Caribou County Medicare beneficiaries have 11 Medicare Advantage plans to consider.

These plans are broken down into three categories.  These are:

Veterans, which get their prescription medications from the VA

Residents with special needs (Medicaid, chronic health issues, and people with institutional  level of care)

Plans for the rest of the Caribou County Medicare beneficiaries.

When you review your options, we encourage you to consider the 2 low premium Medigap plans too.

Why? 

More of the Caribou County Medicare plans are requiring permission to see a specialist.  Waiting for this may slow your treatment plan.

The Medicare Advantage plans available to you may have fewer licensed physicians in their plan’s network than those available to you if you remained with ‘Original Medicare’.

The Kaiser Family Foundation published a report on this point dated 10/25/2025 and it is available to read here.

The title of this informative document is: “Medicare Advantage Provider Networks Limit Enrollees to About Half of the Physicians in Their Area That Are Available to Beneficiaries in Traditional Medicare, on Average.”

More hospitals in the US are no longer accepting Medicare Advantage plans.  Read this report and this one too.  Both were recently published.

Medigap plans are becoming more attractive for some.

With 2026 premiums and cost sharing of some Caribou County Medicare Advantage plans increasing to the point where these lower premium Medigap plans are attractive and competitive.

There are many positive benefits that come with these two plans which are not available from Medicare Advantage plans.  A few of these are:

the doctors/hospitals in the Salt Lake City area, Boise, Seattle, and surrounding areas (including the rest of the US) are available to you; you just make the appointment;

you do not need referrals to see a specialist,

the limit on your share of the cost for your Medicare covered services is $2,950; remember this figure when you read about the ‘Maximum out of Pocket Cost’ for the Medicare Advantage plans available to you.  These are reviewed below.

More on this below.

The eleven plans are broken down into different categories

                 Plans without prescription drug coverage

There are 3 plans in this category.

Premiums are $0.

The Medicare Part B ‘credit’ (also called ‘giveback’) ranges from: $30 to $100.

Veterans, who chose one of these plans for health care services, need to pay attention to the plan’s provider directory as it identifies which hospitals, physicians, etc. are available to plan members.  Not all physicians in the area which ‘accept Medicare’ may not be available to plan members.

We can help you under stand plan differences and, when you are ready, help with enrollment in the plan you choose.

There are four Special Needs plans (C-SNP, and D-SNP) in 2026.

These include:           

      C-SNP  (Chronic health care Special Needs plans)

C-SNPs are designed to provide benefits tailored to people with specific chronic health issues . Qualifying conditions include Diabetes mellitus; and/or Chronic heart failure; and/or Cardiovascular disorder (cardiac arrhythmias, coronary artery disease, peripheral vascular disease, chronic venous thromboembolic disorder). The plan qualification process includes:

• Doctor Verification: The plan provider will work with your doctor to verify your chronic condition before you are fully approved for the plan.
• Special Enrollment Period: You can use a one-time special enrollment period to join a C-SNP at any time of the year, not just during the annual fall enrollment period.

If you have one of these health issues and feel it you are not making progress getting it managed, one of these plans might help.

D-SNP (Dual eligible Special Needs plans).

If the Idaho Department of Health and Welfare has classified you as having ‘Enhanced Status’ you have Medicaid/Medicare coordinated (MMCP) plans to consider. Individuals awarded with QMB status have their own unique plans available. If you have a different Medicaid status, the plans discussed below are available to you.

All other Caribou County Medicare beneficiaries have 2 HMO and 2 PPO plans to consider.

HMO Plans.

Monthly premiums range from $0 to over $70.

Plan MOOP’s range (your ‘cap’ on your annual share of the costs for plan covered health care services) is $5900 to $6700.

As a general reminder, confirm the physicians, hospital(s), and other providers are in any plan(s) ‘provider directory’ before you enroll in a plan.  If you work with a broker, they do this for you.

Your cost sharing when plan services are used vary by the service you use.  Pay attention to these figures and other rules that apply to any ‘extras’ which may be included in plans. The plan’s ‘Evidence of Coverage’ document explains this and is available on the insurance company’s website.

Why review this document?  Because it tells you the ‘rest of the story’.  The higher level documents (marketing material, messages you hear in TV ads, the Summary of Benefits document typically offer a subset of plan covered services.

We can help you understand the differences between your plan choices, and when you are ready, help with enrollment too.

 PPO Plans.

2026 monthly premiums for this County’s PPO plans range from $64 to over $80

These plans have two MOOP figures.

You must consider both when selecting a plan.

Be sure and check these figures as they set the ‘cap’ for your share of the cost for plan covered health care services.

These figures can be important when comparing plans.

If you choose the ‘out of network’ option, be aware some hospitals in the US do not accept appointments from people insured with Medicare Advantage plans.  The information found here is an up-to-date report on this subject.

Also be aware of the phrase in section 2 of the plan’s ‘Evidence of Coverage’.    It reads: “However, providers that don’t contract with us are under no obligation to treat you, except in emergency situations.”  This document is available on the insurance company’s website.

We can help you understand the differences between your plan choices, and when you are ready, help with enrollment too.

With the rising cost of Medicare Advantage plan premiums AND cost share, Medigap Plan G High-Deductible (HD-G) or Plan F High-Deductible (HD-F) are attractive alternatives.

Don’t let the words ‘high deductible’ scare you.

The figure is usually less than 1/2 of a Medicare Advantage plan’s ‘Maximum out of pocket limit’.

We are seeing more Idaho residents chose these plans.

Why?  Because you have:

• Freedom to choose any physician/hospital which ‘accepts Medicare insurance’ (most do)
• Few ‘prior authorizations; you do not have an insurance company standing between you and your physician to get to the next step in your health care;
• Few/no referrals are needed; you just make the appointment
• Stable coverage year after year
• Nationwide access to health care; this means you minimize the growing issue of hospitals not accepting Medicare Advantage plans
• More predictable costs when you use care.
• Medigap HD-G is tied directly to Original Medicare’s cost structure.  Cost sharing for Part A and B covered services is here.  This means Medicare (CMS) is setting your cost share, not individual insurance companies.

Remember, Medicare is paying the ‘lions’ share of your health care costs (for Part A and B covered services) and you are paying the balance.  This concept is the same with a Medicare Advantage plan.

The ‘Deductible’ compared to the ‘Maximum out of pocket limit’.

Medicare sets this deductible and it goes up a bit annually.  Individual insurance companies offering these plans cannot adjust this figure. Once your annual out of pocket cost for the Part A and B services hit the plans ‘deductible’, you are done paying for Part A and B costs for the calendar year.  Note, Medicare Part B services has it’s own deductible too.  This needs to be met too.  The probability you will not met this and you reach the hi-deductible requirement for this Medigap plan is quite smal).

• 2025 deductible: $2,870
• 2026 deductible: $2,950

This is different from Medicare Advantage, where the insurance company sets the out-of-pocket cost maximum limit (provided it does not exceed Medicare’s permitted ‘maximum figure’.

If you joined Medicare before January 1, 2020, you qualify to join Hi Deductible Plan F.  This plan also covers the annual Part B deductible where Plan G will leave exposed to this potential expense.  This year that figure is $283.  Often the monthly premium for the F and G versions of this hi-deductible plan are the same.

Call us if you have questions.

 Premium Comparison (for Idaho)

Both Medigap HD-G and HD-F often costs less than $85 per month in Idaho (rates vary by insurance company and can go up annually). More comprehensive Medigap plans (Plan F, Plan G, Plan N) have higher premiums, but they require noticeably less cost sharing when you use care.

*Plan F is only available to people who became eligible for Medicare before January 1, 2020. Call us if you have questions about this choice.

Other issues to consider when selecting a Caribou County Medicare plan.

If your doctor ran tests on you to diagnose the reason you are visiting them, and unfortunately the diagnosis came back as a serious health issue.  Would you start thinking about where you want to be treated and by whom?

If you are diagnosed with Cancer…

Proton Therapy is an example of newer technology for treating some cancers. Read this article if you are unfamiliar with this technology. At this point, forty six hospitals (out of over 4500) offer this solution.  One of them is in Northern Utah.   This video does a good job of describing how this works.  A map of facilities that offer this resource is available here.

Some medications treating cancer are covered by Medicare Part B.  These medications can be expensive.  If a person is treated with these medications (and are covered by Medicare), it will contribute to reaching the plan’s MOOP (or ‘deductible if they enrolled in a hi-deductible Medigap plan).

Resources are available to help you find the top hospitals in the US.

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. Some of theses resources in the Western Part  of the US include:      

Mayo Clinic Hospital (Phoenix)      

Cedars-Sinai Medical Center (West Hollywood)      

Northridge Hospital Medical Center (Northridge)      

Providence Holy Cross Medical Center (Mission Hills)      

Scripps Mercy Hospital San Diego (San Diego)      

Stanford Hospital (Stanford)      

Sutter Roseville Medical Center (Roseville.

Some of these hospitals may not accept the Medicare Advantage plans.

If you have a Medigap most will accept your insurance.

Hospitals are assigned a ‘star rating’ by Medicare.  We recommend Idaho residents focus on four and five-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 four or five star rating and have at least ten ratings. We also recommend you use a ‘board certified physician‘.

This tool will point out hospitals in/around Caribou County.

Click here to see a map of the hospitals 50 miles around downtown Soda Springs (zip code 83276).

We recommend  Caribou County Medicare beneficiaries focus on 4 or 5-star rated facilities.

Notice 1 of the 6 facilities appearing on this map are rated in this category and it is located in Wyoming.  This facility may not be in all of the plan’s ‘network’ available to you.  If you pick a Medigap plan, it will be.

Medications covered by each plan.

According to this source, there can be a 25+/- % variance between the number of prescription medications covered by Idaho Medicare Advantage plans. 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.

Dot your I’s and cross your T’s.

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 (show you the reports which show cost differences between plans AND the pharmacies within plan).

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

The Centers for Medicare and Medicaid Services (CMS) have requirements insurance companies(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 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 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.

What insurance companies offer Medicare Advantage plans in Caribou County?

Humana

Molina

United Healthcare.

Would a Idaho based Medicare coach be helpful?

A coach can firm up your understanding of Medicare, explain differences between your choices, and help you with enrollment.  They will also be there year after year to help you. Will the people behind the TV ads include this service for you? Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.

This page was last modified on Mar 2, 2026 @ 7:30 AM.