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Medicare Special Needs Plans Ada County, Idaho

We reviewed the top 5 Medicare Advantage Special Needs Plans (SNPs) available in Ada County, Idaho. This is what we learned:

Key Facts

  1. Special Needs Plans are not available to everyone. Membership is limited to people with specific diseases or characteristics.
  2. The average premium for a Special Needs Plan in Ada County is $42.90 per month.
  3. If you are dual eligible (Medicare and Medicaid), most of your healthcare costs are fully covered.
  4. SNPs cover the same services that all Medicare Advantage plans must cover.
  5. SNPs may also cover extra services tailored to the special groups they serve, like extra days in the hospital.
  6. All SNPs include a Medicare Part D drug plan. The average drug plan deductible is $480.00 per year.
  7. SNPs tailor plan benefits, provider choices, and drug formularies to meet the specific needs of the groups they serve.
  8. Medicare rated 40% of all SNPs in Ada County 4 stars or higher.

Ada County, Idaho Medicare SNP Plans

Medicare Special Needs Plans in Ada County, ID for 2023
Plan Name Type Premium Network Part D
Deduct.		 Rating
American Health Advantage of Idaho I-SNP $43 HMO $480
☆☆☆☆☆
Molina Medicare Complete Care D-SNP $43 HMO $480
☆☆☆☆☆
Molina Medicare Complete Care Select D-SNP $43 HMO $480
☆☆☆☆☆
True Blue Special Needs Plan D-SNP $43 HMO $480
☆☆☆☆☆
True Blue Special Needs Plan D-SNP $43 HMO $480
☆☆☆☆☆

Ada County, ID
Medicare Advantage Special Needs Plan Information

Special Needs Plans (SNPs), which are part of the Medicare Advantage program, are a private health plan alternative to Original Medicare. However, not everyone with Medicare who lives in Ada County will qualify. As the name implies, the 5 SNPs available are for people with special needs. Each plan is facilitated by Medicare-approved private companies that agree to provide coverage by Medicare's rules. All plans offer additional benefits that aren’t available through Original Medicare.

To join a SNP you must first prove you have special needs based on one or more of the following three criteria:

  1. An institutionalized individual,
  2. A dual-eligible (Medicare and Medicaid) person, or
  3. An individual with a severe or disabling chronic condition.

If you qualify for Medicare in Ada County but don't know where to begin, we have licensed agents[1] at 1-855-728-0510 (TTY 711) who can answer your questions and help you get enrolled. There's no obligation.

There are Different Types of Special Needs Plans

Not all Medicare Special Needs Plans are the same. There are three different type:

  1. Dual-eligible Special Needs Plans (D-SNP) are for beneficiaries with both Medicare and Medicaid benefits.
  2. Institutional Special Needs Plans (I-SNP) serve people staying in a long-term care facility or a skilled nursing facility.
  3. Chronic Condition Special Needs Plans (C-SNP) provide coordinated care Medicare beneficiaries with one or more serious diseases, including diabetes, end-stage renal disease (ESRD), and certain lung and heart disease.

D-SNP

Dual Eligible Special Needs Plans (D-SNPs) accept people who are eligible for both Medicare and Medicaid. Idaho covers some Medicare costs, depending on the beneficiary’s eligibility. Medicaid eligibility categories include:

  • Full Medicaid (only);
  • Qualified Medicare Beneficiary without other Medicaid (QMB Only);
  • QMB Plus;
  • Specified Low-Income Medicare Beneficiary without other Medicaid (SLMB Only);
  • SLMB Plus;
  • Qualifying Individual (QI); and
  • Qualified Disabled and Working Individual (QDWI).

    • All D-SNPs must identify whether the plan offers Medicare zero-dollar cost sharing.

    I-SNP

    Institutional Special Needs Plans (I-SNPs) are SNPs that restrict enrollment to Medicare beneficiaries who, for 90 days or longer, have had or are expected to need the level of services provided in a long-term care facility, skilled nursing facility, an intermediate care facility for individuals with intellectual disabilities, or an inpatient psychiatric facility.

    Prior to enrolling in a I-SNP, beneficiaries are advised to verify their institution accepts the plan and that its healthcare providers are in the plan's provider network.

    C-SNP

    Chronic Condition SNPs restrict enrollment to special needs individuals with severe or disabling chronic conditions. About two-thirds of Medicare enrollees have multiple chronic conditions requiring coordination of care among primary care providers, medical and mental health specialists, inpatient and outpatient facilities, and extensive ancillary services related to diagnostic testing and therapeutic management.

    There are 15 SNP-specific chronic conditions::

    1. Chronic alcohol and other drug dependence
    2. Autoimmune disorders (limited)
    3. Cancer, excluding pre-cancer conditions or in-situ status
    4. Cardiovascular disorders (limited)
    5. Chronic heart failure
    6. Dementia
    7. Diabetes mellitus
    8. End-stage liver disease
    9. End-stage renal disease (ESRD) requiring dialysis
    10. Severe hematologic disorders (limited)
    11. HIV/AIDS
    12. Chronic lung disorders (limited)
    13. Chronic and disabling mental health conditions (limited)
    14. Neurologic disorders (limited)
    15. Stroke

    When Can I Get a Special Needs Plan in Ada County?

    Even if you are one of the few Ada County residents who qualify, you are only allowed to join, drop or change plans during a Medicare Election Period. The period between 15 October and 7 December is the Annual Election Period (AEP). That's when most folks make changes to their Medicare.

    You also have an Individual Election Period (IEP). Your IEP begins three months before your 65th birthday, includes your birth month, and continues for three months after your birth month.

    Outside of these periods, you may be able to join a Special Needs Plan with a Special Election Period. Some situations that may qualify you for a Special Election Period include:

    • You are diagnosed with a severe or disabling condition: You can enroll in a Chronic-Condition Special Needs Plan (C-SNP) for beneficiaries with your illness at any time.
    • You move into a nursing home or require skilled nursing care at home: You can enroll in an Institution Special Needs Plan (I-SNP) or switch plans at any time.
    • You qualify for Medicaid: If you have Medicaid or are newly eligible for Medicaid, you can enroll in a Dual-Eligible Medicare Special Needs Plan (D-SNP) at any time.
    • You move outside of your existing Special Needs Plan’s service area: You'll qualify for a Special Election Period to switch to a new plan.
    • Your Special Needs Plan leaves the Medicare program: You'll qualify for a Special Election Period to switch plans.
    Are you ready to enroll? Do you still have questions? Our licensed advisors are ready to help with no obligation. Call 1-855-728-0510 (TTY 711) for assistance Monday through Saturday.

    How to Get Enrolled in a Medicare SNP in Ada County

    There are three ways to enroll in an SNP:

    1. Call our Trusted Partner at 1-855-728-0510 (TTY 711). This toll-free number is staffed by HealthCompare, the outsourced partner of choice for some of the nation’s largest health plans.
    2. Call a plan directly. If you know the plan you want, this way is quick and easy. All of our plan pages provide contact information.
    3. Go to www.Medicare.gov and enroll through the government website. From there you can look up your medications, compare plans, and get your application started online.

    Citations & References

    The 2023 Medicare Special Needs Plans in Idaho information on this page was last updated on .