About us – your Idaho Medicare coach

As your Idaho Medicare coach, I help you understand Medicare, the difference between your plan choices and enroll in the plan you choose.

Besides considering a health plan’s monthly premium, the other important decision you will make is about access. 

Why is ‘Access’ important’.

Depending on your current health or are concerned with a future diagnosis, you may want to pick both the specialist as well as the hospital where you want treatment.   

Your Medicare health plan choice and what you need to know ‘Access’ rules. 

Medicare Advantage plans (HMO) typically have insurance company defined network of doctors and hospitals available for their policy holders. These are the resources you can use.  Networks can change during the year as well as annually.  Exceptions exist depending on the situation. 

Some Medicare Advantage plans (PPO) open access to physicians and hospitals (and other provider types) outside of it’s defined ‘in-network’. 

PPO plans also have a ‘Medicare rule’ which permits ‘out of network’ physicians/hospitals decide if they will accept the appointment request.   This means the out of network resource you want may not be available.

There is a growing list of hospitals in the US which are no longer accepting either of these types of plans (HMO or PPO). 

A different type of plan (Medigap) opens access to all physicians and hospitals in the US what ‘accept Medicare’ insurance.  Often you will find the top hospitals and physicians (by specialty) available to people with this type of plan.

Passing ‘underwriting’ is required in certain situations.

Did you know an insurance company offering Medigap plans can deny your application if have a serious health issue AND wait more than 6-months past your Part B enrollment date to enroll?   They are required to ‘accept’ our application if you submit your application within 6-months of your Part B effective date (see your Medicare card for this date).  

How can they do this?  Medicare gave them the right to require applicants ‘pass underwriting’ in this situation.

If you are already enrolled in Medicare and moving to Idaho. 

If you presently have a Medigap plan.

If you current premium is meaningfully higher than the same plan available in Idaho, you can switch companies and save the difference.  

If you presently have a ‘Medicare Advantage plan’

You have 2 important Medicare rules to be aware of. 

First, you have a 63-day window, which beings when your current plan terminates, to enroll in a Idaho based Medicare Advantage plan.  If you miss this enrollment window, you have to wait until the next valid Medicare enrollment period.   

Second, you have a ‘guaranteed issue’ (GI) right to switch to a Medigap plan.  With a GI, you skip underwriting and the insurance company is required to issue you the policy (provided you remain enrolled in both Part A and B).  

Also, ‘the right plan’ will limit your ‘out of pocket’ costs for services covered by Medicare to less than $3,000 for the year.   Compare this figure to your Maximum out of pocket limit with your Medicare Advantage plan.

  This same plan opens up all physicians and hospitals in the US to you. 

We share the above and more Medicare rules when you work with us.

We help Idaho residents understand Medicare, answer their questions, explain the differences between plan choices and help each person enroll in the plan they choose.

We have chosen to remain licensed with all Idaho Medicare Advantage (except the I-SNP), Medigap (Medicare Supplement) and three of the five insurance companies offering Part D plans to Idaho residents.  Wellcare is no longer using brokers AND we chose to not license with Cigna as their plans in Idaho are rated below 3-stars.  

If the plan you choose does not use brokers, we will guide you to the resource(s) where you can self-enroll.  

Out of pocket costs for Medicare can change annually.

Our service does not stop with initial plan enrollment.  As your Idaho Medicare coach, an annual plan review is  available.

This is an important no cost service. 

Why do we do this? 

Because Medicare can and does make changes which affect insurance companies bottom line. This means insurance companies can update details of their offerings (change cost sharing figures to you) and, if appropriate, drop plans in certain markets or even exit the Medicare marketplace.  

Plan changes include your out-of-pocket cost for covered services, plan premiums, plan networks (physicians moving in/out of a plan’s network), etc.   The details of non-Medicare covered ‘extras’ (dental, vision, transportation, chiropractic, acupuncture, etc.) can change annually too.  Insurance companies make these changes independent of each other.  Their changes are made to simply to improve their plan’s competitiveness or to cut back on certain services to improve their bottom line.   

The Kaiser Family Foundation (KFF) published a report on 9/24/2024 on this subject (available here). I encourage you to review this. 

A broker that specializes in Medicare and is licensed with all plans available to them can help you navigate your way through this maze. 

 How your Idaho Medicare coach will work with you

It is not unusual we spend 6 hours in one-on-one work with each person.  This is done over 3 or more sessions.  We cover the basics of Medicare, answer questions and review your options.

Our goal is to be sure you understand Medicare and your optional insurance choices. 

When we are done with the reviews you should be able to make an informed choice between both plan types and individual plans within type.  This means Original Medicare with or without a Medicare Supplement plan (Medigap Plan) or a Medicare Advantage Plan (Part C).

Once you are a customer, we keep you informed of the changes in Medicare.  We check back with you at least once a year to see if your needs have changed.  If they have, we start the process over again.

How to use this website

This website is available for people who want to learn more on their own about Medicare.   

If you are comfortable with your understanding of Medicare and want help with plan selection/enrollment, call us. 

The website home page (available here) is a quick guide to the topical information available to you.  Just click on any of the icons.  Each contains information of interest to you.  When done reading, simply hit the ‘back’ icon on the browser you are using (upper left-hand corner).  This will return you to the home page so you can move on to your next topic of interest.  Keep in mind, we go over much of this material the first time we meet.

My background

I am a Boise native and attended local schools from grades 1 through 12.  College degrees include a BA and MBA from Boise State University.  

My professional experience includes over 30 years in the software industry with responsibilities ranging from technical work to company management. My wife and I have three sons and nine grandchildren.  I am on Medicare and pay attention to the Idaho Medicare marketplace.

Summary

We look forward to being your trusted adviser for your Idaho Medicare insurance choices and coaching you on Medicare Part A, B, C, D, and Medigap.

Call us when you are ready. We are here to help.