Idaho Medicare Insurance Plan | Everything You Need To Know About Medicare Coverage

How Do You Know If Your Medicare Coverage Is Right For You?

If you're just getting started with Medicare or are in your first year, we have the information you need to help you understand your health care options and get the coverage that best fits your situation.

Medicare.gov to get answers to questions like "what are the parts of Medicare?" and "Medicare basics: What you need to know" w hen it comes to choosing between private and public plans for seniors like yourself, there are some basic differences that may not be obvious.

Here’s what you should know about both types of coverage before making an informed choice.

Idaho Medicare Insurance Basics

• What is Medicare Advantage?

The MA program offers supplemental benefits beyond those offered by traditional fee-for-service Medicare. 

• When can I sign up for Medicare?

You have until the end of your IEP to apply for coverage. You must be at least 65 years old on January 1st or December 31st to qualify for Medicare Part A & B benefits. However, if you are younger than age 60 as of September 30th, 2016, you will not need to wait until your IEP expires to start receiving these benefits. Instead, you'll automatically become a member of Medicare when you turn 66.

Original Medicare (Part A and Part B)

You may need supplemental insurance if you have additional expenses such as deductibles, co-insurance and/or out of pocket maximums. We recommend contacting us at any time so we can help you find the right plan.

Medicare Supplement Plans

There are many different types of plans available from private companies. These plans supplement original Medicare by covering some or all of what is missing. They also offer other advantages like lower premiums than traditional Medicare. 

New to Medicare?

You may want to start with our New Member Guide which provides basic information about what Medicare covers and does not cover. It also includes links to helpful resources such as the Centers for Disease Control and Prevention website where you can access additional information about Medicare.

The following sections describe some of the most common questions people have about Medicare. We hope this helps answer many of them!

What Is Medicare Automatic Enrollment

You can enroll automatically for Part D coverage if:

• You have been enrolled in a qualified health plan through an employer-sponsored group insurance program;
• The QHP has provided information about its prescription drug benefit options;
• You meet certain income requirements; and
• You do not qualify for Medicaid or CHIP.

In addition, you may be able to sign up for Medicare at any time during the year by calling 1-800-MEDICARE (1)

Initial Enrollment Period

If you are not eligible for Automatic Enrollment, contact the Social Security Administration at 800-772-1213 or enroll online at, or visit the nearest Social Security office to enroll in Medicare Part A and Medicare Part B. The initial enrollment period begins when you become entitled to benefits as determined by age, disability status, and other factors. The initial enrollment period ends three days after the end of the calendar year in which you became entitled to benefits. For example, if you turn 65 years old on January 1st, then the initial enrollment period would begin on January 2nd and last until February 3rd. 

General Enrollment Period

• January 1 – March 31
• July 1 – December 7

Special Enrollment Periods

You may be able to qualify for special enrollment periods if:

• Your spouse or partner has died;
• You have been diagnosed as having end stage renal disease ;
• You were covered under an employer plan that was terminated before February 14, 2006;
• You had a break in insurance because you moved out of state without changing providers;
• You lost health care benefits due to bankruptcy;
• Working Past Age 65 (Special Enrollment)
• You can apply for special enrollment after you turn 66 years old. This allows you to remain on your EGHP until 70 years old with no premiums or deductibles. However, there are some restrictions:
• Your EGHP cannot cover services received while employed outside the United States.
• The maximum number of days allowed for Special Enrollment is three times the amount of time remaining on your original eligibility period. 

Medicare enrollment in Idaho

In 2019, there were approximately 1,814,000 Medicare enrollees living in Idaho, representing a little more than 20% of all Medicare recipients nationally. This number represents an increase from 2016, when there were roughly 1,633,000 Medicare enrollees in Idaho. The national average has remained relatively steady since 2012, hovering around 18 million Medicare enrollees.

Medicare spending in Idaho

The spending amounts are based on data that were standardized to eliminate regional differences in payment rates, and did not include costs for Medicare Advantage. Per-beneficiary spending for Medicare was highest in Louisiana, at $11,932 and lowest in Hawaii, at just $6,971.

It was about 10 percent below the nationwide average of $10,096 in 2018. In 2017, it was 9 percent higher than the national average of $8,744.

The top five states with the largest increases in average per-beneficiary spending between 2017 and 2018 were:

• New York
• California
• Texas
• Florida

Medicare statistics in Idaho

Idaho has an estimated population of 2,907,000 people. The median age was 37 years old. There were approximately 565,000 males and 624,000 females living in the state at this time. In 2016, there were 4,744 Medicare enrollees who lived in Idaho. In 2015, there were 3,631 Medicare enrollees who lived here.

There were 7,564 Medicare enrollees in 2014. 

Medigap in Idaho

As of 2018, there were 87,738 Idaho Medicare beneficiaries with Medigap coverage, according to an AHIP analysis. Although Medigap plans are sold by private insurers, the plans are standardized under federal rules, with ten different plan designs. Also for all Medigap plans sold since 1995, state law also prohibits insurers from using attained-age rating, which means that premiums cannot increase simply due to the enrollee's increasing age.

Idaho joined those states in 2018, with changes to Idaho insurance statute that took effect January 1, 2018 Idaho Medigap insurers are now required to offer their plans to disabled Medicare beneficiaries under age 65, with the same six-month open enrollment period that applies to people who gain eligibility for Medicare due to age.

In addition, the new rule limits the premiums for under-65 Medigap to no more than 150 percent of the premiums that apply to a person who is 65 years old. The following table shows how the average monthly premiums compare between Medigap plans in Idaho:

What Are the Most Popular Medicare Supplement Plans?

The most popular Medicare Supplement plans are Plans F, G and N. America's Health Insurance Plans. “ State of Medigap: Trends in Enrollment and Demographics.” ahip.org. Medigap policies can be confusing because they offer different benefits for different types of coverage. The following table shows which Medicare supplement plans cover what. It also lists some other important features that you should know about each type of plan.

*Note: Some states require insurers to pay 80% of all medical expenses incurred by their members who use skilled nursing facilities. This is called SNF-related benefit. 

Medicare Advantage in Idaho

Medicare beneficiaries can choose to get their healthcare coverage directly from the federal government via Original Medicare, or through private Medicare Advantage plans assuming Advantage plans are available in their area. Despite the lack of Medicare Advantage availability in some of Idaho's more rural areas, almost third of Idaho Medicare beneficiaries had Medicare Advantage plans as of 2018, which was nearly the same as the nationwide average.

Medicare Advantage plans include all of the benefits of Medicare Parts A and B, and they often provide additional benefits and programs, such as integrated Part D coverage for prescription drugs, dental and vision coverage, a 24-hour nurse hotline, gym memberships, and even assistance with things like transportation and in-home safety.

Out-of-pocket costs for Medicare Advantage are often higher than they would be if a beneficiary had Original Medicare plus a Medigap plan. There are pros and cons to either option, and the right solution is different for each person.

People who are already enrolled in Medicare Advantage also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.

In 2019, about half of Idaho Medicare beneficiaries chose Medicare Advantage over Original Medicare. That number increased slightly in 2018, but it remained below 50 percent throughout 2017–2019.

The percentage of Idaho Medicare beneficiaries choosing Medicare Advantage grew significantly after 2010, when the Affordable Care Act went into effect. By 2016, Medicare Advantage accounted for roughly two thirds of total Medicare enrollment in Idaho. And while Medicare Advantage enrollment declined somewhat in 2017, it rebounded in 2018 and continued growing in 2019.

Idaho Medicare Part D

The following table shows the number of people enrolled in different types of Medicare Part D plans sold in Idaho in 2019:

Plan Type Number of Plans Percent Total Stand Alone Plan 28 11% Medicare Advantage With Prescription Drug Coverage 117 67% Other 10 5% No Supplemental Insurance 9 4% Not Stated 3 2% Totals 195 100% Source: Centers for Medicare & Medicaid Services

The following table shows the number of people enrolled in different types of Medicare Part D plans in every county across Idaho:

Medicare resources in Idaho

The following links provide more detailed information regarding Medicare coverage options available in Idaho. For additional information, please contact your local Area Agency on Aging office.

• Medicare Resources - AARP
• Medicare Resource Center - United States Department of Health & Human Services
• Medicare Plan Finder - United States Department of Labor
• Medicare Rights Center - National Senior Citizens Law Center
• Medicare Supplement Information - Kaiser Family Foundation
• Medicare Supplements - U.S. Government Accountability Office
• Medicare Savings Programs

Idaho SHIBA Resources

The SHIBA website provides information and resources to help you understand how Medicare works, what it covers, where To find out more about SHIBA or if you have any questions please contact us at: 1-800-722-9072 Or visit our web site at www.shiba.idaho.gov

Idaho Medicaid Program - The Idaho Medicaid Program offers health insurance coverage to low income individuals who are not eligible for other types of medical care programs such as Medicare.

What is SHIBA?

SHIBA Is Idaho's State Health Insurance Assistance Programs (SHIP), a program that helps states enhance And support a network of local staff And volunteers to assist people with Medicare.

Learn About Medicare with SHIBA

Medicare helps cover medical care costs that may not otherwise be covered under your health plan. It pays doctors, hospitals, nursing homes, home healthcare agencies, hospices, pharmacies, durable medical equipment suppliers, dialysis centers, ambulance companies, and more. Learn More »

About Us

SHIBA provides information and resources to Idaho residents who want to learn more about Medicare and its benefits. We offer free one-to-one counseling sessions where we will answer questions and explain what Medicare covers and

 In Conclusion, Medicare can be confusing so don't hesitate to give us a call today with any of your questions. Our agents work throughout all of Idaho

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