Medicare plays a key role in providing health and financial security to beneficiaries residing in Idaho. With more than 342,800 Idaho beneficiaries enrolled in Medicare, we’ll cover some very important information below about Medicare in Idaho. We want to help you better understand your options and make the decision-process as seamless as possible once you’re ready to enroll in Medicare or discover different coverage options.

Who Qualifies for Medicare in Idaho?

Medicare covers most Idaho residents who are 65 or older, and it also covers disabled Idaho residents. In general, Medicare enrollment in Idaho works the same way as it does in the rest of the country. If you qualify for Original Medicare, also known as Part A and Part B, it will help cover 80% of your health care costs.

When you’re first eligible for Medicare, you have a 7-month Initial Enrollment Period to sign up for Part A and/or Part B. If you’re eligible for Medicare when you turn 65, you can sign up during the 7-month period that:

  • Begins 3 months before the month you turn 65
  • Includes the month you turn 65
  • Ends 3 months after the month you turn 65

In most cases, if you don’t sign up for Part B when you’re first eligible, you’ll have to pay a late enrollment penalty. You’ll be responsible for paying this penalty for as long as you have Part B, and you could have a gap in your health coverage.

Once you reach Medicare eligibility, you can begin choosing additional coverage options to help pay for the remaining 20% of your medical expenses through Medicare Advantage (Part C), Medigap, and/or a Medicare Prescription Drug (Part D) plan.

Who Qualifies for Medicare

Idaho Medicare Enrollments

215,710

Original Medicare Plans
(Part A and B)

127,124

Medicare Advantage & Other Health Plans

131,234

Stand-alone Medicare
Part D (Drug plans)

342,834

Total Medicare Beneficiaries
in Idaho

Idaho Medicare Advantage Plans (Part C)

About 34% of Idaho Medicare beneficiaries select Medicare Advantage plans.

Medicare Advantage plans are private, Medicare-approved insurance companies. They provide all of your Original Medicare benefits and often include extra benefits such as drug, dental, and vision coverage.

The Medicare Advantage Open Enrollment Period runs from January 1 to March 31. During this period, Medicare beneficiaries in Idaho who are already enrolled in a Medicare Advantage plan can switch to a different Medicare Advantage plan or drop their Medicare Advantage plan and enroll in Original Medicare instead.

In Idaho, Medicare Advantage plans aren’t for sale in every county. Residents who are in 32 of Idaho’s 44 counties can purchase Medicare Advantage plans. Residents in the other 12 counties only have the option to enroll in Original Medicare.

As of 2020, 68 Medicare Advantage plans are available in Idaho. The average monthly Medicare Advantage premium in Idaho changed $49.25 in 2019 to $44.02 in 2020. $0 is the lowest monthly premium for a Medicare Advantage plan in Idaho. 94% of people with Medicare have access to a Medicare Advantage plan. According to the Centers for Medicare and Medicaid Services (CMS), as of May 2020, there are 127,124 beneficiaries enrolled in Medicare Advantage and other plans in Idaho.

Idaho Medicare Supplement (Medigap) Insurance Plans

Idaho requires that Medigap insurers offer coverage to people under age 65.

Medigap plans are used to supplement Original Medicare, covering some or all of the out-of-pocket costs (for coinsurance and deductibles) that beneficiaries would otherwise incur if they only had Original Medicare on its own. Typically, Medigap plans are popular for those who want little to no copay when they access healthcare services.

Idaho Medigap insurance is available to everyone with Medicare in the state, including those who are under 65 and are enrolled in Medicare. Often, Medigap plans in Idaho can be more expensive if you don’t enroll during your Initial Enrollment Period and wait for an Annual Open Enrollment Period. 

There are two initial times to enroll in a Medigap plan before and after you turn 65:

  • 6 months prior to turning 65
  • Once you turn 65, your 6 month period begins the month you enroll in Part B

During this period, an insurance company can’t use medical underwriting. 

The Idaho Department of Insurance requires all insurance companies offering Medigap plans to offer these plans to eligible individuals of all ages enrolled in Part B, including beneficiaries under 65. Yet, sometimes premiums for individuals under 65 can be much more expensive than for individuals who are 65 and older. It is recommended that you consider an Idaho Medicare Advantage plan if this happens to be the case for your specific situation.

Idaho Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t cover outpatient prescription drugs. However, Medicare beneficiaries can get prescription coverage via a Medicare Advantage plan, an employer-sponsored plan (offered by a current or former employer), or a stand-alone Part D plan. Medigap plans don’t cover prescription drugs unless they’re covered under Part B.

As of 2020, there are 131,234 Medicare beneficiaries in Idaho enrolled in stand-alone Part D plans and 115,935 enrolled in Medicare Advantage Prescription Drug plans. For 2020 coverage, there are 28 stand-alone Part D plans available in Idaho, with premiums ranging from about $16 to $110 per month.

Nearly 92% of people with a stand-alone Medicare prescription drug plan have access to a plan with a lower premium than what they paid in 2019. About 23% of people with a stand-alone Medicare prescription drug plan get Extra Help (also called the low-income subsidy, or LIS).

When deciding on a Part D plan, it’s important to evaluate several factors such as each plan’s premium, formulary, and copays since every plan is different. Learn how you can save money on your out-of-pocket costs with a Medicare Advantage, Part D, or Medigap plan, fill out this form or give us a call.

Local Medicare Health Plan Resources in Idaho

  • Idaho’s Senior Health Insurance Benefits Advisors (SHIBA) serves Idahoans on Medicare and those who help them by offering free, unbiased Medicare benefits information and assistance through workshops, group presentations, and personal counseling.
    Contact: Call (800) 247-4422

  • Idaho’s Senior Medicare Patrol helps prevent, detect, and report health care fraud. The program relies on volunteers in local communities to provide education and one-to-one counseling to help protect our identity and identify other types of Medicare fraud like double-billing and overcharging and unnecessary or inappropriate services.
    Contact your SMP program through your local Area Agency on Aging. Links to the six AAAs in Idaho are available on the Idaho Commission on Aging, Senior Medicare Patrol website.

  • The Idaho Commission on Aging is a state-run organization that assists older adults and people with disabilities to remain independent, avoid institutionalization, and age in place in their own homes and communities of choice.
    Contact: Call (208) 334-3833

  • Located in Coeur d’Alene and serving Benewah, Bonner, Boundary, Kootenai, and Shoshone counties, the Area Agency on Aging of North Idaho is part of a nationwide aging network created through the Older Americans Act. Each of the Area Agencies has a volunteer commissioner appointed by the governor through the Idaho Commission on Aging (ICOA). The focus of the AAANI is helping people stay independent and contributing members of their community.
    Contact: Call (208) 667-3179, (800) 786-5536, or email [email protected]

The licensed agents that are partnered with Timefor65 can help you compare the availability, benefits, and costs of Medicare plans in your specific region of Idaho. Our process makes it easier for you to access your Medicare eligibility in Idaho so that you receive personalized, affordable, and easy-to-use coverage options and solutions. Fill out the form or give us a call at (866) 327‑0148 anytime to get a free quote or to ask any questions.

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