Finding affordable healthcare coverage is a primary concern for many individuals and families, especially those who are eligible for Medicare. Medicare offers health benefits to millions of people. Figuring out how to make the most of your benefits can be a challenge, though. Here’s everything about Medicare Idaho residents need to know.
Quick Look: Best Medicare in Idaho
- Best Overall in Idaho: BCBS
- Most Affordable in Idaho: Humana
- Best for Travel: Regence BlueShield of Idaho
- Best for Dual Eligibility: Molina Healthcare
- Best for PPOs: Aetna
Best Medicare Insurance Providers in Idaho
Ready to get quotes for Medicare insurance? Here are the top five providers in Idaho.
1. Best Overall in Idaho: Blue Cross of Idaho
Blue Cross of Idaho received 4.5 out of 5 stars from Medicare. This means it has a track record of good customer service. Blue Cross Blue Shield offers HMO and PPO plans.
It also has several benefits not included with Medicare. Its MDLive benefit allows you to securely talk to a doctor online or by phone. It also includes vision, hearing aid and dental coverage. You can purchase additional dental coverage.
- Offers plan options including Medicare Advantage, Medicare supplement and Medicare Part D plans
- Provides health and wellness discounts
- Good reputation for customer service and satisfaction
- Limited coverage for certain healthcare services or medications
2. Most Affordable in Idaho: Humana
Humana offers multiple plans with no monthly premium. Those plans include a PPO, which has more flexibility when it comes to seeing providers.
Its plans have no deductible for medical services, but there is a deductible for prescription coverage. Humana also includes vision and hearing aid coverage, fitness membership and an allowance for over-the-counter drugs in its plans.
- Offers Medicare Parts A + B and Medigap plans
- Strong network of healthcare providers and hospitals
- Offers additional benefits such as vision and hearing coverage
- Limited coverage options compared to other insurers
3. Best for Travel: Regence BlueShield of Idaho
Regence offers several plans with no monthly premium and no deductible for health care or prescriptions. If you like to travel, Regence allows you to see any provider in the U.S.
You pay less if you stay in-network, but you do have coverage even if you see someone out-of-network. Regence also offers impressive perks like in-home health visits from a doctor and membership at a fitness club or YMCA.
- Wide network of doctors and hospital
- Offers additional perks and services, such as fitness programs and wellness resources
- Some medical services may have coverage limitations.
- Certain medications and treatments may require prior authorization.
4. Best for Dual Eligibility: Molina Healthcare
If you have Medicare and Medicaid, Molina Healthcare offers a plan that coordinates your care and provides additional benefits. Its dual eligibility plan has no premium and no deductibles.
You also don’t pay a copayment for up to 90 days of inpatient care and no copay for doctor visits and outpatient care. Molina includes a transportation benefit, an allowance for over-the-counter medicines, a meals benefit and a fitness club membership.
- Offers affordable plan options for low-income individuals and families
- Provide members with additional benefits, including transportation, meals and over-the-counter medications
- Customer service can be inconsistent.
5. Best for PPOs: Aetna
If you like the flexibility of seeing the providers you want, when you want, Aetna might be a good choice. It offers multiple PPO plans with low monthly premiums. Like most PPOs, you do pay more to see out-of-network providers, but you can see them. Aetna also includes coverage for hearing aids, eyewear and seeing a dentist.
- Wide variety of health plan options
- Extensive network of healthcare providers
- Offers additional coverage for hearing, visionss and dental services
- Higher premiums and out-of-pocket costs compared to other insurers
- May have specific network restrictions
What is Medicare?
Medicare is a national health insurance program. The federal government offers this insurance based on age and other factors. Medicare has several parts. Each part offers a different type of health coverage. Many people refer to Parts A and B as Original Medicare. These are the oldest parts of Medicare and the parts most people have.
Part A: Part A is hospital insurance. Part A helps to cover inpatient care in a hospital or in a skilled nursing facility. It doesn’t cover long-term care in a facility. It also covers hospice care at home or in a facility and some home health care. Part B may also cover home health care.
Part B: Part B is medical insurance. It helps to cover doctors’ services, durable medical equipment, outpatient care and mental health services. It covers a wide range of screenings and preventive services.
Part C: Medicare Advantage plans are Part C of Medicare. Medicare pays these plans to provide services that fall under Parts A and B of Medicare. Most of these plans also include prescription drug coverage. You must have Parts A and B of Medicare to qualify for a Medicare Advantage plan. These plans are an optional way to receive your Medicare benefits.
Part D: Part D provides prescription coverage. You still have out-of-pocket costs with Part D, but the coverage provides some help with your costs. You can buy standalone Medicare Part D plans or you can buy a Medicare Advantage plan that includes prescription drug coverage.
What Isn’t Covered by Medicare?
Medicare covers a lot, but it doesn’t cover everything. Medicare covers what it considers “medically necessary” care. Medicare doesn’t cover services and items like:
- Cosmetic surgery
- Most dental care
- Custodial care (long-term care)
- Eye exams for glasses/contacts
- Hearing aids
- Massage therapy
If there’s a service you need but you aren’t sure whether it will be covered, talk to Medicare or your Medicare Advantage plan agent.
Medicare Advantage plans are one option for covering Medicare’s out-of-pocket costs. Medicare supplemental insurance is another option. Medicare supplement policies are also known as Medigap plans. Medicare regulates these policies. Private insurance companies sell these plans.
Medicare supplements pay for your health care costs after Medicare pays. Your healthcare providers would bill Medicare first. After Medicare pays its share, your Medicare supplement pays its share. You’re responsible for any balance after that.
Medigap plans do not include prescription coverage. If you want prescription coverage, you must purchase a standalone Part D prescription plan in addition to your Medicare supplement insurance plan.
Most people are eligible for Medicare Parts A and B at age 65. Medicare Part A is free at age 65 for people who have worked and paid Medicare taxes for 40 quarters (10 years) or longer. If you have other health insurance through an employer or your spouse, you may want to wait to take Part B. Contact your health insurance provider to find out whether or not to take Part B. Everyone pays a premium for Part B.
People with end-stage renal disease are also eligible for Medicare, regardless of age. People who receive Social Security disability benefits are also eligible for Medicare after receiving benefits for two years.
Legalities of Medicare in Idaho
The Department of Health and Human Services regulates Medicare. The Idaho Department of Insurance regulates insurance companies that operate in Idaho. If you buy a Medicare supplement or Medicare Advantage plan, the Department of Insurance oversees that plan. Social Security handles some of the administrative aspects of Medicare, but it is not in charge of the program.
Types of Medicare Advantage Plans
Medicare Advantage plans use a network to coordinate your care. Here are the main types of Medicare Advantage plans:
HMO: An HMO has a network of providers. Some HMOs require you to use in-network providers. Others allow you to go out-of-network, but you’ll pay more than you would with an in-network provider. You often need to get a referral to see a specialist.
PPO: A PPO also has a network. You can see providers outside the network, but you will pay more to see those providers. You typically don’t need a referral to see a specialist.
SNP: An SNP (Special Needs Plan) is available to Medicare beneficiaries who meet the plan’s requirements. Some plans are for people who are on both Medicare and Medicaid. Others are for people who have diabetes or who need home health care. An SNP may be an HMO or a PPO, depending on the insurance company offering the plan.
Medicare supplement plans don’t have a provider network. You can typically use a Medicare supplement with any provider who accepts Medicare.
How to Sign Up for Medicare in Idaho
If you’re receiving Social Security benefits when you turn 65, Social Security will enroll you in Medicare automatically. If you’re not already receiving Social Security, you will need to contact Social Security to enroll. If you’re receiving Social Security disability, it will automatically enroll you after you’ve received two years of benefits. If you have end-stage renal disease, you must contact Social Security to enroll.
You can only enroll in Medicare at certain times. You have an initial enrollment when you turn 65. If you don’t enroll in Part A or Part B during your initial enrollment due to having other coverage, you receive a special enrollment period when you lose your benefits. Your special enrollment lasts for eight months after the month your coverage ends.
Medicare also offers a general enrollment period from January 1 to March 31 each year. Your coverage starts the following July 1. You may pay a late enrollment penalty if you don’t enroll during your initial or special enrollment. The Part B late enrollment penalty is 10% for each year you waited to enroll. You pay that penalty for the life of your Medicare coverage.
If you pay for Original Medicare Part A, you can also receive a late enrollment penalty if you miss your initial and special enrollment periods. The penalty is 10%, and you pay the penalty for twice as long as you could have been enrolled if you enrolled on time. For example, if you waited to enroll for one year after you were eligible, you would pay the 10% penalty for two years.
Average Cost of Medicare Advantage Plans in Idaho
Medicare Advantage plans are surprisingly affordable. Here are the costs associated with several plans in Idaho:
|Health Plan Deductible
|True Blue Rx Preferred
|Blue Cross of Idaho
|SelectHealth Advantage Essential
|AARP Medicare Advantage Focus
|PacificSource Medicare MyCare Rx 32
Which Plan is the Best for You?
There’s a lot to consider when it comes to choosing a health plan. Your monthly payment is an important factor, but you should also look at the deductibles and out-of-pocket maximums. Most plan options allow you to enter the prescriptions you currently take to ensure the plan covers them. You should also look at the network to see if it includes your preferred providers.
If you’re not sure of the right plan for you, you can contact Idaho’s Senior Health Insurance Benefits Advisors (SHIBA). They give free support to help you choose the right health plan. You can reach them by phone at 800-247-4422. They also have regional offices you can visit for assistance.
Frequently Asked Questions
What are the different parts of Medicare?
Medicare has four parts named Parts A, B, C, and D. Part A provides hospitalization coverage while Part B provides outpatient coverage, like doctor visits. Parts A and B make up Medicare’s core coverages. Part C provides private-market Medicare plans, called Medicare Advantage Plans. Part C coverage often includes additional benefits. Medicare Part D provides coverage for prescription drugs. Get a Medicare Insurance Quote through the top providers here.
Is Medicare free?
Because there are four parts to Medicare, there can be different cost structures. Most people won’t have to pay for Medicare Part A (hospitalization). Eligibility for premium-free Part A is based on your work history during which you paid Medicare taxes. Many people do pay a monthly premium for Medicare Part B, however, which covers outpatient services, like doctor visits. Deductibles also apply to services covered under Medicare Parts A and B, so you’ll pay a part of the annual cost.
Medicare Parts C and D are optional coverages and have premium costs of their own. Medicare Part C refers to Medicare Advantage Plans that offer additional coverage in exchange for a monthly premium. Part D, the prescription plan, reduces the cost of medications but also requires a monthly premium. Subsidies may be available for low income households to help reduce overall Medicare costs.
Do I need to sign up for Medicare?
If you signed up for Social Security before age 65, you were enrolled in Medicare automatically but benefits will begin at age 65. In most cases, there are penalties for not enrolling at age 65, so it pays to sign up on time. Click here to get a medicare quote in minutes from the best providers.
If you have employer coverage, you may be able to delay Medicare coverage while your work plan is still in force. However, the size of the employer determines whether you’ll pay a penalty for not enrolling at age 65. Employees (and their spouses) of companies that offer group health insurance to 20 or more people are usually exempt from late sign-up penalties if they are covered by the employer’s plan.