CMS Required Statement for Idaho residents interested in a Medicare Advantage or Prescription drug plan.

We are licensed with all Idaho Medicare Advantage plans listed on the Medicare plan finder tool, except the I-SNP.  This plan is limited to Idaho residents eligible for this plan.

6 of the 7 insurance companies offering Part D (prescription plans) in Idaho use our services.  Regence Blue Shield of Idaho does not use brokers.

Additional information on his subject is documented here.

What you need to know!

Your County does not have any Part C (Medicare Advantage plans) available at this time.  Why?  The insurance companies offering this plan type chose to not offer their products to you.  More than likely the company(s) cannot ‘break even’ because the number of Medicare enrollees is too low in your County.

This may change next year.

Your other health insurance option.

If you are enrolled in Medicare Part A & B, you may be eligible to enroll in one of the 10 Medigap plans available in Idaho.

If you are not sure how to enroll in Medicare, read this document.

Two of the Medigap plans limit your annual out of pocket costs for Part A and B covered services to less than $3,000.

When you choose this option, all doctors/hospitals that accept Medicare insurance in the USA are available to you.  Call if you have questions.

If you are unfamiliar with this plan type, download this PDF document (click here).  This is published/maintained by Centers of Medicare and Medicaid Services (CMS). We suggest reading pages 6 – 24 initially and the balance at your convenience.  We can answer your questions on this content.

Why would you consider a Medigap plan?

1. They give you the opportunity to use any hospital/physician/other provider that accepts Medicare insurance in the US.  This gives you far more flexibility (than a Medicare Advantage plan) to choose who and whereyou get your Medicare covered health care services.  This means many of the top hospitals in the US are available to you.  This includes resources like the Mayo Clinic.  You just need to make the appointment.  The hospitals/physicians found in Medicare Advantage plans are also available to you.
2. There are 10 different plans.  Each covers a different combination of the left-over costs that Medicare Part A and/or B do not completely pay for.
3. You can better budget for your Medicare health care covered services with one of these plans.

Plese call if you have questions.

We have been helping Idaho residents on this subject (since 2012) and are also enrolled in this plan type.

There is no fee for our services.

Prescription Drug plans are available. 

Idaho has 12 different Medicare prescription drug plans available to residents.  This figure can change annually.

These plans are offered by private insurance companies which have a contract with CMS to offer this service.

These companies may offer more than one plan.  Each plan has their fees.  These include a premium, deductible, and fill/refill cost for the meds they cover.  Each plan has its own list of medications (formulary) they cover.

Monthly premiums in 2025 vary from $.00 to over $100.

Our experience, when comparing plans to each other, it is common to see a 300%+/- difference in your annual out of pocket cost (plan’s premium + med refill cost) for the same set of medications.  This is why we review all plans when a person initially enrolls.  Then we do this annually for our customers as the insurance companies can change details of their plan(s).

Most of these insurance companies offering these plans compete with each other with the goal of increasing their market share.

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 drug 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.

We will send you a copy of the reports documenting the cost of all plans for your meds.

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

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.

We can help you navigate your way thru plan understanding, differentiation and enrollment.

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.

This page was last modified on Jan 21, 2024 @ 2:12 PM