Alternatives To High Cost Idaho Medicare Advantage Plans
There are attractive lower premium Medicare Advantage plans available.
Most Idaho Counties have good alternatives to high-premium ($70+/month) Idaho Medicare Advantage (MA) plans.
If you live in an Idaho County with 5 (or more) plans with premiums below $70, we encourage you to review your options.
A caveat when reviewing plans with lower premiums, exclude those which do not include prescription drug coverage (these plans are for Veterans that get their med’s from the VA AND plans reserved for residents eligible for Medicare Medicaid Coordinated plans (MMCP).
When should you review plans?
Between 10/1 thru 12/7 AND 1/1 thru 3/31 every 2 – 3 years.
Why every 2 – 3 years?
Because new plans can come to market and the details of existing plans change annually. Be aware the details of each plan can change at their own rate; some insurance companies are simply more aggressive about taking market share from other companies; they do this by offering higher value plans at a lower cost to the Idaho Medicare beneficiary.
If you are uncomfortable with this task, work with a Idaho based broker that is licensed with all/most all plans available in your County. How do you find out? Ask them which plans they are NOT licensed with. Check out what plans we are/are not licensed with here. Call us if you would like help.
Why do this?
If you look at the higher premium Medicare Advantage plans available in Idaho, they may have been the initial plans available from that particular insurance company when they got in the Idaho Medicare Advantage plan business. In our opinion, these same plans do not compare well to some of the plans this same company introduced to the Idaho market in the past 5-years. Often the newer plans have lower premiums, the same or lower out of pocket costs (for most covered services) and the value of ‘extras’ in the newer plans can benefit the shopper. Of course, your out of pocket cost for covered prescription medications will be part of any plan change decision.
What is really important when considering a plan change.
- The doctors/hospitals you wish to get care from are in the plan’s network.
- Make sure you have access to Hospitals with a 4 or a 5 Medicare star rating. We suggest avoiding facilities with no rating or a rating below 3-stars. Check current hospital star ratings here. When this web page appears, check off ‘hospitals’; when this page refreshes, enter your zip code and the radius around the zip code you want to search. If hospitals outside of Idaho appear in the list, be aware they may not be in any Medicare Advantage plans you are considering. By the way, this same tool is very useful finding doctors/other providers that ‘accept Medicare insurance’ anywhere in the US.
- If you are considering a PPO plan, be aware if you go out of network, the provider you may want to work with may choose to NOT accept your plan’s terms. This means you need to keep looking for another hospital/provider. This language is contained in each plan’s ‘Evidence of Coverage’ document. If you have an HMO plan and wish to use the services of an out of network provider (and you do not have agreement with your insurance company to go out of network AND they will help you pay for the services received) you will pay retail for any services received. Also be aware the Mayo Clinic(s) do not accept Medicare Advantage plans available to Idaho residents. Read their announcement here. Another issue to be aware of is a Medicare Advantage plan’s network of doctors/hospitals can change during the year. An example of this is found in this article.
- Review the plan’s cost for services received AND the plan’s ‘Maximum out of pocket limit’ (MOOP). We recommend adding the plan which has the lowest MOOP to the ‘short list’. Be sure and look at the number of days the ‘skilled nursing care’ copay is in place. The plan(s) with the fewest days this copay is in place should also be on your short list.
- Look at the details of the plan’s ‘extras’ (services not covered by Medicare). These can vary widely between plans. Separate these ‘extras’ into 2 classifications – those you will use and the ‘nice to have’ but may not use. Place emphasis on those you will use and compare the details of the differences.
We can do this for you if you prefer to work an Idaho based broker.
Are there other more flexible plans available?
Yes. Medicare Supplement (also known as Medigap) plans are available to Idaho residents.
There are 12 different plans; they are offered by private insurance companies. Each of these plans pickup a different combination of the costs that Medicare does not completely cover.
We like this plan type because you have access to any doctor/hospital/other provider in the US that ‘accepts Medicare insurance’. This means the top 50, 100 and 250 hospitals are available to you…including the Mayo Clinics.
Some of these plans pay for most/all of the left over costs that Part A and B do not completely pay for. To us, this means you can budget with confidence for your Medicare covered health care services and you have access to the top physicians/hospitals (provided they ‘accept Medicare’….most do.
Idaho Medigap Plans…the basics
Before we get started, remember MA plans are ‘repackaged’ Medicare Part A and Medicare Part B (also known as Original Medicare). You are getting your Medicare from a private insurance company offering the plan. MA plans are required by law to cover everything Medicare Part A and Part B cover, but they can charge different amounts for covered services than Original Medicare. Some plans cover items not covered by Medicare.
Depending in the individuals’ preferences, we feel Medigap plans are a viable alternative to Medicare Advantage plans.
You have 12 plans to choose from. Each plan covers a different combination of the left-over Part A and B services that Medicare does not completely cover. The coverage in each of these 12 plans is the same between the 20+ insurance companies offering them. The only difference is the monthly premium.
The other advantages we like include:
no networks; you can use any doctor/hospital in the US that accepts Medicare (most do);
you do not no need for permission to see a specialist; you just make the appointment with the doctor you prefer;
no more 72-hour waits for prior authorizations (to see if your doctor recommended treatment will be approved by your insurance company);
depending on the specific type of Medigap plan you choose, you’re left over out of pocket cost for Medicare covered services can range from $0 and up; you pick the plan that meets your needs and budget.
Before you go further, learn more about Idaho Medigap Plans and carrier differences here.
The Low Cost Medigap Alternative-Plan F and G Hi-Deductible
You seldom see Medigap Plan F Hi-Deductible mentioned in the Medicare materials. I have not seen any ad’s on either TV or in the print media. This is an alternative for some.
The advantage of this Medigap plan is:
- Low monthly premium.
- A low annual out of pocket limit (check here to see this year’s limit) is lower than the out of pocket limit on any Medicare Advantage plan available in Idaho.
- No network/plan restrictions on what doctors and hospitals you can use. You do not need permission to see a specialist as long as the providers you use ‘accept Medicare’. Be aware some specialists may want certain tests done and results reviewed before an appointment will be accepted.
- Prior authorizations found in Medicare Advantage plans are minimized.
- You do away with reading the MA plan’s 150 -300 page ‘Evidence of Coverage’ document. This contains the rules/details of the plan and is updated annually. Each MA plan has their own document with their own rules, etc. This means when you change Medicare Advantage plans, you have to familiarize with your new plan’s rules. The guidelines for Original Medicare (Part A and B) are found in the easy to read and understand ‘Medicare and You’ booklet.
You can learn more about Medigap Plan F Hi-deductible here.
Your other Medigap plan alternatives
Medigap Plan F is and has been the ‘gold standard’ of health insurance for people enrolled in Medicare.
Why? Because this plan covers ALL left over costs for approved Medicare expenses that Part A and Part B doesn’t completely cover.
Medigap Plan G is rapidly replacing Plan F as the preferred plan. Why? Plan F is no longer available to Medicare beneficiaries that became eligible for Medicare past 12/31/2019.
Additionally, when you take a moment to understand the coverage differences between Plan F and Plan G, you will see the annual out of pocket cost (annual plan premium plus the Part B deductible) favors Medigap Plan G. We feel Medigap Plan G makes good sense for some Idaho residents when compared to Plan F. Some people may find Plan N to Plan G.
Alternatives To High Cost Idaho Medicare Advantage Plans
We are here to help think your plan choices through.
We can give you objective information, answer your questions, compare your current policy with your other options, and help you enroll in a different plan if that is your choice.
Learn more about us here.
Call us when you are ready.
We are here to help.
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