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Medicare Advantage Plan Options in Idaho – Top 3 in 2022

A Medicare Advantage plan in Idaho for 2022 is a great option for some Idaho Medicare beneficiaries. To decide whether a Medicare Advantage plan is the best fit for you, it’s important that you understand how the Medicare system works.

What is Medicare Advantage in Idaho?

If you are eligible for Medicare and want an all-in-one plan, you may want to enroll in a Medicare Advantage plan in Idaho. Medicare beneficiaries who join a Medicare Advantage plan in Idaho have Medicare Part A, Medicare Part B and likely Medicare Part D packaged in one plan.

Most Idaho Medicare Advantage plans offer:

  • Annual out-of-pocket maximum on covered expenses
  • Extra benefits like hearing, vision, dental and wellness
  • Prescription drug coverage, built into Medicare Advantage Prescription Drug (MAPD) plans so you don’t have to pay a separate Part D plan premium

Medicare Advantage, also known as MA or Medicare Part C, has some limitations, which vary with the type of MA plan you join:

  • Benefits tied to use of network providers
  • Referrals needed from your primary care physician before you can see specialists
  • Monthly premiums due to insurance company, separate and in addition to Part B premiums billed from Medicare. The annual deductible for Medicare Part B beneficiaries are $223 in 2022. The standard monthly Part B premium is $170.10 in 2022.
  • Impact on benefits if health care received outside your service area

When you join an MA plan, you are not giving up your Medicare coverage under Original Medicare. Your level of coverage will be at least the same as Original Medicare coverage.

How MA plans work:

  • MA plans can only be sold by a Medicare-approved insurance company.
  • The insurer must comply with established Medicare rules to remain a Medicare plan sponsor.
  • The company manages the billing, claims and customer service for your Medicare benefits.

What is the Best Medicare Advantage plan in Idaho in 2022?

Best for network freedom: Medicare Advantage PPO plans

  • Expansive network
  • Freedom to see out-of-network healthcare providers for some services in exchange for higher deductibles, copays and/or coinsurance
  • Zero premium for some PPOs – price varies by insurance company and location

Best for reducing out-of-pocket costs: Medicare Advantage HMO plans

  • Tighter network restriction positions the plan to cover more of the cost
  • Referrals generally required
  • Zero premium is common

Best for beneficiaries who are dually eligible or have long-term health conditions: Medicare Advantage D-SNP

  • Serves people with eligibility for both Original Medicare and Medicaid
  • Reduces copayments, coinsurance and deductibles for Medicare-approved services
  • Accommodates people who need specialized providers, drugs and benefits to treat specific health conditions

What Medicare Advantage plans are available in Idaho?

Private insurance companies sell 80 Medicare Advantage plans in Idaho.

The popularity by type of plan is:

  • Local HMO: 58,237
  • Local PPO: 40,502

How much does Medicare Advantage in Idaho cost?

In 2022, the average premium of a MA plan in Idaho is about $34. You will likely find differences in cost and availability across counties.

When can you enroll in a Idaho Medicare Advantage plan?

Initial Enrollment Period

  • Can enroll when you first become eligible for Medicare Part A and Part B
  • Seven months to enroll but best to sign up is during the three months prior to the month you turn 65 to avoid a delayed start date

Open Enrollment Period – aka Annual Election Period

  • October 15 – December 7
  • Can join, switch or drop an Idaho Medicare Advantage plan

Medicare Advantage Open Enrollment Period

  • January 1 – March 31
  • Must be an existing MA plan member
  • Can switch to another MA plan or go back to Original Medicare

Special Enrollment Periods – Special Circumstances

Generally, once you enroll in MA, you commit to staying in the plan for the calendar year. However, an exception may be made if you:

  • Relocate to an area your plan does not cover
  • Lose group health insurance that you had through an employer or union
  • No longer qualify for Medicaid

5-star Special Enrollment Period

If you are in an area where a 5-star MA plan is available, you can switch from a plan that has a lower quality rating. This is a one-time option, which can be executed between December 8 and November 30.

Special Enrollment Periods if you get “Extra Help”

Qualification Special Enrollment Period Options
Dual eligible First three quarters of the year Join, switch or leave MA or Part D
Eligible for help paying for drug plan First three quarters of the year Join, switch or leave Part D
State Pharmaceutical Assistance Program (SPAP) members One time each calendar year Sign up for Medicare drug plan or MAPD plan

 

When can I make changes to my Medicare Advantage plan?

When you sign up for an MA plan, you are expected to keep it for the remaining calendar year. Beneficiaries may be eligible for Special Enrollment Periods based on special circumstances.

The most common time to make changes is during the Open Enrollment Period:

  • October 15 – December 7
  • Enroll in an MA plan, change from one MA plan to another or discontinue your MA plan and return to Original Medicare
  • Effective start date: January 1

Are Medicare Advantage plans in Idaho “bad”?

Medicare Advantage plans in Idaho are great health plans. Enrollment in Idaho Medicare Advantage plans has grown 13% from 2020 to 2021.

Number of enrollees in Medicare Advantage in Idaho: 122,947

Number of enrollees by type of Medicare Advantage plan:

  • Local HMO: 58,267
  • Local PPO: 40,502
  • Regional PPO: 0

Percentage of enrollees in Medicare Advantage in Idaho: 35%

Number of enrollees in Medicare Advantage nationwide: 29.5 expected to enroll in 2022

Percentage of enrollees in Medicare Advantage nationwide: 42%

Related Topics

Idaho State Links

Ready to Learn More?

We help educate Medicare beneficiaries on their Medicare Advantage options and help them go through the process of reviewing and comparing plans. We work with most of the nation’s top-rated Medicare Advantage carriers. Give us a call today, or request a quote online to learn more about plan options.   

Key Take Aways
  • In Idaho, PPO Medicare Advantage Plans are very popular for many Medicare beneficiaries.
  • You can make changes to your Advantage plan each year during the Annual Election Period.
  • You must continue to pay your Medicare Part B Premium with most Medicare Advantage plans.