Medicare Advantage Plans in Idaho

Medicare Advantage, also known as Medicare Part C, combines all the benefits of Medicare Parts A and B into a single plan provided by a private insurer. The federal government does not administer Medicare Advantage, as it does with original Medicare, so plan providers can set their own policies around eligibility, cost and physician networks. Medicare Advantage plans can also offer additional benefits such as annual dental cleanings and vision checkups, but they must provide the same coverage as Original Medicare as a baseline. 

Most Advantage Plans include prescription drug coverage, so often there’s no need for Medicare Part D supplements. Beneficiaries are responsible for paying their Medicare Part B premium and the premium of their Advantage plan unless they choose a zero-premium plan. 

Medicare Advantage plans have grown in popularity nationwide, with more than four in 10 Medicare beneficiaries choosing Advantage plans in 2021. There are 24 states with enrollment percentages higher than 40%. Idaho narrowly misses the cut, with 39% of its Medicare beneficiaries choosing to enroll in Medicare Advantage plans. This is a little less than the national average of 42% for the same year. 

Idaho residents considering enrolling in a Medicare Advantage plan can use this guide to understand exactly what plans are available, what they cover and how much they cost. It also features an easy-to-follow overview of Advantage plan enrollment periods and information they can use to find the right plan for their needs. 

The Top 10 Medicare Advantage Plans in Idaho

In Idaho, the number of Medicare Advantage plans depends on what service area a beneficiary lives in. The table below lists the Top 10 Medicare Advantage Plans in Idaho in terms of enrollment. It includes the total enrollment numbers to give a complete picture of how many Idaho residents enrolled in each plan. Cost info and star ratings provide further context to each plan. Because many plan providers offer multiple Medicare Advantage plans, the table presents average monthly costs as a range rather than a set number. 

All plan information in the table below is accurate as of April 2022. Idaho residents can go to Medicare.gov to find the most up-to-date information about Medicare Advantage plans in their area. 

How Medicare Advantage Plans Work in Idaho

The 16% of Idaho’s population aged 65 and older, along with younger adults with disabilities, can choose between various different Medicare Advantage plans. The four main types of Medicare Advantage Plans in Idaho are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) and Special Needs Plan (SNP). Each one varies in price and differs when it comes to the referral requirements and in-network versus out-of-network health centers. Plan providers often offer more than one plan type. Information comparing and contrasting the four main types of Medicare Advantage plans is below. 

What Medicare Advantage Plans Cover in Idaho

In Idaho and nationwide, Medicare Advantage plans cover all the same health care services as Original Medicare, except for hospice care which remains covered under Medicare Part A. This includes services such as preventative screenings, X-rays, lab tests, hospital care and durable medical equipment.

Medicare Advantage plan providers can also offer additional benefits such as dental, vision, hearing aids and prescription drug coverage. Beneficiaries considering a Medicare Advantage plan should carefully review plan documents to compare and contrast coverage. 

*Select plans offer this coverage

** Most plans offer this coverage

Eligibility for Medicare Advantage in Idaho

All Idaho residents eligible for Medicare Parts A and B can enroll in Medicare Advantage. They must be age 65 or older, have a qualifying disability and be U.S. citizens or lawful immigrants. Beneficiaries must enroll in Original Medicare before applying for Medicare Advantage. 

Some Medicare Advantage plans have additional eligibility requirements. For example, Medicare Special Needs Plans (SNP) are only available to individuals with specific diseases or chronic conditions. 

Beneficiaries can only apply for Medicare Advantage during specific enrollment periods. Once the enrollment periods are over, there’s no way to sign up for a plan or change coverage unless a qualifying life event occurs, such as moving or losing coverage elsewhere. Medicare Advantage enrollment periods include:

• Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
• Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
• Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.

Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.

How to Find & Choose a Medicare Advantage Plan in Idaho

Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.

First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.

State-Wide Medicare Advantage Resources

Local Medicare Advantage Resources