We help  residents living in any of Idaho’s 44 Counties understand differences between Idaho Medicare Advantage plans and have been doing so since 2012.

This means people living in Arco, Boise, Nampa, Caldwell, Twin Falls, Sun Valley, Ashton, Bergdorf, New Meadows, Council, Salmon, Coeur D’Alene, Bonners Ferry, and all  areas between is our service area.

Idaho is our home and we remain licensed with all Medicare health plans, except for the ‘Institutional Special Needs Plan’ (I-SNP).  This plan type is not available to brokers. 

When you are ready, call us on 1-208-867-0296 between 8 am and 8pm Monday through Saturday.

Your choice of Idaho Medicare Advantage plans include:

Residents enrolled in Medicare and Idaho Medicaid have specific plans available. 

These plans are referred as D-SNP (Dual Eligible Special Needs Plans). The industry pronounces this acronynm as ‘D Snip’. 

There are multiple different plans and each is based on the persons State of Idaho ‘Medicaid status’.  We will help you navigate your way through your choices.

People diagnosed with Diabetes mellitus, chronic heart failure, or cardiovascular disorders have their own unique plans whose networks of providers specialize in these health issues. 

These plans are called C-SNP.  This means ‘Chronic Condition Special Needs Plans.  This acronym is often pronounced as ‘C-Snip’.

If you have a current diagnosis of one of these issues, we can help find the right plan and with the right insurance company. 

Veterans who get their prescriptions from the VA and want additional options on where they get their emergency and regular health care have specific plans for consideration. 

These plans are called MA plans (Medicare Advantage plans). They do not include ‘prescription drug coverage’ (Part D).

Some of these plans help you pay for your monthly Part B premium too. There are several plans and based on your interests and needs, one of these should match up with your budget and specific interests.

Individuals who prefer to get their health care from medical resources based in Idaho.

These plans are called MAPD plans.  This means ‘Medicare Advantage prescription drug plans’.

 Each County has their own unique plans which offer specific hospitals and physicians to treat you.  Often these resources are near where you live. This category is referred as HMO plans. 

A different category of Medicare Advantage plans have their own defined network of doctors/hospitals which are often near where you live AND they let you use the same type of resources in the rest of Idaho and the US.  These Medicare Advantage plans are called PPO plans.

If a person has a PPO plan and they wish to use doctors/hospitals outside of the plans network, it  is up to the provider to agree to accept the terms of the policy holders plan before they will accept the appointment.  

Insurance companies offering 2026 Medicare plans to Idaho residents include:

Blue Cross of Idaho

Humana

Molina

Pacific Source

St. Alphonsus Hospital System

United Healthcare

Other important differences to be aware of:

Insurance companies offering Medicare Advantage plans decide which Idaho Counties they will offer their plans.  This means plans available in Bonneville County will be different than plans available in Lemhi County.

Plan premiums vary from $0 to over $150/month.  When premiums get above $60/month, we encourage you to review the lower premium Medigap plans too (Plan G Hi-deductible, for example). Why?  Because you have more flexibility and you do not have an insurance company standing between you and your physician to get to the ‘next step’ in your health care.

Deductibles found in 2026 plans are set by the respective insurance company.  They range from $0 to $900.

If you are attracted to a plan with a ‘deductible’ for health care services, we encourage you to review your Medigap plan options.  They may end up saving you money too.

We recommend any plan you consider has a 4 or 5 star hospital in it’s network. 

The Centers for Medicare and Medicaid Services (CMS) assign these ratings to all hospitals which accept ‘Medicare’.  At this writing, the Idaho hospitals listed below have this rating. 

Be aware each insurance company choose which hospitals they wish to include in each of their plan’s network.  This means the hospitals above may not be in the Medicare Advantage plan you choose. 

 Provider Networks: What “Strong” Really Means

Medicare Advantage provider networks may be smaller than most people realize.

Medicare provides a free provider search tool on Medicare.gov that helps put provider access into perspective.

Anyone can enter a ZIP code, adjust the travel radius, and see all doctors and hospitals that accept Medicare in that area. 

This same resource shows you the figures by specialty (internists, cardiologists, neurologists, neurologists, oncologists, and more).

We encourage you to visit the website of any Idaho Medicare Advantage plan you are considering and review their plan’s ‘provider directory’. Compare the figures by type of physician available to that plan’s members vs what is available to people staying with traditional Medicare. 

Given the physician shortage in Idaho, you may want access to all/most all the providers near you. 

Opening access to facilities in Seattle or Salt Lake City may be nice too. 

Why should you do this? 

Because a recent publication (10/27/2025) by the Kaiser Family Foundation, found that Medicare Advantage enrollees, on average, had access to just under half (48%) of the physicians in their area who accept Medicare insurance.  The remaining 52% are typically outside the Medicare Advantage plan’s network. 

Idaho residents with a Medigap plan have access to both the 48% commonly found in Medicare Advantage networks and the remaining 52%.  This includes all physicians/hospitals/other providers in the US too.    

This also means the top hospitals (Mayo Clinics, Cleveland Clinic, Cedars Sinai Medical Center, etc.) in the US (provided they continue to ‘accept Medicare’) are available to people that stay with traditional Medicare with or without a Medigap plan.

That difference is not academic — it directly affects who can treat you, where you can receive care, and how much flexibility you have if your health needs change.

 What the 2027 Federal Subsidy Cut Means

Medicare Advantage plans receive federal subsidies to help cover the cost of members’ care. Historically, these subsidies increased by about 4–6% per year.

For 2027, that growth rate is lower than previous years .     

When funding grows more slowly than the cost of providing health care, insurance companies must adjust to avoid losing money. They can respond by:

• Reducing benefits
• Increasing premiums
• Raising deductibles and copays
• Narrowing provider networks
• Increasing prior authorization requirements
• Reducing plan availability in certain counties

This makes it even more important you understand what your cost sharing for plan covered services, not just what the premium is.

Key Difference

Medicare Advantage cost sharing is set by the insurance company and can change each year. The monthly subsidy they get from the government may not keep up with their cost to provide health care services to their plan members. 

With increased health care utilization in the US the past few years, financial margins have tightened.  This is causing affected companies to find new sources of revenue (raise costs to members, exit certain markets, etc.).

 Why People Choose Medigap 

People which prefer this solution may place emphasis on the points below: 

• Freedom to choose any doctor or hospital that accepts Medicare
• Minimal prior authorizations
• Stable coverage year after year
• Nationwide access
• More predictable costs when you use care.
• There are 12 different plans to consider.  When you use Medicare covered services, Medicare typically pays the ‘lions share’ of those costs for you.  This means you have ‘left over costs’ and they can vary based on the specific service you use.  Each Medigap plan covers a different combination of the left over costs which Medicare does not completely pay for.  

 With the rising cost of Medicare Advantage plans, Medigap Plan G High-Deductible (HD-G) is looking attractive.

Medigap HD-G is tied directly to Original Medicare’s cost structure.  Check out your cost sharing for Medicare Part A and B services here. 

Why do we like the G Hi-deductible Medigap plan?  Because when your annual cost share for the services you use hits the ‘deductible’ below, you are done paying the cost share for the Medicare services you use for the balance of the calendar year.  The 2026 deductible is: $2,950

Remember Medicare care pays for most of your cost of health care (for Part A and B covered services AND if you are enrolled in Part A and B).

There is cost sharing for Idaho residents enrolled in traditional Medicare as well as those enrolled in a Medicare Advantage plan.

If an HD-G plan is chosen to supplement traditional Medicare, your out of pocket cost for Part A and B services (for 2026)  is capped at $2,950.   

This is different from Medicare Advantage, where the plan sets the out-of-pocket cost maximum and can change them annually.  The acronym for this term is MOOP. 

Medicare sets the maximum figure a plan MOOP can have.  The insurance company sets this figure for the plan’s they offer (it cannot exceed the Medicare permitted maximum).  

 Premium Comparison (for Idaho)

Medigap HD-G 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 less cost sharing when you use care.

*Plan F is only available to people who became eligible for Medicare before January 1, 2020.

 Why Some Insurers Are Tightening Benefits

Several Medicare Advantage insurers have reported financial pressure in 2024. Some lost money.  The 2025 financials for some of these companies are available on the Idaho Department of Insurance website (here).  Others publish their quarterly financials and are available via internet search.  

To stay sustainable, many adjusted their 2026 plan designs, including:

• higher premiums in many counties
• higher cost sharing
• adding a health care ‘deductible’
• fewer extra benefits (many not covering/limiting comprehensive dental)
• narrower networks
• more prior authorization requirements

Even when plans still offer $0 monthly premiums, out-of-pocket costs can be higher and the quality/value of “extras” may have declined.

In Idaho, several 2026 plans show higher premiums, increased deductibles, and reduced extras compared to 2025. 

You always need to check the depth of the provider network no matter which plan you are interested in. 

Ask yourself if you are diagnosed with a serious health issue, where would you want to be treated.  A top hospital with physicians specializing in that issue, or a different resource which may treat the same issue less than 20 times a year?   

This is why it’s important to look beyond the monthly premium when choosing a plan. 

Learn about each Idaho County’s Medicare plans and their differences here. 

We are here to help you think through your choices of Idaho Medicare Advantage plans.

Thank you for reading the article. 

Contact us.  We will answer your questions, help you think through your plan choices and enroll in the plan you choose.  

*Statistics on Medicare Advantage plans available in Idaho and other facts stated above came from this resource and this resource.