Several 2025 Camas County Medicare Advantage plans caught our attention.

The first is an HMO-POS plan with key 5-star hospitals in Oregon, Washington, Utah and Idaho in their network!  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.  

Next are plans for people that 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 Camas 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.

Don’t forget, if you are enrolled in a Medicare Advantage plan now and the 2025 version of your 2024 plan left you wanting, you can switch to a different plan between January 1 and March 31.

What else you need to know!

For 2025, Camas County has 15 Medicare Advantage plans for residents to consider. 

Here is the high level break down:

          4 plans do NOT include prescription drug coverage; Veterans may find these plans attractive.

                  2 of these are PPO;

                  2 are HMO plans.        

         9 plans do include prescription drug coverage and services covered by Medicare Part A and B.  

                  5 are HMO plans;

                  4 are PPO plans. 

           The remaining plans are reserved for individuals which qualify for Chronic Special Needs plans (C-SNP).  This plan is available to residents qualifying for this type of care.

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.

What does this mean?  Your  insurance company can approve or deny the service request from your physician.  If the service is denied, your prescribing physician has to go to ‘plan B’ and start the process over.  This article documents points out what has been going on in the US on this subject. 

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 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 a limitation on the number of cleanings too (2-year when you may need 4); periodontal services, if covered, may have their own limitation, etc.

The dollar value the insurance company offers you for dental coverage can vary widely between plans.

When reviewing 2025 dental coverage for some plans we noticed something we have not seen before.  It reads ‘Submitted claims are subject to a review process which may include a clinical review and dental history to approve coverage’.  To us, this is an example of why people interested in dental coverage included in a Medicare Advantage plan need to read the fine print before choosing a plan.

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 for treating cancer.

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 OR the top hospitals by type of surgery?

Resources are available to help you find these.

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.  This group of hospitals may not accept the Medicare Advantage plans available to you.

Hospitals are assigned a ‘star rating’ by Medicare.  We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.  Learn more about this subject here.

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.

We also recommend you use a ‘board certified physician‘.

What are the differences between Camas County Medicare Advantage plans?

One 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?

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 $4,500 to $6,300.  The range for PPO plans is $5,900 to $14,000.

We prefer plans that meet a person’s needs AND have a low MOOP.

You can check out the above figures by using the resource found here.

The example below will help you understand how your plan’s MOOP works.

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.

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.

Medicare Supplement plans.

These plans give you the choice of any doctor/hospital/other providers (in the US) that offer services to people enrolled in Medicare (both Part A and B).  Over 90% of physicians in the US accept Medicare insurance (Part A and B) and most of the hospitals do…and prefer people with this insurance when compared to Medicare Advantage plans.

When you have a Medicare Supplement plan, typically the hospital as well as physicians you work with have far fewer ‘prior authorizations’ and denial of claims issues to deal with.  You and your physician are making the decision on the ‘next step’ in your health care. You do not have an insurance company standing between you and your physician to get the ‘next step’ in your health care done.

Read the articles supporting the above comments here, here, and here.

Do you want a plan that pays for most all of the left over cost for Part A and B in the US?

We recommend you consider a Medigap Plan G.  

Camas County Medicare Advantage plans for Veterans

Veterans enrolled in Medicare Part A and B can enroll in a Medicare Advantage or a Medigap plan.  

Camas County residents have VA Clinics in Twin Falls (and several locations around the State) and hospitals in Boise, Salt Lake City and several other parts of the US.

Why would a Veteran consider a Medicare Advantage plan? Because:

• You will have flexibility to get your health care services from the VA and the network of providers in your Medicare Advantage plan. Available services include urgent, emergency, and regular health care.  You can still get services from the VA.
• Take advantage of the Part B buyback offered by some of these plans.  This means the insurance company MAY offer to pay part of the Veterans Part B monthly premium.  At this writing, this ‘give back’ varies from $0 to $100 a month for plans available in Idaho.  These figures are determined by the insurance company offering the plan and can change annually. 
• Get the $0/low cost ‘extra’ features not covered by Medicare. Some plans have attractive features that may benefit the Veteran.
• Many of these plans have a $0 monthly premium.  

Is an HMO or a PPO plan right for you?

A veteran may prefer a PPO plan if they want to open their choice of hospitals and doctors to include those beyond Idaho’s borders. 

Be aware when plan services are provided by ‘out of network’ providers, the plan members share of the cost for services can be noticeably higher when compared to using ‘in network doctors/hospitals/etc.  Getting ‘out of network’ services may greatly increase the Veterans probability of hitting their ‘out of network’ maximum out of pocket limit.  Check out this figure if you are interested in a PPO plan.  Call us if you want help thinking this through.

An HMO plan may fit a veteran that wants coverage outside the VA for regular health care OR just want access urgent and emergent care when it is needed. 

Some Veterans choose a $0 premium plan so they can get the low/no-cost ‘extra’ benefits which can come with these plans.  We noticed some plan(s) with a high Part B giveback also come with high-cost sharing when plan health care service is used. Call us if you want help thinking this through.

If a Veteran plans to get health care from an HMO plan, we need to pay attention to the plan’s network.  Participating hospitals and doctors can vary by plan and this can change annually. 

Why the interest by insurance companies in the Veterans niche?

A couple of obvious reasons could include they want to say thank you to the Veteran for their service. 

Another can be is these plans can be more profitable to the company if the Veteran continues to get their health care from the VA.

This market niche has become quite competitive between the insurance companies.

We expect more insurance companies will enter the Camas County MA marketplace in the future. 

Keep in mind, some of these companies want to increase their market share by offering more attractive features than their competitors.   

When this occurs, we need to pay attention to plan differences.

These can include the doctors/hospitals in the plan’s network, the cost for health care services provided to the plan member, and the details of any ‘extra’ services not covered by Medicare. 

Many MA plans in Idaho also include the Part B buyback.  This means the insurance company MAY offer to pay part of the Veterans Part B monthly premium.  In other Idaho Counties, this figure varies from $0 and up. 

Some Veterans that get their health care from the VA simply enroll in one of these plans to get help paying for their Part B monthly premium and to take advantage of the $0/low cost for the other features included in the plan.  Others want access to urgent and emergency care outside of the VA.  Others simply want a broader choice of doctors and hospitals. 

Another key point is these companies may improve their offerings annually.  They do this to attract Veterans already enrolled in another insurance company’s plan as well as Veterans new Medicare. 

We suggest Veterans work with an Idaho broker that is also a veteran and is licensed with all these plans.

We can help you with this when you are ready. Learn more about us here.

Camas County residents on Medicaid and enrolled in Medicare.

If you are on Medicaid and enrolled in Medicare and recently received a Medicaid cancellation notice, we can help you. 

Please remember you have 60-days from your cancellation date to find replacement insurance for both your health and prescription medications.  If you miss this window, you may have to wait until the next ‘annual enrollment period’. 

You have new options for replacing your health and medication insurance. 

We help you understand the differences between your Medicare Advantage and your Medicare Supplement choices.  Then we explain the specific plans available in each category. 

Others like you recently benefited from our help.

If you not affected by this Idaho Department of Health and Welfare audit…

There are several different types of plans available to Idaho residents enrolled in Medicaid. These include people eligible for ‘Basic’ or ‘Enhanced’ Medicaid or are eligible for an ISNP or a CSNP. Click here to learn more about your options.

Medicare Advantage plans for the rest of the Medicare beneficiaries living in Camas County

Check out the hospitals in each plan’s network and where they are located.

There are no hospitals in Camas County.  

Check out the other facilities within 50 miles of zip code 83327 by clicking here.  

Notice there are 4 hospitals within this radius. 

Take a look at the Medicare Star rating for each hospital.  We recommend Idaho residents consider hospitals rated 4 or 5. 

Learn more about CMS hospital rating here. 

Hospital(s) without a rating may have not reported their results or did not meet the minimum number of procedures to be measured and rated for the current period.  

When selecting a health plan, be sure the hospitals and doctors you want to take care of you no matter the health issue is available to you.  

The CMS hospital rating system is a guideline to consider using. 

You can also use another tool that identifies the top 100 hospitals in the US.  This information rates hospitals by type of surgery within hospital too.  Learn more here. 

You can consider these resources if you have a plan which opens up these facilities to you.  Depending on the plan you choose, some/all of these facilities may or may not be available to you.

What insurance companies offer Medicare Advantage plans in Camas County?

Humana

Pacific Source

United Healthcare

Other tidbits to be aware of

Additional details about the plans available in Camas County.

Monthly premiums of Medicare Advantage plans range from $0 to $68.   

The differences between these plans include the available hospital(s), physicians, skilled nursing facilities, physical therapists, durable medical equipment providers, etc. Your share of the cost for services received AND the ‘out of pocket maximum limit’ also vary between plans. 

Some plans let you use ‘out of network’ providers at a higher cost sharing and ‘out of pocket maximum limit’. 

Be aware out of network providers are not required to accept your plan, unless you have an ’emergency’. 

Also note Mayo Clinic no longer accepts Medicare beneficiaries enrolled in a Medicare Advantage plan, unless their facilities are part of the plan(s) network (reference the plan’s provider directory).   Reference this note for details.  

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’ benefit.   

You really need to pay attention to the details as they can vary widely between the plans. 

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 class II and III services.  If they do, there may be restrictions on specific services covered and may explicitly exclude certain dental billing co

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.  Some plans may charge you more for services if they you use an out-of-network dentist.   

We suggest you read dental coverage section of the ‘Evidence of Coverage’ document.

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. 

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. 

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This page was last modified on Mar 29, 2025 @ 11:20 AM