Medicare Advantage (MA) has nearly doubled in popularity over the past decade. The program is also known as Medicare Part C, and over one-third of beneficiaries now have it. This page describes the types of Medicare Advantage plans in Idaho, how Part C works, and how to compare your options.
What is Medicare Advantage in Idaho?
As in every state, Idaho Medicare Advantage plans must provide the same benefits and coverage that you get with Original Medicare. This includes:
- Medicare Part A, which covers inpatient services that you receive in a hospital or skilled nursing facility (SNF)
- Medicare Part B, covers outpatient services, such as doctor visits, lab work, durable medical equipment (DME), and more
Prescription drug coverage is not included with Original Medicare. Those benefits are part of Medicare Part D.
Although Medicare Advantage plans must provide the same coverage as Original Medicare, they are not limited to those benefits. In fact, over 90 percent of plans offer additional coverage, including:
- Fitness programs like SilverSneakers
- Prescription drugs
- Routine vision and dental care
Please note that, even if you join a Medicare Advantage plan in Idaho, you are still responsible for the Medicare Part B premium.
Idaho Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Original Medicare and Part D benefits into a single policy.
The extra benefits you get with an MA-PD plan could cost you less than Original Medicare plus a standalone Part D plan, especially if it also covers other services, like eye exams and prescription lenses.
Who is eligible for Medicare Advantage in Idaho?
You are eligible for Medicare Advantage in Idaho if you have Medicare Parts A and B.
You qualify for Medicare if you are an American citizen or permanent legal resident aged 65 and older. However, enrollment in Parts A and B is only automatic if you began collecting Social Security benefits at least 4 months before your 65th birthday.
If you collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months, you may qualify for Medicare before you turn 65. Enrollment in Medicare Parts A and B is automatic if you qualify due to a disability.
When can you sign up for a Medicare Advantage plan in Idaho?
You may first sign up for a Medicare Advantage plan in Idaho during your Initial Enrollment Period (IEP). It starts 3 months before your Medicare eligibility date and lasts for 7 months. So, if your 65th birthday or 25th month of collecting disability benefits occurs in February, your IEP begins on November 1 and extends through May 31.
The General Enrollment Period is for people who did not sign up for Medicare Part A and/or Part B during their IEP. It lasts from January 1 through March 31. After General Enrollment ends, you have from April 1 to June 30 to join a Medicare Advantage plan.
The Medicare Annual Enrollment Period (AEP) lets current Medicare beneficiaries to make any necessary change to their coverage, including signing up for an MA plan. AEP lasts from October 15 until December 7.
Those who already have Medicare Part C can participate in the Medicare Advantage Open Enrollment Period from January 1 through March 31. Options are limited to switching to a new MA plan or returning to Original Medicare. However, you may also enroll in a standalone Part D plan if making that change means you lose your prescription drug coverage.
Certain life changes may entitle you to a Special Enrollment Period (SEP). There are dozes of ways to qualify. The full list of qualifying special circumstances is on Medicare.gov.
Types of Medicare Advantages plans in Idaho
There are four common types of Medicare Advantage plans in Idaho.
More than half of Medicare Advantage enrollees belong to a health maintenance organization. HMO plans help manage costs by using a provider network. Non-emergency care received from an out-of-network provider is rarely covered by an HMO plan. Members must also choose a primary doctor and get a referral to see a specialist.
Preferred provider organizations (PPO) also use a provider network. But they also cover out-of-network care, just at a higher copay. PPO plan members do not need to choose a primary doctor or get a referral to see a specialist.
Private fee-for-service (PFFS) plans set price points for all covered services. Most also have a provider network but cover out-of-network care for a higher price. PFFS plans do not require members to choose a primary doctor or get a referral for a specialist.
Special needs plans (SNPs) limit membership to people who meet certain guidelines. This may include:
- Having a chronic condition, such as chronic heart failure, diabetes, dementia, HIV/AIDS, or ESRD
- Living in a nursing home or requiring at-home care
- Qualifying for both Medicare and Medicaid (i.e. being dual eligible)
SNP members must also choose a primary doctor who coordinates care and get a referral to see a specialist.
How to choose a Medicare Advantage plan in Idaho
Before joining a Medicare Advantage plan in Idaho, consider the following:
- Costs: These may include a yearly deductible, monthly premium, and copays or coinsurance.
- Coverage: Benefits vary from plan to plan, so make sure you're comparing apples to apples. For an MA-PD plan, don't forget the drug formulary.
- Network: Any entity that provides healthcare services may be included in the provider network.
- Ratings: Medicare releases plan ratings every fall to help beneficiaries during Annual Enrollment.
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Idaho. Just enter your location information and estimated coverage start date to review Medicare plans in your area.
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