Medicare Plans in Idaho – Coverage and Benefits
For anyone who lives in Idaho age 65 and older, you can start receiving health care benefits from the federal government through the Medicare Program. The benefits you are eligible for fall under Part A and Part B of Traditional Medicare. These benefits include hospital stays and most hospital services, in addition to outpatient care. There are many more services too, and they are outlined in the table below.
There are some base costs associated with receiving Medicare benefits. Depending on your history of employment, you may have to pay for both Parts A and B, or only Part B. Those who have a lengthy work history (10 years/40 quarters) will only have to pay for Part B. However, those who have worked less than 10 years in their lifetime will also be required to pay a premium in order to have access to Part A benefits. Exact expenses can be estimated here.
|Medicare Part A (Hospital Coverage)
||Medicare Part B (Medical Insurance)
|Medicare Part C (Medicare Advantage)
||Medicare Part D (Drug Coverage)
The Scope of Idaho Medicare Insurance Programs
In Idaho, there are 242,889 retirement-age citizens currently enrolled in Medicare. Of those, one third (33%) are getting Medicare Benefits through a Medicare Advantage policy. There is also another group of beneficiaries – 22% of the nearly quarter million number mentioned above – who supplement Traditional Medicare with one of ten available Medigap policies. The remaining 45% may be relying on Medicare alone to cover their health costs, or they may be receiving some other sort of benefits (such as through an employer).
All qualified seniors who are currently enrolled in Medicare should be looking into a supplemental insurance policy. If you are not yet enrolled, or if you are unsure, click the link above and learn how to get yourself enrolled today.
Should You Supplement Your Medicare if You Live in Idaho?
Costs will inevitably vary by state, but this is only one of many, many factors which will influence your decision to supplement your Traditional Medicare benefits. Your age is another factor; the older you are, the more coverage you will need to protect yourself from expensive and/or unexpected medical bills. The table below illustrates only some of the costs you might be stuck paying if you don’t protect yourself from the gaps in Medicare coverage:
|Medicare Part A Costs||Medicare Part B Costs|
You have several options when it comes to supplementing your Original Medicare package. It can be hard to pick the right supplement, especially if you are on a tight budget. The two simplest and most affordable options are Medicare Advantage, and Medigap (named so because it covers the “gaps” in Traditional Medicare). We’ll discuss each option, and give you plenty of information to help you decide.
Medigap Policies for Idaho Residents
As mentioned earlier, Medigap supplement policies are designed to protect you from the coverage gaps associated with Medicare Parts A & B. There are 10 government-approved policies to choose from. They are listed alphabetically for simplicity’s sake: A, B, C, D, F, G, K, L, M, and N. There also used to be a Plan E, H, I, and J. In order to reform and enhance the Medicare system, however, they were eliminated back in 2010.
Federal laws demand that Medigap policy providers offer the exact same benefits in each plan, and in every state. This means that Medigap Plan A in Idaho is the exact same policy as a Medigap Plan A in Iowa or Alaska. They will differ in price, however, as well as in which companies are able to provide them to you. The table below can tell you more:
[chart category=”supplement” name=”planTypes” state=”ID” zipcode=”83704″]
Medicare Advantage in Idaho
Medicare Part C, Medicare Advantage, and Medicare Replacement are all essentially the same thing, regardless of the name you call them by (but most prefer the term Medicare Advantage). As you may imagine, signing up for a Medicare Advantage policy will, essentially, replace your traditional Medicare benefits. There are some small benefits to this. Government laws ensure that your Advantage policy will provide “equal or greater” benefits than Traditional Medicare alone. And you only have to deal with one (private) company through Medicare Advantage, which helps keep things simple.
While the benefits provided through Medicare Advantage may cost the same or less compared to Original Medicare, keep in mind that most of their HMO and PPO networks are fairly restricted. Therefore, switching to Medicare Part C may require you to switch doctors as well. And you’ll be dealing with a private health insurance company instead of the government, which may or may not be a benefit depending on your personal experience with either entity.
HMO (Health Maintenance Organization) and PPO (Preferred Provider Organization) networks are carefully selected groups of doctors and medical facilities which must be utilized if you want your Medicare Advantage provider to pay out claims. Here are some plans available near you:
[chart category=”advantage” name=”topHMOPlans” zipcode=”83704″ state=”ID”]
[chart category=”advantage” name=”topPPOPlans” zipcode=”83704″ state=”ID”]
Idaho Medigap vs. Idaho Medicare Advantage
There are many subtle differences between these two forms of Medicare supplemental coverage. It can be difficult to learn exactly how these supplements are different from one another at first. Below, we have set up an informational chart to show you exactly where and how these supplement policies differ:
|Questions||Medicare Advantage||Medicare Supplement|
|How are the plans funded?||Medicare will pay your insurance company a fixed amount based on average healthcare costs for your region. You may also be required to pay a premium based on your location and insurance company.||Your monthly premium takes care of the majority of your expenses.|
|Do I continue paying for Part B?||Yes||Yes|
|What does it cost me?||Some plans offer a zero-dollar premium (because the government subsidy covers the full cost). Other plans may cost up to 0-0 monthly.||While each plan does require a monthly premium, many of them are affordably priced.|
|What does the plan cover?||Depending on your plan, it will cover at least the same benefits offered by Medicare parts A & B. Possibly other benefits; but the more benefits you sign up for, the higher your out-of-pocket expenses may be.||All eligible expenses are split between Medicare, and your Medicare Supplement plan. If you have a comprehensive plan, such as Plan F, 100% of eligible expenses not covered by Medicare will be covered by your supplement insurance.|
|Can I budget my health care expenses?||It’s challenging; the more often you require medical care, the more often you may be required to pay out-of-pocket.||Budgeting is much easier with a Medicare supplement. You have fewer out-of-pocket expenses, and one simple monthly premium.|
|Can my plan be cancelled?||Yes. Unfortunately, your health insurance company has the legal right to review their Medicare Advantage services annually and decide whether or not they wish to continue providing coverage.||No – not unless you fail to pay your monthly premium, or your insurance company goes bankrupt. Only under such extenuating circumstances could your plan be cancelled.|
|Are pre-approvals or pre-certifications required?||Unfortunately, yes. These Plans usually require pre-certification or other qualification for some specific types of care.||No pre-approvals are required. If you qualify for Medicare, you will qualify for a Medicare supplement plan.|
|Can I use any doctor or hospital?||Usually, you choose from a network of pre-approved providers. These networks can fluctuate over time.||Yes. You are free to choose any doctor and/or hospital in the U.S. which accepts Medicare.|
|Can drug, vision, or dental coverage be included in the policy?||Yes.||No. These forms of coverage must be purchased separately.|
|Who is this plan type generally best suited for?||If you are relatively young, healthy, live in an urban area, and have a limited income, a Medicare Advantage plan could work for you.||If you live in a rural area without easy access to provider networks, if you like to budget your finances, or if you want comprehensive coverage, you might prefer a Medicare supplement plan.|
Idaho Medicare Resources & Contacts
Everyone has their own unique situation, and this short article alone cannot clear up every single possible question you might have. For this reason, we have included some helpful resources for you. By using the contact information at the bottom of this page, you can get in touch with Idaho Medicare supplement insurance experts near you who can clear up any confusion you may have regarding Medicare, your benefits, and how best to supplement your existing coverage:
[chart category=”general” name=”usefulContacts”]
Important Medicare-Related Healthcare Terms
- HMO: Health Maintenance Organization, this refers to a network of doctors and hospitals with a plans’ network.
- PPO: Preferred Provider Organization, this refers to a network of doctors and hospitals with a plans’ network.
- Co-Pay: Amount of money charged per visit to doctor, specialist, etc.
- Co-Insurance: A percentage required by the policyholder to pay out-of-pocket. For example, 80/20 coinsurance means the insurance company will cover 80% of the charges, and the policyholder pays the remaining 20% of the charges.
- Deductible: This is the amount of money required out-of-pocket by the policyholder before the insurance will kick-in and pay for any remaining charges. For example, a policy with a $1,000 deductible means that you must pay full healthcare costs out-of-pocket up to $1,000 before the plan will start coverage.