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Medicare Advantage Plans in Idaho


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What is Medicare Advantage in Idaho?

Medicare Advantage in Idaho, also known as Medicare Part C, is another way to get your Original Medicare (Part A and Part B) benefits through a private insurance company contracted with Medicare. The advantages of Medicare Advantage plans in Idaho are:

  • They cover everything Original Medicare covers (with the exception of hospice care which is still covered by Part A)
  • They often offer extra benefits
  • They come with out of pocket maximums, unlike Original Medicare, which has no out of pocket maximum

According to the Centers for Medicare and Medicaid Services (CMS) in 2018 about 1/3 of Medicare beneficiaries in Idaho were enrolled in Medicare Advantage or another health plan.

What are my options for Medicare Advantage in Idaho?

According to CMS, 92% of Medicare beneficiaries in Idaho have access to a Medicare Advantage plan in 2018. There are a total of 43 Medicare Advantage plans available in Idaho, although not all plans may be available in all areas.

As you’re looking for a Medicare Advantage plan, consider what kind of benefits you want. Medicare Advantage plans may cover prescription drugs, routine vision, routine dental, routine hearing, exercise and fitness benefits, as well as other benefits generally not covered by Original Medicare.

There are generally four types of Medicare Advantage plans:

  • Health Maintenance Organizations (HMOs): HMOs in Idaho typically have a provider network of hospitals and doctors you must use to get coverage. These plans require a referral from your primary care doctor to see a specialist
  • Preferred Provider Organizations (PPOs*): PPOs in Idaho have more provider flexibility; you have the option to use doctors in the plan’s preferred provider network, or you can use out-of-network providers and pay higher costs. These plans don’t require primary care doctors, and you don’t need a referral before seeing a specialist.
  • Private Fee-for-Service plans (PFFSs**): PFFS in Idaho do not have provider networks. Instead, you can use any doctor or hospital that agrees to the plan’s terms and conditions, on a case-by-case basis.
  • Special Needs plans (SNPs): Special Needs plans are for certain demographic groups, for example, people with cancer. The prescription drugs offered by that plan may be according to the needs of that group.

What are the costs of Medicare Advantage in Idaho?

Medicare Advantage plan costs can include premiums, deductibles, and copayment or coinsurance.

A premium is the amount you pay monthly to have the plan. Some Medicare Advantage plans in Idaho may have monthly plan premiums as low as $0, although you still have to pay your Medicare Part B premium. Keep in mind that the plan with the lowest premium may not be the overall cheapest plan.

A deductible is the amount you pay out of pocket before the plan begins to pay. Some Medicare Advantage plans in Idaho may have $0 deductibles.

A copayment or coinsurance is the amount you pay when you use a service. For example, there may be separate copayments for a primary care doctor visit, a specialist visit, an outpatient surgery, and an emergency room visit. Some Medicare Advantage plans in Idaho charge $0 copayments or coinsurance for various services.

How do I enroll in Medicare Advantage in Idaho?

To be eligible to enroll in a Medicare Advantage plan in Idaho, you generally must

  • Be enrolled in both Medicare Part A and Part B
  • Live in the plan’s service area
  • Not have end-stage renal disease (ESRD).

You may enroll in or switch plans during your Initial Coverage Election Period (ICEP), which begins three months before you become eligible for Medicare and lasts for a total of seven months.

You may also enroll during the Annual Election Period (AEP), which occurs from October 15 to December 7 of each year.

Qualifying beneficiaries may also have the option of enrolling during a Special Election Period as well. Some circumstances where you may get a Special Election Period are if you change where you live or if you lose your current coverage.

You can start comparing Medicare Advantage plan options in Idaho today. Simply enter your zip code where indicated on this page, and we will display a customized list of plan options available to you.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.
The provider network may change at any time. You will receive notice when necessary.

*Out-of-network/non-contracted providers are under no obligation to treat Preferred Provider Organization (PPO) plan members, except in emergency situations. For a decision about whether we will cover an out-of-network service, we encourage you or your provider to ask us for a pre-service organization determination before you receive the service. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.

**A Private Fee-for-Service plan is not Medicare supplement insurance. Providers who do not contract with our plan are not required to see you except in an emergency.

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