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Medicare Advantage in Idaho

Last Updated on

October 6, 2016

Medicare Advantage (Medicare Part C) lets you receive your Medicare benefits from a private insurance company approved by Medicare rather than from the government-administered Original Medicare, Part A and Part B. If you’re a Medicare beneficiary living in the state of Idaho, you may have the option of enrolling in a Medicare Advantage plan. Plan availability may vary across the state.

How Medicare Advantage works in Idaho

Under Medicare Advantage in Idaho, as in all states, plan beneficiaries receive at least the same medical and hospitalization benefits as they would under Original Medicare, Part A (hospital coverage) and Part B (medical coverage), as required by the United States government. In addition, some Medicare Advantage plans offer extra benefits not available under Original Medicare.

To qualify for a Medicare Advantage plan in Idaho, you must already be enrolled or be eligible to enroll in Original Medicare, Part A and Part B, and you must live within the plan’s service area. In most cases, you can’t have end-stage renal disease.

You can sign up for Medicare Advantage during your Initial Coverage Election Period (ICEP).

  • If you sign up for Medicare Part A and Part B when you’re first eligible for Medicare, you can enroll in Medicare Advantage at this time; your ICEP is the seven-month period that starts three months before the month you turn 65. The ICEP continues through your birth month, and for three months after that.
  • If you delay enrollment in Medicare Part B, your ICEP is the three-month period before your Part B start date. For example, if you enrolled in Part B during the General Enrollment Period (January 1 to March 31), your Part B start date would be July 1, so your ICEP would be April 1 to June 30.

Another chance to enroll in a Medicare Advantage plan is during the Annual Election Period, also referred to as the fall Open Enrollment Period, which runs from October 15 to December 7. Your new coverage goes into effect on January 1 of the following year.

You may also be able to enroll in, or switch, Medicare Advantage plans during Special Enrollment Periods, under certain circumstances. Those situations include, but aren’t limited to, losing your current employer-sponsored group health coverage, moving out of your plan’s service area, qualifying for other coverage, or experiencing changes in your current plan that affect your health benefits.

You can leave your Medicare Advantage plan and switch back to Original Medicare, Part A and Part B, during the Medicare Advantage Disenrollment Period, which runs from January 1 to February 14 each year. You can add stand-alone Medicare Part D prescription drug coverage during that time.

Types of Medicare Advantage plans in Idaho

If you decide to sign up for private Medicare approved health insurance, you may have a number of Medicare Advantage plans from which to choose. Here’s a look at the main types of Medicare Advantage plans.

  • Health Maintenance Organizations (HMOs) plan is one of the most popular types of Medicare Advantage plans. HMO plans generally require you to visit doctors, health-care providers, and hospitals in their network, and they may also require you to get a referral from your primary doctor to receive coverage for a number of health services.
  • If you’re seeking an option that may be more flexible, you may want to sign up for an HMO Point-of-Service (HMO-POS) plan, which may let you go out of network for certain health services, but generally at a higher cost.
  • Medicare Advantage options in Idaho may also include Preferred Provider Organization (PPO)* plans which may offer even more flexibility than HMO-POS plans, allowing you to choose doctors, health-care providers, and hospitals outside of the plan’s network, but again usually at a higher cost.
  • You may also have the option to sign up for a Private Fee-for-Service (PFFS) plan. This type of Medicare Advantage plan generally reserves the right to decide how much it will pay for your doctor, health-care provider, and hospital visits. A PFFS plan also determines your share of each expense.
  • A Medical Savings Account plan is a Medicare Advantage plan that combines a high deductible with a savings account that beneficiaries can use to pay for their health-care expenses.
  • Medicare Advantage beneficiaries in Idaho with specific health concerns may qualify for a Medicare Special Needs Plan (SNP). A Medicare SNP limits enrollment to people with certain health needs, with coverage tailored to suit those specific needs. For example, there are Medicare SNPs for HIV/AIDS patients, for patients with congestive heart failure, and for those suffering from dementia (this is not a complete list of qualifying health needs).
  • Most of the plan types described above include prescription drug coverage. These Medicare Advantage Prescription Drug plans combine health and drug coverage into a single insurance plan.

Comparing Medicare Advantage plans available in Idaho

As a Medicare beneficiary in Idaho, you may find it useful to compare all the Medicare Advantage plans available in your area.

The availability and cost of Medicare Advantage plans can vary depending on your area of residence. You may find that some Medicare Advantage plans in Idaho offer premiums as low as $0, but always keep in mind that you must continue paying your Medicare Part B premium, no matter which Medicare Advantage plan you choose, to retain your Medicare insurance coverage.

Some Medicare Advantage plans may offer additional benefits beyond what is included in Original Medicare, Part A and Part B, such as routine dental, vision or prescription drug coverage.  When you are evaluating your Medicare coverage options, you may want to take into consideration whether some of the additional benefits that may be available from Medicare Advantage and Medicare Advantage Prescription Drug plans are of value to you.   With all these options that may be available in Idaho, you can see why it’s a good idea to review and compare each plan to find one that offers benefits and costs suited to your personal health and financial needs.

If you want to start comparing Medicare Advantage plans in Idaho right away, enter your zip code in the eHealth plan finder located on this page for a customized list of plans available in your area. You can also enter your prescription drug needs to further customize your search and cost estimates.

For more information about Medicare in Idaho, access the following resources:

 

* 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.