Introduction to Medicare Advantage in Idaho (Medicare Part C)

While Traditional Medicare Parts A and B tries to provide seniors with comprehensive and affordable medical care during their golden years, there are gaps in coverage which can turn expensive quickly if you aren’t protected. One way to protect yourself is via a Medicare supplement policy. This article discusses one supplement in particular: Medicare Advantage (Medicare Part C).

Federal Regulations for Medicare Advantage

Technically, Medicare Advantage plans are private health insurance policies issued by a private company – which is why Medicare Advantage plans are sometimes called “Medicare Replacement Plans”. However, in order to make sure American Seniors receive the medical benefits they are entitled to after years of hard work, these policies are regulated by the government. These regulations ensure that you receive at least the basic medical benefits you are entitled to under Original Medicare. More often than not, though, Medicare Advantage companies will offer additional coverage in order to sweeten the deal.

Medicare Advantage Enrollment In Idaho

For Idaho, Medicare Advantage plans are fairly popular. About a third of Medicare-qualified seniors (33%) are signed up for a Medicare Advantage plan right now. This is opposed to Medigap plans, or employer plans. Among Medicare Advantage plans, you can see how the different types break down by popularity in the chart below:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Living in Idaho, as opposed to somewhere like Alabama, will significantly influence the cost of your Medicare Advantage plan. Take a look at the chart below to see what seniors in your area might be paying. These prices are estimates based on age, health status, Medicare enrollment, and more:

Most Popular Medicare Advantage Plans in Idaho

In addition to your rates being altered by personal circumstances, the type of Advantage plan you choose will change your rates that much more. There is essentially a trade-off between more inexpensive HMO plans, which strictly limit what doctors and hospitals you can use, and pricier PPO plans, which include more doctors and hospitals, yet cost more.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

Medicare Advantage plans are unique in that they are one of the few types of supplements which are not always accepted everywhere that Medicare is. Because of these doctor/provider network restrictions, it can be hard or expensive to get medical care if you need treatment from a doctor or hospital which is outside of your pre-approved network. Make sure you keep this in mind when determining whether a Medicare Advantage policy is right for you.

Doctor/Providers List

Drug, Vision and Dental Coverage

Some seniors prefer Medicare Advantage plans above other supplement options because of one important reason: convenience. There are lots of supplement policies out there which don’t leave room for optional benefits, such as vision, dental, or prescription drugs. But Medicare Advantage gives you the option for any or all of these added benefits. However, you will have to pay more for them. Medicare Advantage plans with Medicare Part D prescription drug coverage are often referred to as MAPD plans.

Enrollment Options & Best Time To Enroll

It may be slightly more difficult to get coverage under a Medicare Advantage plan than it is with typical Medicare supplement policies. Some companies will accept you if you are within your first six months of Medicare enrollment. Others may require a little more information about your medical history, even if you are still within the Initial Enrollment Period. And if you have a serious medical condition, such as ESRD, you could be rejected from the start. Talk to your local insurance agent, and consult with your state’s department of insurance for special rules and regulations on getting covered with serious health conditions.

  • Initial Enrollment Period: 6-month timeframe when you first enroll in Medicare to purchase a Medicare Advantage plan.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): During special circumstances, you may be eligible to purchase/change a plan outside of the Annual Enrollment Period. Things such as moving out of the plans’ service area, losing group health or employer coverage, a company no longer offering plans in the area, etc. are all events that could trigger a SEP.

What Medicare Advantage Plan Is Best For Me?

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