Medicare Advantage Plans In Idaho

Fact Checked
Published: 5/16/2021

When you sign up for Medicare in Idaho, you can receive your insurance in two ways: basic coverage through the federal government's Original Medicare program or more expansive coverage through a private Medicare Advantage Plan. Medicare Advantage Plans cover you for the same medically necessary services as Original Medicare, which includes Part A hospital insurance and Part B medical insurance. Medicare Advantage also offers extra benefits that aren't part of Original Medicare, such as prescriptions, eyeglasses, hearing aids, dental care, and fitness.





  • In 2019, there were 44 Medicare Advantage Plans available in Idaho.
  • 32% of the total Medicare population in Idaho is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $8,467 per beneficiary in Idaho, which is 16% lower than the national average.
  • Available Medicare Advantage Plans range from 1 to 43 across Idaho’s 44 counties.

If you decide the broader coverage of a Medicare Advantage Plan is a good fit, you can enroll in a plan in your service area. To find the best plan for your needs, compare the overall costs based on how often you expect to require health care. For example, plans that have no monthly premiums may have higher deductibles when you seek treatment, but this may be cost-effective if you don’t anticipate needing health care frequently. Plans with higher premiums may cost more upfront but typically offer more benefits and savings. Look for a plan that fits your particular health care needs.

Medicare Advantage Plans in Idaho

Types of Medicare Advantage Plans

Idaho’s Medicare Advantage program is also known as Medicare Part C and includes four main types of plans. Plans differ in terms of the supplemental benefits offered, so be sure to review the policies carefully. For example, some may cover only dental cleanings, while others may help pay for crowns, fillings, and dentures. You should also compare policies to determine any limitations on the health care providers you can choose.

Health Maintenance Organizations (HMO)

HMOs deliver health care through a network of providers that usually offer services at a reduced rate. With this type of plan, you’re only covered if you use providers within the network. The HMO may also require you to choose a primary care doctor to oversee your care, order tests, and refer you to specialist physicians. You should be prepared to change primary physicians if your current one isn’t part of the HMO network.

Preferred Provider Organizations (PPO)

Under a PPO, you can get health care services from any Medicare-approved provider. Your costs are lower, however, when using one from the PPO’s network of preferred providers. This type of plan doesn’t require you to have a primary care physician and can be a good choice if you want the flexibility of coordinating your own care and seeing a specialist when you wish.

Private Fee-For-Service Plans (PFFS)

PFFS plans establish the rate the company will pay for different types of health care services, even when a provider may have set the fees. If you sign up with a PFFS, you can use the plan with any provider that accepts the plan’s rates. Not all providers do, so you must confirm you can use the plan before you’re treated.  You do have the freedom of managing your health care under a PFFS and don’t need to get a doctor’s referral to see a specialist.

Special Needs Plans (SNP)

Suppose you have a chronic illness such as diabetes, HIV/AIDS, cardiovascular disease, or an autoimmune disorder. In that case, you may qualify for an SNP designed to meet your specific health care needs. These plans are customized to cover certain medications, treatments, and services from specialist doctors. SNPs typically require you to have a primary physician or care coordinator to oversee your health needs. This type of plan is only available in selected service areas.

Enrollment and eligibility for Medicare Advantage Plans in Idaho

Eligibility

Before you can enroll in a Medicare Advantage Plan in Idaho, you must be eligible for basic Medicare Part A and Part B. Most Americans are automatically enrolled in Medicare when they turn 65 if they receive Social Security benefits; otherwise, you need to sign up on your own. Once you’re enrolled, you can join a Medicare Advantage Plan in your service area if you’re not in a Medicare Supplement Insurance Plan, as the two plans don’t work together.

According to new Medicare guidelines, you can now join a Medicare Advantage Plan if you have end-stage renal disease.

Enrollment Periods

You can only enroll in Medicare Advantage or change your existing Medicare coverage during specific periods.

  • Initial enrollment period: The first time you can enroll in Medicare Advantage is during your initial enrollment period starting three months before the month you turn 65. This is a seven-month window and ends three months after the month you turn 65.
  • Medicare open enrollment period (October 15 to December 7): If you don’t join a Medicare Advantage Plan when you’re first eligible, you usually have to wait until Medicare’s annual open enrollment period. During this period, you can move between Original Medicare and Medicare Advantage or change Medicare Advantage Plans. Your new coverage is effective on January 1.
  • Medicare Advantage open enrollment period (January 1 to March 31): This annual window applies to those currently in a Medicare Advantage Plan. You can switch between Medicare Advantage Plans or return to Original Medicare. You can’t join Medicare Advantage from Original Medicare at this time.

Prescription drug coverage

Prescription drug coverage (Part D) is included in most Medicare Advantage Plans. If you’re getting health insurance through Original Medicare, you can add on a standalone Part D drug plan from a private company to have your medications covered. You cannot add on a Part D plan if you enroll in an HMO or PPO Medicare Advantage Plan. Drug plans typically have an annual deductible, which means you must pay for your prescriptions until you meet this threshold. While you can delay enrolling in a drug plan until you need it, keep in mind that a late enrollment penalty applies if you wait.

Medicare Advantage Resources in Idaho

It can be hard to keep track of the different parts of Medicare and the available options. Before enrolling in a plan, be sure to thoroughly understand the plan’s policies so that you can maximize your health insurance and avoid unexpected costs. If you have any questions or difficulties, reach out to one of the following resources for help.

Senior Health Insurance Benefits Advisors (SHIBA)

SHIBA provides Idaho seniors with up-to-date, objective Medicare information, whether you’re just learning about your options or want to review your existing coverage. You can register for webinars on a variety of Medicare topics or speak with a trained counselor for free, one-on-one consultations. Call the toll-free helpline to ask Medicare-related questions or make an appointment for personalized Medicare counseling.

Contact Information: Website | 800-247-4422

Idaho Department of Health and Welfare

Idaho seniors with limited resources may be eligible for help in affording health care insurance. If you’re enrolled in Medicare and meet certain income requirements, you may qualify for the state Medicare Savings Program that helps with premiums, deductibles, and copays. Some residents may qualify for health care coverage through Medicaid. You may apply for these programs online or call the Department of Health and Welfare’s helpline for more information.

Contact Information: Website | 877-456-1233

Idaho Legal Aid Services

If you have a dispute or problem related to public benefits such as Medicare and Medicaid, you can call the Senior Legal Advice Line at Idaho Legal Aid Services. Because the organization assists low-income individuals and seniors, be prepared to answer questions about your income to see if you qualify for help. The Senior Legal Advice Line may provide you with legal information and advice, connect you with a staff attorney, or refer you to another organization.

Contact Information: Website |  208-746-7541

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