cash price for services and explicitly allows covered persons to choose to pay out of pocket rather than routing payment through their insurance plan. Providers who accept cash payment must treat it as payment in full and cannot balance-bill the patient or the insurer for the difference between the cash price and the provider’s standard billed charge.

The bill’s most consequential provision requires health insurers to count out-of-pocket cash payments toward a patient’s deductible and annual out-of-pocket maximum, provided the patient negotiated a price lower than the plan’s allowed amount and submits documentation confirming the provider will not separately bill the insurer. Payments count toward in-network or out-of-network accumulators depending on the provider’s network status. The bill excludes several plan types from the deductible-crediting requirements, including limited benefit policies, dental and vision-only plans, Medicaid, Medicare supplement policies, workers’ compensation, short-term plans of six months or less, and certain other specialty coverages. The law takes effect January 1, 2027.

Overall Assessment

House Bill 929 primarily affects the health care and insurance landscape in Idaho by giving insured patients the practical ability to shop for lower cash prices on covered medical services without losing credit toward their deductible and out-of-pocket maximum. The bill’s most direct and meaningful impact falls under the Health and Welfare metric, where it earns a positive rating by expanding patient financial protections and increasing transparency and flexibility in how health care costs are managed. Most other policy areas evaluated are not materially affected by this legislation, resulting in neutral scores across the majority of metrics.

The bill receives a slight negative rating under Responsibility in Government due to the administrative and regulatory burdens it places on health carriers, who must now implement new systems to track and credit cash payments made outside the traditional insurance billing process. While the consumer benefit is real, the compliance infrastructure required of insurers represents an expansion of regulatory obligation. All remaining metrics, including those related to education, agriculture, natural resources, the economy, and others, are unaffected by this bill’s provisions.