Medicare plans in Idaho provide health insurance for people age 65 and older, and for some people under the age of 65 who meet certain qualifications. There are many parts to Medicare, including:
- original Medicare (Part A and Part B)
- Medicare Advantage (Part C)
- prescription drug plans (Part D)
- Medicare supplemental insurance (Medigap)
- Medicare savings account (MSA)
Original Medicare is provided through the federal government. Medicare Advantage, prescription drug plans, and Medigap insurance are all offered through private insurance carriers.
Read on to learn more about your Medicare options in Idaho.
Part A has no monthly premium for most people. You will pay a deductible each time you are admitted into the hospital. It covers:
Part B has a monthly premium and an annual deductible. Once you meet the deductible, you pay a 20 percent coinsurance for any care for the remainder of the year. It covers:
- outpatient clinical care
- doctor’s appointments
- preventive care, such as screenings and annual wellness visits
- lab tests and imaging, such as X-rays
Medicare Advantage (Part C) plans are available through private insurance carriers who bundle parts A and B, and often Part D benefits and additional types of coverage.
Part D covers prescription drug costs and must be purchased through a private insurance plan. Many Medicare Advantage plans include Part D coverage.
Medigap plans are available through private insurance carriers to help cover some costs of your care, since original Medicare does not have an out-of-pocket limit. These plans are only available with original Medicare.
Medicare savings account
Medicare savings accounts (MSAs) are similar to health savings accounts with tax-deductible deposits that can be used for eligible medical expenses, including supplemental Medicare plan premiums and long-term care. These are separate from federal Medicare savings accounts, and have specific tax rules to review and understand before you sign up.
Insurance carriers that offer Medicare Advantage plans contract with the Centers for Medicare & Medicaid Services (CMS) and offer the same coverage as original Medicare. Many of these plans also have coverage for things like:
Another benefit of Medicare Advantage plans is the annual out-of-pocket spending limit of $6,700 — some plans have even lower limits. After you reach the limit, your plan pays 100 percent of covered costs for the rest of the year.
Medicare Advantage plans in Idaho include:
- Health Maintenance Organization (HMO). A primary care physician (PCP) you select from a network of providers will coordinate your care. You need a referral from your PCP to see a specialist. HMOs have rules like providers and facilities you must use within their network, and pre-approval requirements, so read and follow the rules carefully to make sure you aren’t hit with unexpected costs.
- HMO Point of Service (HMO-POS). An HMO with a point of service (POS) option allows you to get care outside the network for certain things. There are additional fees for out-of-network POS care. Plans are only available in some Idaho counties.
- Preferred Provider Organization (PPO). With a PPO, you can get care from any provider or facility in the PPO network. You don’t need referrals from a PCP to see specialists, but it’s still a good idea to have a primary care physician. Care outside the network may be more expensive or may not be covered.
- Private Fee-For Service (PFFS). PFFS plans negotiate directly with providers and facilities to determine what you owe for care. Some have provider networks, but most allow you to go to any doctor or hospital that will accept the plan. PFFS plans are not accepted everywhere.
- Special Needs Plans (SNPs). SNPs in Idaho are offered in certain counties and are only available if you are eligible for both Medicare and Medicaid (dual eligible).
You can choose Medicare Advantage plans in Idaho from:
- Aetna Medicare
- Blue Cross of Idaho
- Molina Healthcare of Utah & Idaho
- PacificSource Medicare
- Regence BlueShield of Idaho
Available plans will vary depending on your county of residence.
Medicare in Idaho is available to U.S. citizens (or legal residents for 5 or more years) who are 65 years old and over. If you are under 65 years old, you may still be able to get Medicare if you:
There are certain times of the year when you can enroll in or change Medicare and Medicare Advantage plans.
- Initial enrollment period (IEP). Three months before you turn 65, you can enroll in Medicare for coverage that begins during your birthday month. If you miss that window, you can still enroll during your birthday month or 3 months after, but there is a delay before coverage starts.
- General enrollment (January 1–March 31). You can sign up for parts A, B, or D during general enrollment if you missed IEP and don’t qualify for a special enrollment period. If you don’t have other coverage and didn’t sign up during your IEP, you may pay a late sign-up penalty for Part B and Part D.
- Open enrollment (October 15–December 7). If you’re already signed up for Medicare, you can change plan options during the annual enrollment period.
- Medicare Advantage open enrollment (January 1–March 31). During open enrollment, you can change Medicare Advantage plans or switch to original Medicare.
- Special enrollment period (SEP). You can sign up for Medicare during an SEP if you’ve lost coverage for a qualifying reason, such as moving out of your plan’s network area or losing an employer-sponsored plan after retirement. You don’t have to wait for annual enrollment.
With so many options available, it’s important to carefully consider your own personal healthcare needs to determine if original Medicare or Medicare Advantage is the best choice as well as whether you might need supplemental coverage.
Choose a plan that:
- has doctors you like and facilities that are convenient to your location
- covers the services you need
- provides affordable coverage
- has a high star rating for quality and patient satisfaction from CMS
Find answers to questions and get help with Medicare Idaho plans from the following resources:
- Senior Health Insurance Benefits Advisors (SHIBA) (800-247-4422). SHIBA provides free help for Idaho seniors with questions about Medicare.
- Idaho Department of Insurance (800-247-4422). This resource offers information on Extra Help and Medicare Savings Programs for assistance paying for Medicare if you cannot afford it.
- Live Better Idaho (877-456-1233). This is a public-private partnership with information and resources about Medicare and other services for Idaho residents.
- Idaho AIDS Drug Assistance Program (IDAGAP) (800-926-2588). This organization offers financial assistance for Medicare Part D coverage if you are HIV-positive.
- Medicare (800-633-4227). You can also contact Medicare if you have additional questions.
When you’re ready to enroll in Medicare:
- Decide if you want the additional coverage and benefits of a Medicare Advantage (Part C) plan.
- Review the available plans in your county and what coverage they offer.
- Mark your calendar for your IEP or open enrollment to know when you can get signed up.
This article was updated on October 5, 2020 to reflect 2021 Medicare information.
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