Bonner County Medicare Advantage Plans
Some 2025 Bonner County Medicare Advantage plans caught our attention.
One plan includes access to Medicare covered services provided by certain 5-star hospitals in Oregon, Washington, Utah and Idaho! This means you pay in-network rates when you use these resources.
This same plan opens up access to other hospitals/physicians in the US that ‘accept Medicare’ too. A plan member will be paying the plan’s ‘out of network’ rate when this feature is used. .
This flexibility can be a nice feature if a person wants to access to other provides that will ‘accept your plan’s payment terms’. This can be useful for ‘snowbirds’ or others wanting flexibility on where they get their health care.
There is a special plan if you have been medically diagnosed with Diabetes mellitus; and/or Chronic heart failure; and/or Cardiovascular disorder (cardiac arrhythmias, coronary artery disease, peripheral vascular disease, chronic venous thromboembolic disorder).
If you have a Medicaid status of QMB and SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.
There are other Bonner County Medicare plans on our recommend list. Which medications, health issues, and hospital preference(s) a person has/does not have are determining factors on which are appropriate.
There are 5 higher premium plans available too.
Three of the remaining plans have monthly premiums above $100; another 2 are above $70. If these plans catch your attention, we suggest you also consider one of the more comprehensive Medigap plans. Specifically, plan G, or N.
Interested in learning more? Print the ‘Scope of Appointment’ document (available here), sign/date it, then take a picture of the signed document and text it to us (1-208-867-0296). Upon receipt we will call you and share the details.
What else you need to know!
For 2025, Bonner County has 25 Medicare Advantage plans for residents to consider.
Here is the high level break down:
6 plans do NOT include prescription drug coverage; Veterans may find these plans attractive.
3 of these are PPO;
3 are HMO plans.
13 plans do include prescription drug coverage and services covered by Medicare Part A and B.
8 are HMO plans;
5 are PPO plans.
The remaining plans are reserved for individuals which qualify for Medicaid special needs plans (C-SNP or D-SNP).
There is another type of Medicare plan you should be aware of.
These are Medigap (also known as Medicare Supplement) plans.
When you choose this Medigap plan, all doctors/hospitals that accept Medicare insurance in the USA are available to you. This means you do not have the network restrictions/rules found in Bonner County Medicare Advantage plans.
Also, you do not have an insurance company standing between your physician to get permission to move forward with your treatment plan. Physicians/hospitals may prefer these plans because they know they will be paid in a timely manner.
You will have fewer ‘prior authorizations’ to deal with.
Medicare published a document that provides the rest of the details you need to know about Medigap plans. You can download this PDF document by clicking here.
Two of these plans limit your annual out of pocket costs for Part A and B covered services to less than $2,900.
This figure is controlled by Medicare and typically goes up a bit annually. If your cost share for Medicare Part A and B used services for the calendar year hits this figure, your Medigap plan pays the rest of your left-over health care costs.
Keep this figure in mind when you read the discussion below on ‘out of pocket limits’ in Medicare Advantage plans.
What are the differences between Bonner County Medicare Advantage plans?
Plan premiums range from $0 to over $140 a month.
This figure can change each year and is one to watch during AEP (your annual election period that starts on October 15 and ends on December 7). You also have a 2nd annual time period you can change Medicare Advantage plans. This is called the annual annual open enrollment period (OEP). This timeframe starts on January 1 and ends on March 31. If your plan’s premium goes up for next year, you may want to find plan with a lower premium that has the same characteristics of next years version of your current plan.
Watch your cost share for Skilled Nursing Care.
We may not know when we will use this service, but when we use it, the out of pocket costs can be more than pocket change.
If you stay with Original Medicare, this copay is in place from the 20th day after care begins and ends on the 100th consecutive day of its use. The daily copay for this year is $204. If you use this service for the 80 consecutive days it is available (for each benefit period), your financial exposure is $204 * 80 or $16,320. Your actual cost will be capped by your plan’s MOOP, which is another very important figure to pay attention to. More on this in a moment.
The insurance company’s offering Medicare Advantage plans can set the daily copay AND the start and end day the copay is in place.
Naturally you want a plan with the lowest daily copay and the fewest days the copay is in place.
Another item is the plan’s Maximum out of pocket limit (MOOP). Read the information below to learn why this is a key differentiator between plans.
This is a key figure you should be aware of. Put plans on your short list that have a lower MOOP. This decision may save you money if you use Medicare covered health care services during the plan year.
Be mindful Medicare pays its share of the cost for services you use. You pay the rest. Your share of these costs can vary noticeably between plans. .
Think of the MOOP as your limit (or cap) for your share of health care costs for Part A and B services you use during the calendar year. The higher your plan’s MOOP, the more you could end up paying for the services you use.
Medicare sets the maximum figure(s) a plan can have and they can change it annually.
The insurance company offering your plan sets the plans MOOP where they want it. It must be at or below Medicare’s limit. This figure can change annually.
What are the actual MOOP figures?
Medicare’s maximum MOOP for this year’s HMO is $9,350.
The MOOP maximum for HMO-POS and PPO plans cannot exceed $14,000.
Insurance companies offering Medicare Advantage plans set their plan’s MOOP based on each of their plan’s business goals.
Once you hit your plan’s MOOP, your insurance company pays the rest of your share of the cost when you use Part A/B services.
The range of MOOP for your County’s HMO Medicare Advantage plans is $4,900 to $9,350.
The range for HMO-POS and PPO plans is $5,000 to $14.000.
We prefer plans that meet a person’s needs AND has a low MOOP.
You can check out the above figures by using the resource found here.
If you understand how the math works when calculating your MOOP after you use plan services, skip the paragraph below.
Let’s say your plan’s MOOP is $7,000 for the year.
In January you are admitted to the hospital for surgery. Your bill for the 5-day hospital stay is $1,750. Your post-op visits to your physician and physical therapist(s) are $475.
When you subtract these figures from your plan’s MOOP the result is how your new MOOP. When, after you use additional services, and your MOOP hits zero, your plan pays the rest of your share of the cost for Medicare A & B services.
If you have a plan with a ‘lower MOOP’ you have the opportunity to keep more money in your pocket.
The insurance company offering your plan sets the cost sharing for each Part A and B service.
This simply means what you pay to see your physician, use hospital services, pay for your MRI/CAT imaging, cancer treatments, skilled nursing care, etc. are often different between plans. When you compare plans annually, you look at these figures and choose the plan that best fits your pocketbook and needs. These figures can change annually.
Cost sharing for services used, the plan’s MOOP, monthly premium, and the financial savings you get when you use the plan’s non-Medicare covered services are some of the differentiators between plans.
Specific plan coverages may have limitations.
Rules may be imposed on specific coverages. You find these rules in your plan’s ‘Evidence of Coverage’.
Prior Authorization is an example.
Prior authorization may be required on specific plan covered services. What does this mean? Your insurance company can approve or deny the service request. If the service is denied, your prescribing physician has to go to ‘plan B’ and start the process over. This is one of the reasons we prefer plans that do not have insurance companies standing between you/your physician to get to the ‘next step’ in your health care. The article found here brings this point to life.
The number of days ‘skilled nursing care’ has their daily co-pays in place is something you need to pay attention to. Why? Because if you need this service and have the ‘wrong’ plan, it can be the quickest way for you to hit your plan’s MOOP.
Dental coverage is another example where rules are important to know.
For example, dental (if included in a plan) may exclude certain coverages. This can be done by dental billing code(s) or by limitations on specific services you need that are in coverage class I, II, and III. Implants or braces may be covered by some plans, but not others. There may be limitation on the number of cleanings too (2-year when you may need 4); periodontal services, if covered, may have their own limitations, etc. The dollar value the insurance company offers you for dental coverage can vary widely between plans.
Doctors/hospitals/other providers.
Availability of physicians, hospitals, physical therapists, skilled nursing facilities, durable medical equipment providers and all other provider types vary by plan. Read this article to learn more.
The insurance companies offering Medicare Advantage plans put together their networks of these people/facilities for their plan members. Medicare requires insurance meet a minimum adequacy requirement when they put their networks together. This means there is a good probability not all physicians/providers in your geographic area that ‘accept Medicare’ insurance are not in your plan’s network.
You have the tools available to find out how many of a certain type of specialists are in the plan’s network vs how many that ‘accept Medicare’ are in the same area . If you have existing health issues, would it be important for you to know how many specialists which treat this for you are in the plan you select? We can show you the tools to do this.
The above can change during the calendar year. This announcement is an example of why networks can change during the year. Another example is found here and here.
Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies is competing for other financial needs of the hospital.
Proton Therapy is an example of newer technology.
Read this article if you are unfamiliar with this. At this writing, 45 hospitals (out of over 4500) offer this solution. Facilities near Idaho include:
Huntsman Cancer Institute (Salt Lake City) (began offering this service in 2021)
The Mayo Clinic Cancer Center (Phoenix…rolled out this service on 2016)
Loma Linda University Cancer Center (began offering this service in 1990)
California Protons Cancer Therapy Center (San Diego) (began offering this service in 2017).
If you are interested in this service, you might check where each of the above facilities are ranked in the top 250 hospitals.
Are you interested in the top 250 hospitals in the country?
Would you consider using the services of the top hospitals in the Seattle area…or the Mayo Clinics?
The top 250 hospitals in the US may have the latest technologies to treat different health issue(s)…and the physicians that know how to use them. These resources are available to you if they accept Medicare insurance (Part A and B). Some do not accept Medicare Advantage plans (Part C). Others prefer you have a Medigap plan.
Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.
There are physician rating services too. One is available here. We focus on physicians with a 4 or 5 star rating and have at least 10-ratings. You can use this same tool to find physicians that ‘accept Medicare insurance’.
We also recommend you use a ‘board certified physician‘.
Medications covered by each plan.
According to this source, there is a 20+/- % variance between the number of prescription medications covered by the plans available to you. Note none of these plans include 100% of the medications covered by Medicare.
This same resource documents the number of medications each plan has in each of the 5 (or 6) drug tiers AND the fill/refill cost by these same drug tiers. These figures can vary noticeably between plans.
Given the wide variance between plans on the above, it is easy to understand why there can be a 300% +/- variance in your projected annual out of pocket cost between your plan choices for the medications you take.
This is a key reason you should not enroll in any Medicare Advantage plan until you understand your cost for your prescription medications. If you are working with a broker/agent that just tells you your medications are covered, we suggest you work with someone else that will share the whole picture.
Are medications that treat serious health issues (cancer, etc.) covered by my plan?
The Centers for Medicare and Medicaid Services (CMS) has requirements insurance company(s) offering Medicare plan(s) must meet when they put together their list of covered medications.
Below is a cut/paste from (Section 30.2.5) the current current Medicare Prescription Drug Benefit Manual.
“Part D sponsor formularies must include all or substantially all drugs in the immunosuppressant(for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic classes. CMS instituted this policy because it was necessary to ensure that Medicare beneficiaries reliant upon these drugs would not be substantially discouraged from enrolling in certain Part D plans, as well as to mitigate the risks and complications associated with an interruption of therapy for these vulnerable populations.“
We feel this is an important statement everyone enrolled/wishing to enroll in a Medicare prescription drug plan should be aware of.
Bonner County Medicare Advantage plans for Veterans
Veterans have 8 Medicare Advantage plans to consider. These plans do not include prescription drug coverage and are offered by private insurance companies which compete each other for your business. The insurance company behind each plan sets (and can change annually) their ‘giveback’ for the member’s Part B monthly premium. Plans available to you this year vary between $0 to $75/month.
The amount of the Veterans out of pocket costs for plan covered health care services can vary widely between these plans. This is also true for the ‘non-Medicare’ covered benefits that are often found in these plans (gym membership, dental coverage, etc.). Which hospitals and physicians available to the plan member can also vary by plan.
Should you consider a PPO or an HMO plan?
A veteran may prefer a PPO plan if they want to expand their choice of hospitals and doctors to include those beyond Idaho’s borders. An HMO plan may fit a veteran that wants health care outside the VA and/or urgent and emergent care. We do need to pay attention to the HMO plan’s network of hospitals and doctors, as they can vary year over year.
We recommend Veterans review their Bonner Veteran Medicare Advantage plans at least every 3-years.
This market niche has become quite competitive between the insurance companies. Some of these companies want to increase their market share by offering more attractive features than their competitors. These companies are changing their offerings annually to attract more potential new members.
Some of these plans have a $0 monthly premium. This means if new plans come to market or the insurance companies behind existing plans sweeten the benefits of their plan (s), it may make sense to consider changing plans.
We suggest veterans work with an Idaho broker that is also a veteran and is licensed with all of these plans.
We can help you with this when you are ready. Learn more about us here.’
Bonner County residents enrolled in Medicare and Medicaid.
Blue Cross of Idaho is exiting the IMPlus and MMCP Idaho market on 5/31/2025.
Idaho Department of Health and Welfare (IDHW) clarified this announcement on February 5, 2025 and is available here. Answers to ‘frequently asked questions’ is available here.
If you are presently enrolled in either of these plans, you will be receiving correspondence from both Idaho Department of Health and Welfare and Blue Cross of Idaho.
UnitedHealthcare will be entering the Idaho IMPlus market on 6/1/2025 and the MMCP market on 1/1/2026.
Molina continues to serve Idaho residents with these important products.
If you prefer to work with an Idaho based broker to get your coverage realigned, we are here to help. We have been helping Idaho residents with their Medicare choices since 2012 and MMCP plans since 2022.
Additional pertinent information about Idaho Medicaid and your plan choices.
There are several different types of plans available to Idaho residents enrolled in Medicaid. If the Idaho Department of Health and Welfare categorized you in the ‘Basic’ category, you have a different set of Medicare Advantage plans to choose from (compared to individuals categorized as ‘Enhanced’).
If you are eligible for an I-SNP OR a C-SNP plan, you have different plans to consider.
Click here to learn more about your options.
We are licensed with C-SNP, D-SNP, QMB and Medicare Medicaid Coordinated plans (MMCP).
Explaining plan differences and helping you with enrollment are other services we help you with.
Additional information about the Medicare Advantage plan(s) available in Bonner County.
Monthly premiums of these Bonner County plans range from $0 to over $135.
If you are interested in a Medicare Advantage plan with a premium above $70/month, an Out-of-Pocket Limit above of $6,000 or have copays for stays in a Skilled Nursing Facility after day 60, be sure you understand your other choices. These include the other lower premium Medicare Advantage plans as well as Medigap plans. Learn more about your Medigap options here.
We can help you think this through.
What insurance companies offer Medicare Advantage plans in Bonner County?
Blue Cross of Idaho
Molina Healthcare
Pacific Source
Regence Blue Shield of Idaho
United Healthcare
Other tidbits to be aware of
Hospitals in your immediate area
There are 7 hospitals within 50 miles of downtown Hope Idaho (83836). Get a visual of their location by clicking here. When you land on this web page, select ‘hospitals’ and enter the zip code of 83836 and adjust the radius to 50.
2 of these hospitals are outside Idaho and may not be in any of the Bonner County Medicare Advantage plan’s network.
One of these hospitals are rated by The Center for Medicaid and Medicare Services (CMS) as 5 stars (Kootenai Health Hospital). There are 4 hospitals with no rating.
Having resources with a ‘5’ Star rating can be important to you when you get regular care, emergency and scheduled surgical procedures.
All of these hospitals may not be in every plan available to you.
Read the fine print on extra Benefits included in Medicare Advantage plans.
Dental Coverage:
Please review the verbiage on dental care found in the Evidence of Coverage.
If you listen to the TV commercials, this is sounds like a great and often needed ‘extra’.
You really need to pay attention to the details as they can vary widely between the plans that include this feature.
For example, some plans restrict coverage to preventative care (a few cleanings annually, x-rays you can get have their own schedule, etc.). The plan may cover certain periodontal services. If covered, the plan may limit the number of times specific service(s) can be used during the year.
Some plans include coverage for class II and III services. If they do, there may be restrictions on specific services covered and may explicitly exclude certain dental billing codes. Please read your plan’s ‘Evidence of Coverage’ for specific details.
Do you need to use the plans network of dentists?
Plans may have a network of dentists you can use; some permit the use of any licensed dentist in the US for services.
Plans may state cosmetic services are not covered. It you use an ‘out of network dentist, you may pay for all services. If your plan permits use of out of network services, your cost may be higher. .
We suggest you read dental coverage section of the ‘Evidence of Coverage’ document.
Your plan may not pay for services you use which are excluded from your plan. If you have any question about whether a service is covered, call your plan’s customer service. You may have to get specific billing codes from your dentist just to be sure you get the right answer.
We like plans that let you use any licensed dentist in the US and cover all non-cosmetic dental services.
Vision Coverage.
The depth of this coverage varies by plan. The same issues pointed out for dental coverage can apply to this service too. Be sure and look at the cost for an annual checkup, network restrictions, how much the plan will pay for glasses, frames, contacts, etc.
Over The Counter benefit.
Some plans have a catalog of ‘drug store‘ items you can order from. The products you select are typically delivered to you at no cost.
It is possible the items you want will not be included in the plan’s catalog of covered items. Plan’s have a quarterly limit on how much it gives you to spend on these items. The amount of the quarterly limit can vary widely between plans.
Gym Memberships.
You need to pay attention to the depth/variety of facilities that are available and close to you. Some plans include a ‘Silver and Fit’, ‘Silver Sneakers’, a membership with their own network of facilities. Some plans may charge ‘extra’ for this feature. Read the plan’s rules for this service…and which facilities in your area are available to you.
Hearing Aids.
Many Medicare Advantage plans have 3rd party business partners that handle this extra benefit. This means you are using that vendor to spend your hearing allowance.
Visiting the Costco hearing department may provide the education you need to understand product differences.
Plans can be different on what specific products (and services) are available to you.
Would a Medicare coach be helpful?
A coach can answer your question(s), help firm up your understanding of Medicare, explain the differences between your choices, and help you through the enrollment process. They will also be there year after year to help you.
Will the people behind the TV ad’s include this service for you?
Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.
We started this business in 2012 explicitly to help Idaho residents work their way through this maze.
Call us. There is no cost for our services.
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