Excellent Medicare isn’t small potatoes in the Gem State.

While Florida gets a lot of retiree attention, Idaho has regularly graced top-10 retirement lists from RetiredLiving to MarketWatch. Idaho natives won’t be surprised, as the state has excellent recreation opportunities, the cultural offerings of Boise, unreal natural beauty, and a top-notch healthcare system—not to mention tons of Medicare options. 

Having a ton of options is great, but choosing the right option can be a bit overwhelming. This article will outline all you need to know to get the best Medicare plan in Idaho. Let’s jump right in.

Ready to shop Idaho plans now? Use the Insurify Medicare comparison tool to find the right Medicare plan for you. Start with your ZIP code to compare Medicare Advantage, Medigap, and Prescription Drug plans. Try it today!

 

 

How Much Does Medicare Cost in Idaho?

The cost of Medicare depends on the type of plan(s) the Medicare beneficiary uses. Location and income can also affect costs. 

The Cost of Original Medicare in Idaho

Original Medicare has standardized costs wherever you are in the country—you can also access Medicare-covered services all over the country. 

Medicare Part A is typically premium-free. To qualify for premium-free, you’ll need 40 work credits. If you don’t have 40 work credits, you’ll need to pay a monthly premium: $259 for people with at least 30 work credits and $475 for people with fewer than 30 work credits. 

The Part A deductible is $1,474, and the coinsurance rate varies depending on the facility and level of care you receive. You can expect to pay $60 to $300 a day for inpatient care. 

Medicare Part B has a premium of $148.50. The premium does work on a sliding scale, with high-income beneficiaries paying more and low-income beneficiaries eligible for a financial assistance program.

The Part B deductible is $203. Part B also has a flat coinsurance rate of 20 percent. All in all, Original Medicare by itself is quite expensive.

The Cost of Medigap Plans in Idaho

Medicare Supplement Insurance, most often called Medigap, is a Medicare plan that you can add to Original Medicare. Medigap fills in the expensive “gaps” of medicare by covering part or all of your deductibles, co-payments, and/or coinsurance. These plans are regulated by the CMS but administered by a private health insurance company

There are 10 types of Medigap plans, designated by letter—Medigap Plan L, Medigap Plan G, and so on. Any Medigap plan of one type is identical to any other Medigap plan of the same type. For example, Medigap Plan G at Company J covers everything the Medigap Plan G at Company Z covers.  

Though the plans are identical in coverage, different insurance companies charge different premiums for the same plan. There are many factors that can influence costs. For example, each company has different business practices, overhead costs, and agreements with providers. 

Remember that price isn’t the bottom line. You should check out customer reviews and company websites before you decide. Better service can be well worth an extra $10 a month. 

The Cost of Medicare Advantage in Idaho

DentalMedicare Advantage plans have been around since the 1970s but weren’t formalized until the mid-1990s. These plans must follow strict guidelines for care as outlined by the CMS. The main benefit of using an MA plan is that many of them offer additional benefits like:

  • Hearing
  • Vision
  • Prescriptions

Most MA plans are organized as health maintenance organizations (HMOs). As such, these plans have well-defined networks of providers. Not only must you work within that network of care, but you must also work with your primary care physician and see specialists on a referral basis.  

Medicare Advantage Plans as Low as $0/month

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The Cost of Prescription Drug Plans in Idaho

To get the most out of your PDP, you should begin by making a list of your medications. From there, you should use the Insurify Medicare plan comparison tool to find PDPs available in your area. Finally, take a look at each plan’s formulary—that’s the pricing schedule the plan uses to assess the costs of prescriptions.

Medicare prescription drug plans (PDPs) are meant to help you cover the cost of prescriptions. The cost of medications has risen exponentially over the past four decades. The treatment options offered by prescriptions have also expanded. To help Medicare beneficiaries cover these costs, PDPs were invented.

Formularies consist of four tiers. The least expensive tier is Tier 1, which covers cheap generics. The most expensive tier is Tier 4, which covers specialty drugs. Ideally, your medications should be covered in either Tier 1 or Tier 2 of your plan’s formulary.

Bear in mind that if you take a specialized or newly patented medication, you may not find a plan that covers it in the first two tiers. In this case, you should look for whatever plan offers you the most generous coverage.  

The Cost of Special Needs Plans in Idaho

Special Needs Plans (SNPs) work a lot like Medicare Advantage plans. SNPs are regulated by the CMS but fulfilled by a private insurance company. SNPs are most often structured as HMOs, meaning you’ll need to work within the plan’s network.

The options differ in who they’re designed for. Medicare Advantage plans are for the general population. But SNPs, as the name suggests, are for people in special circumstances. This includes:

  • People who are dual-eligible for Medicare and Medicaid
  • People who are living with certain conditions like HIV/AIDS, cancer, dementia, chronic heart failure, ALS, and ESRD
  • People who live in long-term care institutions like nursing homes, skilled nursing facilities, inpatient psychiatric facilities, or intermediate care facilities

What Is Medicare?

Founded in 1966, Medicare is a federal health insurance program. It was designed for seniors who were consistently left behind in regards to accessing modern medicine. Before Medicare, most seniors (people over the age of 65) were denied access to healthcare due to the large number of health issues experienced in older age. 

Medicare was designed to provide healthcare to this group and has since expanded. Today, Medicare serves many groups who would otherwise not be able to find or afford health insurance

Medicare is made up of five parts:

  • Medicare Part A is one half of Original Medicare. It’s often called “Hospital Insurance,” as it covers inpatient care such as a stay in a hospital, skilled nursing facility, or rehabilitation center. 
  • Medicare Part B is the other half of Original Medicare. It’s often called “Medical Insurance” because it covers outpatient care such as an annual visit to your doctor.
  • Medicare Part C is an alternative to Original Medicare. It is regulated by the Centers for Medicare & Medicaid Services (CMS) but fulfilled by a private health insurance company
  • Medicare Part D is a prescription drug coverage. Part D plans are regulated by the CMS but fulfilled by a private health insurance company. Part D plans—or an equivalent alternative—are mandatory and protect you from overpaying for pharmaceuticals. 
  • Medicare Supplement Insurance, a.k.a. Medigap, is an additional insurance plan you can couple with Original Medicare. It covers some expenses like deductibles, co-payments, and/or coinsurance

Who Qualifies for Medicare in Idaho?

To qualify for Medicare in Idaho, you need to be either an American citizen or a permanent resident of the last five consecutive years. Most people qualify for Medicare when they turn 65. However, there are some circumstances where people can qualify for Medicare before the age of 65. These scenarios include:

  • Being diagnosed with end-stage renal disease (ESRD)
  • Being diagnosed with amyotrophic lateral sclerosis (ALS)
  • Being on disability (SSDI) for 24 consecutive months

How Do I Choose Between Original Medicare and Medicare Advantage?

Choosing between the public and private options is the biggest decision you’ll make when you enroll in a Medicare plan. Below, we’ve outlined the essential advantages and disadvantages of each type.

Plan Type Advantages Disadvantages
Original Medicare
  • Extensive network of providers
  • Large service area across the U.S.
  • Low monthly premiums
  • Many Medigap plan options to help cover costs
  • No caps on out-of-pocket coverage
  • Must purchase add-ons like Medigap, prescription drug coverage, and stand-alone dental, vision, and hearing 
Medicare Advantage
  • Can purchase a comprehensive plan to cover medical, medication, vision, dental, and hearing
  • Many plan options, including types of plans like HMO, PPO, or PFFS (private fee-for-service)
  • A smaller network of providers
  • Small service area restricted to your state or a region within your state
  • Premiums can be more expensive

Choosing can be daunting, but you should know that:

  1. It’s not forever—you’ll have the opportunity to make changes to your plan at least once every year during the fall Open Enrollment Period (also called the Annual Election Period).
  2. You have protections—you’ll have a 12-month trial period to test out a Medicare Advantage plan. During that time, if you decide you don’t like the private option, you can change back to Original Medicare with Medigap without being subject to medical underwriting. 

How Do I Apply for Original Medicare in Idaho?

Applying for Original Medicare is easy. You might even be automatically enrolled if:

  • You are receiving social security retirement benefits before the age of 65.
  • You are receiving Railroad Retirement benefits before the age of 65.
  • You have been receiving disability benefits (SSDI) for at least 24 months. 

However, even if you are eligible for automatic enrollment, you shouldn’t assume you will be automatically enrolled. We always recommend checking the status of your enrollment. You can check the status of your enrollment or enroll in Medicare for the first time in one of three ways:

  1. Logging into your account with the Social Security Administration at SSA.org
  2. Applying over the phone by calling the Social Security Administration at 1 (800) 772-1213; TTY users can call 1 (800) 325-0778
  3. Applying in person at your local Social Security office

Whichever way you choose, the application process is fast and easy. You can apply online in less than 10 minutes!

How Do I Apply for Medicare Advantage in Idaho?

Before you can apply for Medicare Advantage, you must first enroll in Medicare. That’s because you’ll need your Medicare number to apply. To enroll, follow the instructions above. 

Once you’ve enrolled, you can then begin the Medicare Advantage enrollment process. First, you’ll need to find the right plan. To do so, we recommend this process:

  1. Write down your needs, preferences, and budget for medical expenses. You’ll also want to make a list of any of the medications you take.
  2. Use the Insurify Medicare plan comparison tool to find Medicare Advantage plans available in your area.
  3. Compare and contrast health plans. Be sure to check out customer reviews and the website to be sure the insurance company will be easy to work with. 
  4. Once you’ve found the right plan, you can often enroll online or over the phone within minutes. 

What’s the Best Medicare Advantage Plan in Idaho?

The key to getting the best Medicare Advantage plan is to start with yourself.

  • Your needs: If you have certain health conditions, chances are you will need very specific coverage in your plan. If you have special needs that aren’t covered by regular Medicare, you will need an extensive Medicare Advantage plan or possibly a Special Needs Plan. Furthermore, you’ll want to make sure that any prescriptions you take are covered in the prescription coverage of your plan (if applicable).
  • Your preferences: Do you like using an online portal to manage your care? You’ll want to look for providers with excellent website design. Do you prefer being able to talk out your options with a customer service representative over the phone? You’ll definitely want a company with a 24/7 customer service line and great customer service reviews. Do you want to keep your current doctor? You’ll need a plan that already includes your doctor in its network.
  • Your budget: The final piece of the budget is to ensure that the plan you choose fits the budget you have. Remember that it’s not all about the monthly premium. You should choose a plan that offers extensive coverage for the care you receive. That way, you won’t be stuck with a huge medical bill when you receive service.

Learn More: Best & Worst Medicare Advantage Plans 

 

 

FAQ: Idaho Medicare

How much is Medicare per month for seniors?

That will depend on the way you set up your Medicare plan. You should expect to spend $200 to $400 per month on insurance premiums. You should also budget for around $500 a month for coinsurance, deductibles, co-payments, and other costs. The average Medicare beneficiary spends between $5,000 and $6,000 for Medicare coverage each year, according to the Kaiser Family Foundation. 

Does Idaho offer Medicare resources?

Idaho has an excellent program to help residents choose a Medicare plan. The Senior Health Insurance Benefits Advisors (SHIBA) is a counseling program. Representatives will help you understand your options and choose the best plan for you. The service is free. 

Do you automatically get Medicare when you turn 65?

So long as you’re a citizen or permanent resident of five consecutive years, you will be automatically eligible for Medicare at the age of 65. You may be automatically enrolled if you’re receiving Social Security, Railroad Retirement, or SSDI benefits before the age of 65. 

How much will I have to pay for Medicare when I turn 65?

Again, this will depend on the way you set up your Medicare plan. You should expect to cover your Part B premium of $148.50, plus premiums for Medigap or Medicare Advantage. You’ll also need to cover your prescription drug plan premium if it’s not included in your MA plan. PDP premiums are typically less than $100 per month. Beyond premiums, you should also budget for other costs of care.

Conclusion: Compare Idaho Medicare Plans Before You Buy

The best way to get the most out of Medicare is to do some comparison shopping. Always start with yourself first—getting clear on what you need and what you can spend helps you weed out bad matches. Knowing your preferences helps you choose between two similar plans. 

Once you know what you want, you can uncover your options with the Insurify Medicare plan comparison tool. Just enter your ZIP to learn about the options in your area. Try it today!

The Easy Way to Find Low-Cost Medicare Plans

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Updated April 9, 2021

J.J. Starr is a health and finance copywriter who enjoys helping readers find the information they need. In addition to her background in banking and financial advising, she is also a poet with an MFA from New York University. She lives in Amherst, Massachusetts. You can learn more at jjstarrwrites.com.