Medicare Advantage Plans in Idaho

Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B). are private health plans available to people with Medicare benefits. Unlike Original Medicare, they are not the same in all states. In fact, plans in every Idaho County are different. For this reason, you must shop and compare plans locally.

Use our zip code lookup above to see which plans are available in your region. Or click below to select your county. Keep reading to learn more about the Medicare Advantage program in Idaho.

Compare the Best Medicare Advantage Plans in Idaho by County

What is a Idaho Medicare Advantage Plan?

Traditional MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage. covers about 80% of all major medical costs. It does not cover minor medical, including vision, hearing, and dental, and it does not offer prescription drug coverage. The Medicare Advantage plans available in Idaho can include minor medical benefits but are not required to. Most do include coverage for your prescriptions. To get a Medicare Advantage health plan (also known as Part C of Medicare), you must first have both Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care. and Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare services. benefits.

While it is nice to have coverage for minor medical costs, such as a prescription drug plan, you must understand exactly what you get when you join a Medicare Advantage plan in Idaho. In particular, you need to know that these plans have complete control over your access to doctors and other healthcare providers. If you've ever had a managed care insurance plan (HMO, PPO, etc.) through an employer, you already know what to expect.

Medicare Advantage vs. Original Medicare: Is There a Big Difference?

One way to better understand how different Original Medicare coverage is from Medicare Advantage is to have a look at the pros and cons of each type of health insurance in Idaho. So, let's do that.

Pros and Cons: Medicare vs. Medicare Advantage

1. With Medicare Advantage you must use Idaho healthcare providers within the plan's network. With Original Medicare, you can use the Medicare-approved providers of your choice.
2. If you travel and have a medical emergencyWhen you believe you have an injury or illness that requires immediate medical attention to prevent a disability or death., Medicare Advantage covers you (in the U.S and its territories only). However, if you are a snowbird and winter or summer in another state, a non-emergency doctor outside of your plan's network won't be covered.
3. All Medicare Advantage plans sold in Idaho protect you with an annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsuranceCoinsurance is a percentage of the total you are required to pay for a medical service.  that you'd normally pay out-of-pocket. Original Medicare does not have an out-of-pocket maximum.
4. Most Medicare Advantage plans come bundled with a Idaho Medicare Part DMedicare Part D plans are an option Medicare beneficiaries can use to get prescription drug coverage. Part D plans provide cost-sharing on covered medications in four different phases: deductible, initial coverage, coverage gap, and catastrophic. Each... plan for prescription coverage. With Original Medicare, you must enroll in a stand-alone Part D plan. But, the stand-alone plans offer more choices to get lower-cost prescriptions.
5. With Original Medicare, your costs (copays, coinsurance, etc.) are predictable, and you can get a Medicare supplement to help pay these costs. In the Medicare Advantage program, each plan can charge what they want for copays and coinsurance, making it very difficult to compare actual costs.
6. There are eligibility requirements with Medicare Advantage plans. For example, you must have both Medicare Part A and Medicare Part B to join, and you cannot have end-stage renal diseaseEnd-Stage Renal Disease (ESRD), also known as kidney failure, is a condition that causes you to need dialysis or a kidney transplant. People with ESRD are eligible for Medicare coverage regardless of age. (ESRD) or one of a handful of other diseases.

Idaho Medicare Advantage Plans vs. Medigap

We're frequently asked:

• Why are Medicare Advantage plans bad?
• What are the disadvantages of Medicare Advantage plans in Idaho?
• Is it better to have Medicare Advantage or Medigap?

Let's take just a minute to dispel any misconception that these plans are bad or might have serious disadvantages.

Why Idaho Medicare Advantage Plans are Bad

People that say Medicare Advantage plans are bad simply misunderstand them and don't know how they work. Over 42 percent of all Medicare beneficiaries choose Medicare Advantage enrollment and like their care. However, these plans are not suitable for everyone living in Idaho.

MedicareWireMedicareWire is a Medicare insurance consulting agency. We founded MedicareWire after seeing and hearing how confusing and frustrating it is to find, understand, and choose a plan. Our services are free to the consumer. advises people who have one or more serious chronic conditions to keep their Original Medicare, particularly if you have specialists treating you and you want to stay with them. Our opinion is that Medicare Advantage is an excellent option for those who qualify for both Medicare and MedicaidMedicaid is a public health insurance program that provides health care coverage to low-income families and individuals in the United States. (dual eligible), for those with retiree healthcare benefits, and for extremely healthy, active seniors.

Similarly, traditional Medicare, plus Medicare supplement insuranceMedicare Supplements are additional insurance policies that Medicare beneficiaries can purchase to cover the gaps in their Original Medicare (Medicare Part A and Medicare Part B) health insurance coverage., work best for people with chronic health conditions, as well as those who can afford a higher monthly premiumA premium is an amount that an insurance policyholder must pay for coverage. Premiums are typically paid on a monthly basis. In the federal Medicare program, there are four different types of premiums. . Most experts agree that this is the best health insurance seniors can get in Idaho.

You can learn more about Medicare supplements in Idaho on our Idaho Medicare supplements page.

Are There Disadvantages to Joining a Medicare Advantage Plan in Idaho?

As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay. This fact remains the same no matter what type of Medicare Advantage plan you are considering (e.g., HMO, PPO, PFFS, Cost, or HSA).

With most Medicare Advantage plans, you pay a little each month (the monthly premium) and copaymentsA copayment, also known as a copay, is a set dollar amount you are required to pay for a medical service. when you use medical services. It does not matter if you have a Health Maintenance Organization (HMO) plan or a Preferred Provider Plan (PPO). You pay the majority of your costs when you use health services.

With most Medigap plans, you pay most of your costs upfront with your monthly premium. As a result, your costs (e.g., the deductibleA deductible is an amount a beneficiary must pay for their health care expenses before the health insurance policy begins to pay its share.) are more predictable than they might be if you have Medicare Advantage and use a lot of healthcare services

Which is Best in Idaho, Medicare Advantage or Medicare Supplement Insurance?

• If you can afford Medigap Plan FMedicare Supplement Plan F is the most comprehensive Medicare supplement plan available. This plan covers all Original Medicare deductibles, coinsurance, and copayments, leaving you with no out-of-pocket costs on all Medicare-approved services., G, or N, then keep your Original Medicare and add one of these supplements. These plans help you manage your out-of-pocket costsOut-of-Pocket Costs for Medicare are the remaining costs that are not covered by the beneficiary's health insurance plan. These costs can come from the beneficiary's monthly premiums, deductibles, coinsurance, and copayments. the best, giving you complete peace of mind.
• If you are a healthy senior and have good health in your family heritage, Medigap Plan NMedicare Supplemental Plan N is one of the ten standardized Medigap plans. Although it is one of the newest plans available, Medicare Plan N is quickly becoming a favorite with Baby Boomers aging into their... will let you save money by sharing some costs when you see your doctor. The plan benefits are excellent, and you pay just a little to see your doctor (up to $25 per visit).
• If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice. Both Original Medicare and Medicare Advantage cover preventive care at no additional cost to keep you healthy
• If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
• If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
• If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
• With both Medigap and Medicare Advantage, you must continue to pay your Medicare Part B premiumThe Medicare Part B premium is the monthly charge paid by beneficiaries for their outpatient medical care, services, and supplies. A beneficiary's premium may be uplifted by an IRMAA surcharge if their income is above... (it typically comes straight out of your Social Security income, unless you're not yet taking it).
• With Medicare supplement insurance, there are no service area restrictions. With Medicare Advantage, you must receive care within the plan's provider network unless you need emergency care.
• Medicare Advantage plans have an enrollment period. You get an individual enrollment period when you're first eligible. After that, there's an annual enrollment periodThe Annual Enrollment Period is when Medicare beneficiaries can join, drop or change Medicare Advantage and Medicare Part D prescription drug plans. AEP begins on 15 October and ends on 7 December. to switch plans or go back to Original Medicare. Medigap plans do not have the same restrictions, but you can be turned down if you leave a Medigap plan and later want to come back. Medicare Advantage plans cannot generally turn you down as a Medicare supplement insurance company can.

References

medicare.gov

• Medicare.gov: the official U.S. government site for Medicare | Medicare http://www.medicare.gov/
• Find a Medicare plan https://www.medicare.gov/plan-compare/

ssa.gov

• Medicare Benefits | SSA https://www.ssa.gov/medicare/
• Extra HelpSocial Security's Low-Income Subsidy (LIS) program helps Medicare beneficiaries pay for their Medicare Part D prescription drugs by paying some of the costs. Also known as "Extra Help", beneficiaries who qualify for LIS receive premium... with Medicare Prescription Drug Plan Costs | SSA https://www.ssa.gov/medicare/prescriptionhelp/
• Medicare Benefits | SSA https://www.ssa.gov/benefits/medicare/

cms.gov

• Five-Star Quality Rating System | CMS https://www.cms.gov/medicare/provider-enrollment-and-certification/certificat...
• https://www.cms.gov/Medicare/CMS-Forms/CMS-Forms/Downloads/CMS10106.pdf
• Medicare Open Enrollment | CMS https://www.cms.gov/Outreach-and-Education/Reach-Out/Find-tools-to-help-you-h...

This Medicare Advantage state information page was last updated on June 29, 2022.