Idaho Medicare Guide

Get free advice and support from one of our licensed Idaho Medicare Advisors. Schedule a consultation here or give us a call at (888) 604-0055 to get started! 

This guide will help you get to know the basics about Medicare in Idaho. Learn what you need to know to feel confident in making your Medicare decisions! 

Use this table of contents to jump to specific sections:

• A Snapshot of Medicare in Idaho

• Medicare Eligibility and Enrollment Step

• Idaho Medicare Advantage Plans

• Idaho Medicare Supplement Plans

• Idaho Medicare Part D Plans

• Get help paying for Medicare in Idaho

A Snapshot of Medicare in Idaho

There are 362,000 Idaho Medicare beneficiaries, making up 19% of the state population. The majority of beneficiaries are on Medicare due to age, but about 12% are on Medicare due to having a disability. 19% of Idaho Medicare enrollees are also receiving Medicaid benefits due to having low-incomes and resources.

Medicare beneficiaries have a choice between Original Medicare and Medicare Advantage. 60% of Idaho Medicare beneficiaries stay on Original Medicare and 40% enroll in Medicare Advantage plans.

Idaho Medicare Eligibility and Enrollment Steps

All US citizens who meet one of the following criteria are eligible for Medicare:

• You’re 65 or older

• You have certain disabilities like ALS and End-Stage Kidney Disease

Medicare Enrollment Steps

1. Enroll in Original Medicare (Part A & Part B) 

Most people age into Medicare and are able to enroll during their Initial Enrollment Period (IEP). Your IEP is a seven-month period unique to your birth month. It starts three months before the month you turn 65, includes your birth month, and lasts for three months after. It’s important to know when your IEP is because if you miss it, you may be subject to Medicare’s late enrollment penalties. In some cases, people choose to delay their Part B enrollment because they’re still working and receiving employer coverage. If you do delay Part B enrollment, just be sure you’re eligible for a Special Enrollment Period when you stop working!

2. Compare additional coverage options

Medicare beneficiaries have options. The first is between Original Medicare and Medicare Advantage. Once you’ve chosen your path, you have additional options. For Original Medicare, you have the option to add a Medicare Supplement plan and/or a prescription drug plan. For Medicare Advantage, you have different plans to choose from, and each plan has different provider networks and added benefits. You should make your Medicare decisions based on a thorough understanding of your options and your personal health and financial situation. We explain more about each option below, but we’re also here to help! If you have any questions about your Medicare options, call us at (888) 604-0055 to speak with one of our licensed Idaho Medicare Advisors.

3. Get the best value from Medicare

There are two things you should do to ensure you’re always getting the best value from Medicare. First, use your plan! Even if you don’t need to go to the doctor, make use of your preventive services, including your annual wellness visit. 

You should also review your Medicare insurance coverage every year to be sure you’re still receiving the best value for your unique needs. The best time to do this is during the Medicare Open Enrollment Period, which occurs every year between October 15 - December 7. If you need advice and support, we’re always here!

Idaho Medicare Advantage Plans

There are 69 Medicare Advantage plans in Idaho. Your specific pricing and availability will depend on the county you live in. For example, Ada County, ID has 45 Medicare Advantage plans from ten insurance carriers available to its residents. Twin Falls County has 24 plans available from seven insurance carriers.

Medicare Advantage plans bundle together Part A and Part B coverage, providing at least the same amount of coverage as Original Medicare. Most enrollees choose plans that also include Part D (prescription drug) coverage. These plans also include a set of added benefits, which may include::

• Dental, vision, and hearing services

• Transportation services

• Flex cards

• Fitness perks

Many people are surprised that many Medicare Advantage plans offer prescription coverage and other added benefits with no or low additional premiums. Note: Medicare Advantage enrollees do still need to pay their Original Medicare premiums. 

More benefits for no added premium sounds great, so why doesn’t everyone choose to enroll in a Medicare Advantage plan? These plans also have their downsides:

• Provider networks limit the doctors you can see

• Prior authorizations are commonly required (and denied) for covered services

• Cost structures result in high out-of-pocket costs (compared to Original Medicare + a Medicare Supplement plan)

Idaho Medicare Supplement Plans

There are ten different Medicare Supplement (Medigap) plans available to Medicare beneficiaries. These plans are labeled by letters A through N, and each plan of the same letter (e.g., all Plan Ns) are identical in coverage, even if pricing is different between insurance carriers.

Many Medicare beneficiaries choose to stack a Medigap plan on top of their Original Medicare coverage to help cover the 20% of costs that Original Medicare doesn’t cover. These plans significantly reduce your out-of-pocket costs. For example, with a Plan G, once you meet your annual Part B deductible ($226 in 2023), you owe nothing else for Medicare-covered services that year.

Three key benefits of Medigap plans that you don’t get with Medicare Advantage are:

• No limited provider networks

• No prior authorization requirements

• Lower out-of-pocket costs

The best time to enroll in a Medigap plan is during your Medigap Open Enrollment Period, which lasts for six months following your Part B effective date. During this time, you are guaranteed acceptance into any Medigap plan, regardless of your health history. Outside of the Medigap Open Enrollment Period and a handful of other guaranteed issue periods, insurance carriers are allowed to ask you questions about your health history and may reject your Medigap application.

Idaho is one of a handful of states with a Medigap Birthday Rule. This rule allows current Medigap plan holders to switch to another Medigap plan each year. You have a 63-day period that starts on your birthday to change from one Medigap plan to another. During this period, you can change plans and be guaranteed acceptance—as long as you’re switching to a plan with equal or lesser coverage. For example, if you’re on a Plan G, which is the most comprehensive plan, you can switch to another Plan G or to any other Medigap plan. 

Idaho Part D Plans

Original Medicare doesn’t provide prescription drug coverage, but  Idaho Medicare beneficiaries can get coverage through either a Medicare Advantage plan that includes it or through a stand-alone Part D (prescription drug) plan. There are 23 stand-alone Part D plans available in Idaho, but plan pricing and availability varies by county.

If you don’t have any prescriptions when you first enroll in Medicare, we still recommend enrolling in one of the lower-cost options to avoid paying a Part D penalty later.

If you have questions about your Medicare options or want to compare plan benefits and pricing, schedule a free consultation with one of our licensed Idaho Medicare Advisors or give us a call at (888) 604-0055. 

Get help paying for Medicare in Idaho

There are three government programs that can help low-income Medicare beneficiaries with their healthcare costs.

Idaho Medicaid

Medicaid is a joint federal and state program that’s managed by each state. Idaho’s Medicaid program is run by the Idaho Department of Health & Welfare. One of the programs offered is the Aid to the Aged, Blind, and Disabled (AABD Cash and AABD Medicaid). Beneficiaries of this AABD Cash Assistance program receive a small payment each month to help with living expenses. These individuals may also be eligible for AABD Medicaid

Idaho Medicaid also supports three Medicare Savings Programs (MSPs) that help Medicare beneficiaries pay for Medicare-related expenses. 

The Qualified Medicare Benefit (QMB)

This MSP pays for Part B premiums, deductibles, and coinsurance. If you qualify for the QMB program, you’ll also qualify for Extra Help (explained in the next section). 

Specified Low-Income Medicare Beneficiary (SLMB)

This MSP pays for beneficiaries’ Part B premiums. If you qualify for the SLMB program, you are also automatically eligible for Extra Help.

Qualifying Individual (QI)

This MSP only helps beneficiaries with the Part B premium.

Medicare Extra Help

Extra Help is a federal program that helps pay for costs associated with prescription drug coverage, including premiums, deductibles, and coinsurance. 

You automatically qualify for Extra Help if you:

• Receive full Medicaid coverage from Idaho

• Idaho pays your Part B premium

• Are eligible for Supplemental Security Income (SSI)

If you don’t automatically qualify for Extra Help, you can learn more about the program here or talk to one of our licensed Idaho Medicare Advisors to get free support with your application.

Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:

• You are 65 and older, blind, or have a disability

• You have limited income and limited resources

You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.