Medicare Advantage Plans in Idaho

Medicare Advantage plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans bundle Part A (hospital insurance) and Part B (medical insurance), and most include Part D (prescription drug coverage). Many plans also offer added benefits such as dental, vision, hearing, fitness programs, and telehealth services.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people become eligible for Medicare enrollment at age 65, but some may qualify earlier due to disability or medical conditions like ALS or ESRD. Missing your enrollment window or not qualifying for premium-free Part A may result in late penalties. Enrollment periods include:

• Initial Enrollment
• General Enrollment
• Special Enrollment

What Types of Medicare Advantage Plans Are Available in Idaho?

Idaho offers several types of MA plans:

• Health Maintenance Organizations (HMOs): Require in-network care; referrals needed for specialists.
• Preferred Provider Organizations (PPOs): Allow out-of-network care at higher costs; typically no referrals needed.
• Private Fee-for-Service (PFFS) Plans: Any provider who accepts plan terms can be used; some plans have networks.
• Special Needs Plans (SNPs):
  • C-SNPs: For chronic conditions like diabetes, cancer, or heart disease.
  • I-SNPs: For individuals in institutions or requiring nursing care.
  • D-SNPs: For those eligible for both Medicare and Medicaid; often include drug coverage and care coordination.
• Medical Savings Accounts (MSAs): Combine a high-deductible plan with a medical savings account funded by your insurer.

What Are Your Prescription Drug Options with Medicare Advantage?

Most MA plans include Part D drug coverage. Exceptions include MSAs and some PFFS plans. If your MA plan doesn’t include drug coverage, you may:

• Enroll in a separate Part D plan (only allowed for some plan types).
• Face a late enrollment penalty if you delay getting prescription coverage without having creditable coverage.

How Do You Choose a Medicare Advantage Plan?

Understand Medicare Advantage costs before choosing a plan:

• Premiums: Many plans have $0 premiums, while others charge a monthly fee.
• Deductibles, Coinsurance & Copays: Know what you’ll pay for medical services.
• Out-of-Pocket Maximums: Sets a cap on your yearly healthcare costs.
• Extra Benefits: Some plans include dental, vision, hearing, fitness, telehealth, and OTC allowances.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during specific enrollment periods:

• Initial Enrollment: 3 months before to 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop an MA plan.
• General Enrollment (Jan 1–Mar 31): For new Part B enrollees.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch MA plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by events like moving out of your plan’s area, losing existing coverage, plan termination, or qualifying for a SNP.

What If You Want to Change Your Medicare Advantage Plan?

You can switch MA plans during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Understanding Medicare Advantage Star Ratings

The Centers for Medicare & Medicaid Services (CMS) rates MA plans using a 5-star quality system to help consumers compare options. CMS star ratings overview:

• 1 star: Poor performance
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings reflect data from MA (Part C) and MA Prescription Drug Plans (Part D), and are updated annually.

What Are Medicare Resources in Idaho?

Idaho offers several helpful programs:

• SHIBA Program: Provides free Medicare counseling. Learn more.
• SMP Program: Educates beneficiaries about avoiding healthcare fraud. Learn more.
• Idaho Department of Insurance: Handles complaints. Learn more.
• Medicare Savings Program (Medicaid): Assists low-income residents. Visit Medicaid or call 1-877-456-1233. Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, are standardized private policies that help cover costs not paid by Original Medicare such as copayments, coinsurance, and deductibles.

• You must be enrolled in Parts A and B.
• Best time to enroll is during your six-month Medigap Open Enrollment Period.
• Medigap plans don’t cover prescription drugs; enroll in a separate Part D plan.
• There are 10 standard plans. Medicare Supplement Plan G has the highest enrollment as of 2023.
• Plan F is not available to those newly eligible after Jan 1, 2020.
• Medigap offers predictable costs, no referrals, and nationwide access.

Learn more about Medicare Supplement plans in Idaho.

Next Steps

If a Medicare Advantage plan in Idaho fits your needs, compare options in your area. Review provider networks, out-of-pocket costs, and extra benefits—then enroll during the appropriate period.