Medicare Plan Options

Original Medicare is a federally funded program that provides good base coverage for retirees with limited health needs. However, if you’re accustomed to private health insurance with a wide range of benefits, Original Medicare’s scope of coverage may seem limited. In Idaho, several private insurance companies provide plans that can be added to or used in place of Original Medicare to gain additional coverage.

Original Medicare

Original Medicare is the basic standardized coverage that you’re eligible for when you turn 65. Depending on whether you’re drawing Social Security, you may be automatically enrolled in the program, or you may have to sign up. As long as either you or your spouse paid Medicare taxes for at least 10 years, you won’t have to pay anything for Part A coverage. This insurance pays for the care you receive in a hospital or nursing home, hospice care, and home health care. Part B’s monthly premium is roughly the same for everyone at $149, but income-based financial assistance is available. This coverage pays for medically necessary services and durable medical equipment, such as mobility aids, inpatient and outpatient mental health services, ambulance services, and preventative care.

Medicare Advantage Plans

If you’re looking for more robust coverage, a Medicare Advantage Plan may be a good option. These plans are provided by private insurance companies that follow federal rules and regulations. MA Plans, also called Part C, feature the same benefits as Original Medicare. At a minimum, you pay the monthly premium for Part B coverage, and there may be an additional premium depending on the MA you choose. MA plans are popular because they often feature additional benefits such as vision, dental, and hearing coverage; prescription drug coverage; and discounts for fitness and wellness programs. Unlike Original Medicare, Part C plans usually have annual out-of-pocket limits, and many plans don’t have deductibles that must be met before the coverage kicks in.

Medicare Prescription Drug Coverage Plans

To control out-of-pocket medication costs, a Medicare prescription drug coverage plan can be added to your Original Medicare policy. These plans are offered by private health insurance companies, and each plan features its own drug formulary, cost-sharing responsibilities, and rules about seeing network providers. While it may be tempting to skip this coverage when you first enroll in Medicare if you don’t regularly take any medications, if you add it later on, you pay late enrollment fees for as long as you have your policy.

Medicare Supplement Insurance Plans

Medicare Supplement Insurance Plans are sold by private companies and help you control the out-of-pocket costs associated with your Original Medicare policy. These plans cover a portion of your deductibles, coinsurance, and copays. Some plans also offer annual out-of-pocket limits, which can yield significant savings if you experience an injury or illness. Plans are standardized, making it easy to compare them.

Medicare in Idaho by the Numbers

People enrolled in Original Medicare Average plan cost Annual state spending per beneficiary Spending per beneficiary compared to the national average
218,557 Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
$8,467 -16.00%

*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.

Medicare Resources in Idaho

As an Idaho resident, you have access to a network of support that can help you make educated decisions regarding your health insurance coverage. Through the following resources, you can get information about your Original Medicare benefits and available Medigap, prescription drug, and Part C plans. You can also get help with addressing billing errors and suspected fraud.

Idaho Department of Insurance

The Idaho Department of Insurance is the regulating body that licenses insurance companies in the state. This department can advocate on your behalf by fielding and investigating complaints and questions you have about how a claim was handled. The department also provides general fraud information and tips on what to do next if you believe that you’ve been the target of a scam.

Contact Information: Website | 208-334-4250

Senior Health Insurance Benefits Advisors

SHIBA is a free statewide program that provides confidential, unbiased information about your health insurance options. Its volunteer counselors aren’t affiliated with any health insurance agencies and aren’t licensed to sell policies, but they can answer questions about your Medicare benefits and billing statements. They can also help you compare Medicare Advantage Plans, Medigap, and prescription drug plans to determine which options best fit your needs and budget.

Contact Information: Website | 800-247-4422

Idaho Commission on Aging

The Idaho Commission on Aging is federally funded and provides a variety of services to those aged 60 and over. It provides these services through a network of six Area Agencies on Aging, each of which serves seniors in specific regions. Through your local AAA, you can connect with a SHIBA counselor for free Medicare assistance.

Contact Information: Website | 208-334-3833

Idaho Legal Aid Services, Inc., is a statewide agency that provides free civil legal aid to those aged 60 and over. Its representatives can help you obtain government benefits, such as Medicare, Medicaid, and Social Security. They can advocate on your behalf if your Medicare policy is canceled or if a claim isn’t handled properly.

Contact Information: Website | 208-746-7541

Idaho Senior Medicare Patrol

The Idaho SMP program educates older adults about Medicare fraud and abuse. Its volunteers can help you identify and resolve issues such as double charges for services and getting billed for services your doctor didn’t order or you didn’t receive. It can also help you protect yourself against mail and phone scams and identity theft.

Contact Information: Website | 208-334-3833

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