Medicare Advantage Plans 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.

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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 is built into Medicare Advantage Prescription Drug (MAPD) plans, so you don’t have to pay a separate Part D plan premium

Medicare Part C has some limitations, which vary with the type of MA plan you join:

  • Benefits tied to the use of network providers
  • Referrals are needed from your primary care physician before you can see specialists
  • Monthly premiums due to the insurance company, separate and in addition to Part B premiums billed from Medicare.
  • The annual deductible for Medicare Part B beneficiaries is $226 in 2023.
  • The standard monthly Part B premium is $164.90 in 2023.
  • 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. Instead, your level of coverage will be at least the same as Original Medicare coverage.

How MA plans work:

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

Top-rated Medicare Advantage Providers in Idaho

  • Blue Cross of Idaho: Distinct from Blue Shield, this insurer offers a True Blue HMO with a real quality history.
  • 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.

Popular Medicare Advantage Plan Types in Idaho

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

Idaho Enrollment Facts

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%

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.

How much do Advantage Plans cost in Idaho?

PPO Plan $0.00 to $34.00

HMO Plan $0.00

When can I enroll in a 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”

QualificationSpecial Enrollment PeriodOptionsDual eligibleFirst three quarters of the yearJoin, switch or leave MA or Part DEligible for help paying for drug planFirst three quarters of the yearJoin, switch or leave Part DState Pharmaceutical Assistance Program (SPAP) membersOne time each calendar yearSign up for Medicare drug plan or MAPD plan.

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.

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