Medicare in idaho

Older adults who are looking for health insurance can choose coverage through Medicare, the federal program for adults aged 65 and older. Some younger adults with disabilities are eligible as well. As of 2022, there are 358,996 individuals enrolled in Medicare in Idaho. This is about 19% of the 1.9 million people who live in the state. Each year the state spends over $1.8 billion on Medicare, around $5,762 per beneficiary.

Original Medicare is the more common type of Medicare in the state, and it has two basic parts. With Part A, seniors receive coverage for inpatient care in a hospital, nursing homes, hospice care and some home health care services as well. This part of Medicare is available at no cost, provided the senior paid enough Medicare payroll taxes while working or they’re married to someone who did. Part B covers preventative care, regular outpatient doctor visits and medical supplies. In 2022, the standard premium for Part B was $170.10 a month. 

For seniors who want a different type of coverage, privately run plans offer the chance to get personalized coverage. Part C, also known as Medicare Advantage, is the choice of about 40% of the total Medicare users in Idaho. These Medicare-compliant plans come from private health insurance providers and have the coverage of both Part A and Part B, and often include drug coverage (Part D), as well. The Advantage plans may also include dental, vision care and various wellness services. s. For prescription drug coverage (Part D), seniors have to enroll separately if they are Original Medicare users or if their Medicare plan does not include it. Medigap is the Medicare supplement plan that reimburses out-of-pocket costs not covered through Original Medicare.

This guide outlines these coverage options in detail for Idaho residents. It also provides resources to help seniors in the state make the best decisions about their Medicare health care 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 is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

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)

Medicare Advantage plans are another option to get Medicare coverage in Idaho. Also known as Medicare Part C, these plans come from private health insurance providers. They have the same coverage as Original Medicare except for hospice coverage, which only Part A provides, but they can also have additional coverage options like prescription drugs, dental care or over-the-counter medications based on the plan’s coverage choices.

Medicare Advantage plans come in four basic forms. Seniors can choose from Preferred Provider Organization, Health Maintenance Organization, Special Needs Plans and Private Fee-for-Service plans. Each has its own rules for eligibility and out-of-pocket costs based on the insurance provider’s decisions. Older adults should shop carefully because of the differences between 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 April 2022, 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 2022 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.