Are you about to become eligible for Medicare? Original Medicare, which includes Medicare Part A (hospital insurance) and Part B (outpatient insurance), helps cover your basic health expenses. However, it won’t cover your prescription drugs and there aren’t any limits on your yearly out-of-pocket expenses.
You could also opt for Medicare Part C, known as Medicare Advantage (MA) plans. MA plans are run by private health insurance companies but must offer the same coverage as Original Medicare. Most also give you benefits like a yearly limit on your out-of-pocket medical expenses and coverage for prescription drugs.
What You Need to Know
You get the same basic coverage with Medicare Advantage plans as you do with Original Medicare.
Most MA plans give you extra perks, like vision and dental coverage.
You can sign up for a Medicare Advantage plan at the same time you enroll in Original Medicare.
What Types of Medicare Advantage Plans Are Available?
The majority of Medicare Advantage plans in Idaho contract with a network of doctors and healthcare facilities. This helps lower the cost of care for people in the plan. Plan types include:
- Health Maintenance Organization (HMO): An HMO plan requires you to use an in-network doctor for care, including choosing a primary care physician (PCP) for regular services and referrals to specialists. Except in emergencies, going to an out-of-network doctor will likely have higher costs.1
- Preferred Provider Organization (PPO): You won’t need to choose a PCP, and you can visit any doctor for care. However, you’ll likely pay less out-of-pocket by visiting an in-network doctor.
- Special Needs Plans (SNP): These plans help cover specific health conditions.2
- Chronic Condition SNP (C-SNP): If you have a chronic condition, like diabetes or cancer, you could be eligible for these plans.
- Institutional SNP (I-SNP): This plan helps cover care if you live in a nursing home or other institution, or if you need in-home nursing care.
- Dual-Eligible SNP (D-SNP): You can join these plans if you’re eligible for both Medicare and Medicaid.
- Private Fee-for-Service (PFFS): These plans don’t require a PCP. Your plan will decide how much it will pay for medical services. It also determines the price you’ll pay for care.3
- Medicare Medical Savings Accounts (MSA): These high-deductible health insurance plans have an MSA that you use to pay for out-of-pocket expenses.
One Way to Save on Costs
You’ll save money on most Medicare Advantage plans by using in-network providers.
What Are Prescription Drug Options with Medicare Advantage?
You’ll need to purchase a separate Medicare Part D plan to get prescription drug coverage with Original Medicare. Most Medicare Advantage plans in Idaho include prescription drug coverage.
Make sure your prescriptions are covered by an MA plan by checking the plan’s list of covered drugs, known as the drug formulary.
How Do You Choose Medicare Advantage Plans?
You’ll need to compare the costs and benefits of different Medicare Advantage plans in Idaho, including:
- Premiums: Your monthly cost for your health insurance, in addition to the Medicare Part B premium ($148.50 for most people in 2021). You might be able to find a zero-premium plan. Be aware that zero-premium plans may lead to higher out-of-pocket costs in other areas, like your deductible.
- Other Costs
- Deductible: The annual amount you need to pay out-of-pocket before your plan starts to pay.
- Coinsurance: The portion of the cost of a service you’ll pay out-of-pocket.
- Copay: The fixed price you’ll pay for care.
- Out-of-Pocket Maximum: The annual limit on your out-of-pocket costs, not including premiums.
- Plan Benefits
- Vision: Covers services like frames and eye exams.
- Dental: Covers services such as regular checkups or teeth cleaning.
- Telehealth: Coverage for remote health services like phone consultations or video office visits.
- Additional Perks: Your plan may include extra benefits like fitness classes or reimbursement for gym memberships.
Plans may also include perks like reimbursement for gym memberships.
When and How to Enroll in Medicare Advantage?
You can sign up for Medicare Advantage plans in Idaho after enrolling in Original Medicare. The best time to do this is during your Initial Enrollment Period, also called your Open Enrollment Period (OEP). This starts three months before you turn 65 and lasts until three months after you turn 65.
You can still join Original Medicare if you miss your OEP by enrolling during the General Enrollment Period from January 1 to March 31 annually. You may have to pay late penalties on your Medicare premiums if you join after your OEP.
You can enroll in Original Medicare through the Social Security Administration. Sign up online, over the phone, or at a local Social Security office. After enrolling, you’re ready to join a Medicare Advantage plan.
There are specific enrollment periods to sign up for Medicare Advantage plans in Idaho, including:
- Initial Enrollment Period: You can sign up for an MA plan at the same time you join Original Medicare.
- Medicare Annual Election Period (Open Enrollment Period): Sign up for an MA plan from October 15 to December 7 each year.
- Medicare Advantage Open Enrollment Period: Change your MA plan or switch back to Original Medicare between January 1 and March 31 annually.
- Special Enrollment Period: Certain circumstances could open a special enrollment period, such as:
- You’re moving out of your plan’s service area.
- You’re receiving coverage from an employer or union.
- You’re about to lose coverage, such as becoming ineligible for Medicaid.
- Your plan is no longer offered by Medicare.
- You need an SNP for a health condition.
Who Has Signed Up for Medicare Advantage Plans in Idaho?
About 130,000 Medicare beneficiaries are signed up for Medicare Advantage plans in Idaho. This is about 33% of people who are eligible for Medicare.
How Much Do Medicare Advantage Plans Cost in Idaho?
The average cost of an MA plan in Idaho is $35.65 per month.4 Your costs could differ based on factors like your location.
Plans in Pocatello could be between $0 and $166 per month, as opposed to $0 to $146 per month in Boise.5 Your premiums aren’t the only costs to consider when looking for an MA plan. You should also compare costs like deductibles and copays.
What If You Want to Change Your Medicare Advantage Plan?
The easiest time to change your Medicare Advantage plan is during one of the annual enrollment periods. Your old plan will automatically be canceled when your new coverage takes effect.
What Are Alternatives to Medicare Advantage?
You don’t have to use an MA plan for coverage. Other coverage options in Idaho include:
- Original Medicare: If Original Medicare gives you the coverage you need, you can stay on Medicare Part A and B.
- Medicare Supplement Plans: These plans are known as Medigap policies and are run by private insurance companies. They provide additional coverage to Original Medicare.
- Medicare Supplement with Part D: Original Medicare and Medigap policies don’t include prescription drug plans. You’ll need to purchase a separate plan for drug coverage.
What Are Medicare Resources in Idaho?
- Senior Health Insurance Benefits Advisors (SHIBA): You can get unbiased counseling on Medicare and your coverage options with this free resource.6
- Idaho Department of Insurance: This government office oversees insurance in Idaho and provides consumer information on Medicare and other programs.7
- Medicare Savings Program (Medicaid): These programs help seniors who meet income or disability requirements afford Medicare costs like premiums, deductibles, and coinsurance.8
Get ready to enroll in Medicare by learning more about your coverage options. You can browse Medicare Advantage plans in Idaho to see what’s available in your area.