October 6, 2016
Medicare beneficiaries in Idaho should take note of every possible Medicare coverage option. The federal Medicare program, sometimes referred to as Original Medicare, includes Medicare Part A (hospital coverage) and Part B (medical coverage). It is available to anyone in the country who is eligible for Medicare.
An alternative way to receive your Original Medicare coverage is to enroll in a Medicare Advantage plan. Medicare Advantage plans are offered by private insurance companies contracted with Medicare. Medicare Advantage plans must provide at least the same amount of coverage as Medicare Part A and Part B (except hospice care, which is covered by Medicare Part A). Many Medicare Advantage plans also include Medicare prescription drug coverage (Part D).
If you have Original Medicare coverage, you may enroll in coverage that compliments your Medicare coverage. Because Part A and Part B don’t usually cover prescription medications, you may wish to enroll in a stand-alone Medicare Part D Prescription Drug Plan (PDP) to get prescription drug benefits. You might want to learn about Medigap (Medicare Supplement) plans if you decide to stay with Medicare Part A and Part B. Medicare Supplement plans are offered by private insurance companies and can help you pay for out-of-pocket costs for services covered under Medicare Part A and Part B.
Medicare Part A covers inpatient hospital stays, while Part B covers doctor’s visits and preventive services such as annual wellness exams.
Some Medicare beneficiaries in Idaho are enrolled in Medicare Part A and Part B automatically at age 65, provided they receive retirement benefits through either the Social Security Administration (SSA) or the Railroad Retirement Board (RRB). Disabled persons under the age of 65, who receive SSA disability benefits, or certain RRB disability benefits, for 24 consecutive months may be enrolled automatically as well.
Idaho residents who are eligible for Medicare but not automatically enrolled in the Medicare program can apply by visiting their local SSA office, registering online or registering by telephone. Call Social Security at 1-800-772-1213. TTY users should call 1-800-325-0778. SSA representatives are available Monday through Friday, from 7AM to 7PM.
Once enrolled, your Medicare card is mailed about three months before the start of your coverage.
There are several types of private Medicare approved insurance plans that beneficiaries in Idaho may wish to consider before making a final decision about the way they receive their Medicare coverage. While Original Medicare Part A and Part B are administered by the federal government, you can also receive your Medicare coverage through private insurance companies contracted with Medicare, doing business in Idaho. Listed below are several common alternatives.
Medicare Advantage plans are offered by private insurance companies that contract with CMS to provide Medicare Part A and Part B coverage (except for hospice care which remains covered under Medicare Part A). Medicare Advantage plans are required to give the same coverage as Original Medicare including the maximum out of pocket spending limit. Once your out-of-pocket expenses have been reached (including the deductible), the Medicare Advantage plan pays 100% of covered health-care costs for the rest of the year. Medicare Advantage plans may also cover extra benefits such as routine dental and vision care, hearing, or wellness programs. Some plans, known as Medicare Advantage Prescription Drug plans, also include prescription drug coverage. To be eligible for Medicare Part C, you must be entitled to Medicare Part A, be enrolled in Medicare Part B, and live in the Medicare Advantage plan’s service area. You’ll need to keep paying your Medicare Part B premium in addition to any premium required by your Medicare Advantage plan.
Medicare Supplement Insurance plans are available to Medicare beneficiaries in Idaho. If you decide to stay with Original Medicare (Part A and Part B), you may have the option to sign up for a Medicare Supplement (Medigap) plan to help pay for Original Medicare’s out-of-pocket costs. Different Medicare Supplement plans pay for different amounts of those costs, such as copayments, coinsurance, and deductibles. Medicare Supplement plans in Idaho offer a number of standardized benefits, identified by letter. Standardized benefits means that benefit plans of the same letter offer the same benefits no matter which insurance carrier offers the plan, although some companies may offer additional innovative benefits. Premiums can differ widely between insurance companies offering the same benefit plan so it is a good idea to shop for the best value in terms of coverage and cost.
Because Original Medicare does not include prescription drug coverage, many Medicare beneficiaries choose to purchase prescription drug coverage from a Medicare Advantage Prescription Drug plan or from a stand-alone Part D Prescription Drug Plan in order to receive Medicare Part D benefits. Whether you purchase your Medicare prescription drug coverage through a Medicare Advantage Prescription Drug plan or from a standalone Medicare Part D Prescription Drug Plan, the plan will have a formulary, which is a list of prescription medications covered by that plan and separated into tiers. Drugs in each tier have a different cost, a drug in a lower tier will cost less than a drug in a higher tier. The formularies vary by plan, so it is a good idea to check to see if your medication is on the plan’s formulary. Also, the formulary can change at any time. You will receive notice from your plan when necessary.
Medicare.gov offers a list of available resources that can help educate you on health resources in Idaho. Medicare-specific resources are included below:
Learn more about how Medicare plans work in Idaho, including:
Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program.