Medicare in Idaho

Seniors 65 and older or those with eligible disabilities qualify for Medicare, a federal health insurance program. Seniors can choose to enroll in one of two programs: Original Medicare or Medicare Advantage. Original Medicare Part A covers inpatient care, while Part B covers preventative and outpatient care. Medicare Advantage offers similar coverage through private insurance providers approved by the Centers for Medicare & Medicaid Services (CMS). Often, Medicare Advantage includes drug coverage (Medicare Part D) and other services such as dental, vision care and mental health care. In 2021, the state spent around $1.93 billion on Medicare payments. According to CMS, this number increased by 4.3% in 2022 and is anticipated to rise by 5.4% annually going forward.

As of 2023, 367,702 individuals in Idaho are enrolled in Medicare, representing about 19% of the state population. 379,420 residents are eligible for Medicare Advantage enrollment in 2023, with 47%, 176,905 people, opting for one of these plans. In comparison, around 48% of the total number of eligible individuals nationwide enroll in this plan, making Idaho about on par with national norms.

From 2022 to 2023, the number of eligible enrollees in Idaho rose by 3.69%, faster than the national average of 2.66%, indicating the state’s population is aging at a higher rate than the rest of the country. Compared to the previous year, 11.6% more people in Idaho opted to enroll in a plan, with the total growth in the percentage of eligible people who enrolled reaching 7.63%. These numbers are similar to national trends, which revealed 9.75% more people across the country enrolling in Medicare Advantage, creating a total growth in the percentage of eligible people who enrolled of 6.90%.

This guide details coverage options for Medicare in Idaho. It also lists several resources that may help seniors make informed decisions about Medicare coverage.

Options for Medicare Coverage in Idaho

Medicare coverage for seniors in Idaho is available in multiple ways. While many choose Original Medicare, which the federal government operates, options through private health insurance providers have the same benefits but with additional coverage options. These coverage choices allow seniors to get the best possible plan for their personal needs. 

Original Medicare (Parts A & B)

Original Medicare benefits can be used nationwide from Medicare-approved providers. Part A covers inpatient hospital care, nursing home care, skilled nursing, hospice services and some home health care. Part B covers medically necessary goods and services, such as outpatient care, mental health services, emergency medical transportation and durable medical equipment.

Original Medicare benefits can be used nationwide from Medicare-approved providers. Part A has no premium for most and a deductible of $1,600 for the first 60 days of inpatient care and daily coinsurance afterward. Part B has a monthly premium based on income starting at $164.90, plus a 20% copay. 

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Seniors in Idaho who opt for Medicare Advantage buy plans from private insurers approved by CMS. These providers must follow CMS regulations and offer the same coverage as Original Medicare. The exception is hospice care, which will always be overseen by Original Medicare Part A. In addition, Medicare Advantage often includes additional coverage for prescription drugs, dental services and vision, and providers may set their own eligibility and out-of-pocket contributions. Medicare Advantage Plans come in several forms. The most common are Preferred Provider Organization (PPO), Health Maintenance Organization (HMO), Special Needs Plans (SNP) and Private Fee-for-Service (PFFS) plans. 

Who Should Consider Medicare Advantage

Seniors may find Medicare Advantage to be a good choice if the following apply:

• They need to control out-of-pocket expenses.
• They like the idea of shopping for a managed care plan.
• They have good overall health that could lower premiums.
• They want the additional coverage options not available through Original Medicare .

The Top 10 Medicare Advantage Plans in Idaho

The table below outlines the top Medicare Advantage plans for Idaho residents. As of August of 2023 , these were the top plans based on the number of people enrolled. The table shows a range of how much beneficiaries pay for coverage and the types of plans offered. The Medicare Advantage Plans in Idaho page has more information about these options.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2023 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Idaho

Navigating the world of Medicare, applications and appeals can feel overwhelming. In Idaho, older adults and their caregivers have a number of resources available to them to help with this process. These resources are available free of charge, and their primary goal is to help seniors navigate Medicare, choose the best plan for their needs and utilize their benefits effectively.