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Best Medicare Advantage Plans in Idaho for 2020

Some of the best Medicare Advantage plans in Idaho for 2020 are a good 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.

When you’re first eligible for Medicare, you have to choose how you will receive your benefits.

You have two options:

Here are the characteristics of Original Medicare:

  • The federal government — through the Centers for Medicare and Medicaid Services (CMS) — coordinates Original Medicare benefits.
  • You can buy supplemental health insurance coverage (Medigap) to help pay for health care costs such as hospital and doctor visits.
  • To cover prescriptions, you have to buy a stand-alone Medicare Part D prescription drug plan.

Here’s how 2020 Medicare Advantage plans in Idaho compare to Original Medicare:

  • Private insurance companies under contract with Medicare provide your benefits.
  • You cannot buy a Medigap policy.
  • Most Advantage plans include prescription drug coverage.
  • If your MA plan doesn’t cover prescriptions, you can buy a stand-alone Medicare prescription drug policy.

Whichever option you choose, you must stay enrolled in Medicare Part A and Part B and pay your Medicare Part B premium.

Overview of Medicare Advantage Plans in Idaho for 2020

Options for a Medicare Advantage plan in Idaho constantly change as new policies come on the market. You must live in the service area of the policy you want to join.

As a Medicare beneficiary, you can only choose a Medicare Part C plan in Idaho from the ones available in your county. Not every Advantage plan is available in all counties. In a few Idaho counties, Medicare Part A and Part B is the only option.

Monthly premiums for a Medicare Advantage plan in Idaho for 2020 start as low as $0 premium. If you choose a plan that has more than the basic Medicare Part A and Part B coverage, rates will be higher.

However, a Medicare Advantage plan in Idaho typically includes prescription drug coverage. Your Advantage monthly premium, even with extra benefits, might be lower than what you pay combined for your Part B premium, a Medigap policy, and a Part D policy.

Your Medicare Advantage plan automatically renews unless you want to make changes. Renewal might include changes in your coverage, premiums, and cost-share amounts, however, so it’s critical that you get a complete description of benefits and changes to make sure it’s still the best plan for you.

Best Medicare Advantage Plans in Idaho: When Can You Enroll?

Once you’re enrolled in Medicare Part A and Part B, you qualify for a Medicare Advantage plan in Idaho. There are several Medicare Advantage enrollment periods available:

  • Medicare Initial Coverage Election Period ICEP. Your initial Medicare enrollment period starts three months before your 65th birthday and ends three months after your birthday.
  • Medicare Annual Election Period AEP. The AEP runs from Oct. 15 to Dec. 7. It’s during the AEP that you can switch between Original Medicare and Medicare Advantage, change Medicare Advantage plans, and join or change Part D policies.
  • Medicare Advantage Disenrollment Period MADP. Before 2019, beneficiaries could disenroll from a Medicare Advantage plan between Jan. 1 and Feb. 14. Now you can disenroll during the Medicare Advantage Open Enrollment Period.
  • Medicare Advantage Open Enrollment Period MA OEP.  Open enrollment runs from Jan. 1 to Mar. 31. You can shift from one Medicare Advantage plan to another during the MA OEP. You can also leave your Medicare Advantage plan and return to Medicare Part A and Part B.
  • Medicare Special Election Periods SEP. SEPS cover circumstances such as losing employer coverage, moving out of the service area, or becoming dual-eligible for Medicare and Medicaid.

The AEP is the best opportunity for a Medicare beneficiary to compare Medicare Advantage plans. A useful tool to help you compare is the star ratings that CMS compiles. CMS bases star ratings on member satisfaction, claims processing, and a variety of other factors. A 5-star rating is the highest.

Best Types of Medicare Advantage Plans in Idaho for 2020

Medicare Advantage plans in Idaho include Health Maintenance Organization HMO plans, Preferred Provider Organization PPO plans, private fee-for-service plans, and special needs plans. HMOs, PPOs, and SNPs are managed, care models. Here are a few features of each type of Medicare Advantage plan.

PPO Medicare Advantage Plans in Idaho

  • In-network providers
  • No primary care physician (PCP)
  • No referrals needed

HMO Medicare Advantage Plans in Idaho

  • In-network health care providers
  • PCP required
  • Referrals required for specialists

Special Needs Plans SNPs in Idaho

SNPs are only available to individuals meeting specific criteria:

  • Live in institutional conditions such as nursing homes
  • Are dual-eligible for Medicare and Medicaid
  • Have end-stage renal disease ESRD, diabetes, heart failure, or other chronic health conditions

Generally, a primary care doctor coordinates care. SNPs must include prescription drug coverage.

Private Fee-for-Service (PFFS) Plans in Idaho

  • May or may not have provider networks
  • No PCP
  • Out-of-network services covered at a lower rate

Enrollment Figures for Idaho Medicare Advantage Plans

Idaho’s five largest counties by population hold roughly 57% of the state’s nearly 1.8 million residents:

  • Ada
  • Canyon
  • Kootenal
  • Bonneville
  • Bannock

Medicare numbers in Idaho:

  • Percent of residents 65 or older: 15
  • Individuals who had Medicare in 2018: 323,878
  • Those choosing Medicare Advantage: 44%
  • Advantage beneficiaries enrolled in an HMO: 56%
  • Percent enrolled in a Medicare Part D plan: 57

Do Medicare Advantage Plans in Idaho Cover Prescription Drugs?

Most Medicare Advantage plans in Idaho cover prescription drugs. These health plans are known as Medicare Advantage Prescription Drug plans (MAPD). MAPDs vary in several ways:

  • Formulary (list of drugs covered)
  • Prescription drug tiers (the way the drugs are categorized)
  • Copayments, deductibles, and coinsurance
  • Pharmacy restrictions

When evaluating Medicare Advantage plans, compare the formulary to make sure your medications are covered. Also, compare the drug tiers to find out where your medications fall. Your copays and cost-share amounts depend on which tier covers your particular drug.

Network Restrictions for Medicare Advantage plan in Idaho in 2020

Health Maintenance Organization HMO plans and Preferred Provider Organization PPO plans both have network restrictions. Here’s how they compare:

  • Within coverage area. PPOs pay for out-of-network services, but at a lower rate compared to in-network providers. HMOs don’t pay for out-of-network doctor and hospital services.
  • Traveling. HMOs and PPOs cover urgent care outside of the network and service area.
  • Relocating. Moving across state lines requires you to change to a Medicare Advantage plan in the new area. An SEP applies.

Added Benefits of Medicare Advantage Plan in Idaho

Some of the best Medicare Advantage plans in Idaho include additional benefits. Each health insurance company offers different benefits, so it’s best to compare plans carefully. Some of the extra benefits offered include:

  • Wellness programs
  • Routine vision and dental
  • Hearing
  • Healthy living classes

The various Medicare plans can quickly turn confusing. If you would like us to help you compare plans or find the best Medicare Advantage rates, give one of our insurance agents a call.  We can also help you decide whether getting your benefits through Medicare Part A and Part B or Medicare Part C in Idaho that best suits your situation, as well as provide more information on Medigap Supplement insurance.

  • Starting in 2020, insurance companies that provide Medicare Advantage plans in Idaho will be able to add some supplemental non-health related benefits to certain beneficiaries, such as providing help with making structural changes to the home when needed. This is designed to help those who might need help with widening doorways or installing ramps for their homes.
  • The Centers for Medicare and Medicaid Services approved a 2.53% payment increase to Medicare insurers that offer Medicare Advantage plans in Idaho.

To help you begin comparing Medicare Advantage Plans in Idaho for 2020, it might help to view a brief overview of local providers:

  • Blue Cross of Idaho: Distinct from Blue Shield, this insurer offers a True Blue HMO that has a real history for quality.
  • Humana: About 10 percent of members of Medicare Part C plans in Idaho chose a Humana plan.
  • Regence of Idaho: This is Idaho’s Blue Shield affiliate. In the past, they have offered HMOs that have earned good quality marks.

Idaho Medicare Resources

Medicare in Idaho

Extra help paying costs

Senior Health Insurance Benefit Advisors