Elmore County Medicare Advantage Plans
Several 2025 Elmore 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.
Would you like over $100 refunded to you each month for the rest of 2025?
This plan should be on your short list. Drug coverage is embedded in this plan too. Veterans interested in Elmore County Medicare Advantage plan(s) without prescription drug coverage should consider this plan too.
People with certain chronic health issues should focus on this plan.
People 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) should consider this plan.
If you have a Medicaid status of QMB and SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.
The rest of the Elmore County Medicare Advantage plans are unique and deserve your consideration too.
There are other Elmore County Medicare HMO and PPO plans on our recommend list. Which medications, hospital preferences, and health issues a person has/does not have are determining factors on which are appropriate.
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, Elmore County has 31 Medicare Advantage plans for residents to consider. This is 11 fewer than 2024.
Here is the high level break down:
7 plans do NOT include prescription drug coverage; Veterans may find these plans attractive.
4 of these are PPO;
3 are HMO plans.
Veterans should also consider the new HMO plan mentioned above. Why? It’s Part B give back is higher than any of the Medicare Advantage plans which do not include prescription drug coverage.
17 plans do include prescription drug coverage and services covered by Medicare Part A and B.
12 are HMO plans;
5 are PPO plans.
The remaining plans are reserved for individuals who qualify for Medicaid special needs plans (C-SNP or D-SNP).
Some of a plan’s out of pocket cost for services your should pay attention to.
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.
The plan’s Maximum out of pocket limit (MOOP).
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 your insurance company 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 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 $4,800 to $9,350.
The range for PPO plans is $6,100 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.
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.
Dental coverage 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. The insurance companies offering Medicare Advantage plans put together their networks of these people/facilities for their plan members.
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.
Some plans in your County specialize in St Lukes hospital(s) and their doctors/other providers. Other plans specialize in the St. Alphonsus hospital(s) and their providers. Other plans include both major hospitals systems. Some may include, at their option, specific 2nd tier facilities (like Treasure Valley Hospital, etc.).
Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies are competing for other financial needs of the hospital.
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‘.
Proton Therapy is an example of newer technology for treating cancer. It is being used as an alternative to radiation treatments.
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?
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; if you have a Medigap plan it will help pay for all/most all of your left over costs for Medicare covered services.
Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.
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 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.
There are 3 different audiences for Elmore County Medicare Advantage plans.
There are Medicare Advantage plans for Veterans, people enrolled in Medicaid and Medicare, and several plans for the rest of us.
Veterans have several Medicare Advantage plans to consider.
These plans do not include prescription drug coverage and are offered by private insurance companies which compete with each other for your business.
Some of these plans help you pay for your monthly Part B premium (the plan’s call this feature a Part B giveback). Each plan sets their ‘giveback’ for the member’s Part B monthly premium.
This year your County’s plans have a giveback between $0 to $100/month.
The Part B payback figures can change annually and is controlled by the insurance company offering the plan.
The Veterans out of pocket costs for plan covered health care services can vary widely between 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.
Which plan is right for you?
Do you want access to doctors/hospitals anywhere in the US?
A veteran may prefer a PPO plan if you want to open your 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 MOOP.
Call us if you want help thinking this through.
Do you just want a plan that is a backup to VA health care and are on with the plan’s network of hospitals/doctors/other providers?
An HMO plan should meet your needs. Participating hospitals and doctors can vary by plan and this can change annually.
Are you getting a plan to take advantage of the Part B give back and/or the ‘extras’ that come with some of these plans?
Some Veterans may have no intention of getting health care from one of these plans. They just enroll in a plan so they can get the low/no-cost ‘extra’ benefits which can come with these plans as well as the Part B buyback. This can save the Veteran money.
We noticed some plan(s) with a high Part B giveback also come with high cost sharing when plan health care service is used. Keep this in mind if you may need to use your Medicare Advantage plan. You may be better off with a plan that has a ‘lower Part B buyback’.
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 insurance company if the Veteran continues to get their health care from the VA.
If you want help with plan selection…
Call us. I am a veteran and have been helping others with Medicare, plan selection, and enrollment since 2012.
Elmore County residents on Medicaid and enrolled in Medicare.
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.
Elmore County Medicare Advantage plans with low/no premium and are rich in non-Medicare benefits.
When you look the Summary of Benefits’ document of the plans available to you, you may notice some plan(s) have $0/low premiums and include attractive extra no cost benefits. These plan(s) may separate their self from other plans because of this.
If you are attracted to these plan(s) be sure and consider your financial exposure if you will use plan(s) health care services. The plan’s ‘out of network limit’ may be higher than other plans.
Insurance companies may offer Medicare Advantage plans in a market niche designed for people which seldom need health care services. If the company is successful attracting this type of consumer, their expenses may be lower (and also be more profitable).
Medicare Advantage plans with only one of the major hospital systems in their network.
Some Medicare Advantage plans focus on St. Lukes hospital OR St. Alphonsus while other plans have both St Alphonsus AND St Lukes hospitals in their network. You get to pick the plan which has the doctors and hospitals you want available to you. Take a close look at plans that focus on single major hospital. They may stand out on their member costs for both health care and medication refills.
If you are mentally sold on either St Lukes OR St Alphonsus let us know. We will help you compare the out-of-pocket costs for both health care services and medication refills for the plans that specialize in either hospital.
A potential downside of any plan with a narrow network is the narrow network. Each of us are one doctor visit or one heartbeat away from needing medical care. If you prefer to research the background and skill set of hospital(s) and other providers before deciding on whom to do business with, a single hospital plan may or may not end up being the right plan. This is for you to decide. There are tools available that identify the top hospitals (and often the top specialists) in the US.
We are here to help you think this through.
What insurance companies offer Medicare Advantage plans in Elmore County?
Blue Cross of Idaho
Humana
Pacific Source
Saint Alphonsus Health Plan
United Healthcare.
Other tidbits to be aware of.
Hospitals in your immediate area.
The St. Lukes hospital in Mountain Home is the single hospital in Elmore County.
Since the plans available in Elmore County include the same plans available to Ada County residents, you can have access to either St. Lukes hospital(s) or St Alphonsus facilities. Some of the plans include both hospital systems in their network.
There are 8 hospitals within 50 miles of downtown Mountain Home. Get a visual of their location by clicking here. Be sure and enter zip code 83647; adjust the ‘radius’ to 50.
Be sure and pay attention to the Medicare assigned Star rating assigned to each hospital. The range is 1-5. We do not recommend Idaho residents use resources from facilities with a star rating below 3.
Having resources with a ‘4 or 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.
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.
Why do this?
Because the details of actual dental coverage can be noticeably different between individual plans.
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 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…or services you use may cost you more when compared to your cost if you use an in-network dentist.
We suggest you read dental coverage section of the ‘Evidence of Coverage’ document just to be sure you understand the plan’s rules. 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 and they are 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. Plans 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.
This benefit may or may not be useful to you because of the lack of participating facilities in your area.
If this changes, 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’ or a membership with their own network of facilities. Some plans may charge the plan member for this ‘extra’ while others may include this. 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.
If you are unfamiliar with these products and are a member of Costco visit their hearing department. They may provide the education you need without the pressure of buying a product. You will be better armed with knowledge when you visit your plan’s hearing aid vendor.
Plans can be different on what specific products (and services) are available to you. We are here to help when you are ready.
Would a Medicare coach be helpful?
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A coach can answer your question(s), help firm up your understanding of Medicare, and explain the differences between your choices. When you are ready, they wll help you through the enrollment process. 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.
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