Idaho Medicare Advantage Plans

County-by-County review of Idaho Medicare Advantage plans*

Each Idaho County has their own specific list of Medicare Advantage plans available to residents.

Why? Because individual insurance companies decide which Counties they will offer which plans.

Some Idaho Counties have five plans available while others have over twenty.

Changes in 2026 Idaho Medicare Advantage plan Market.

Blue Cross of Idaho is repositioning their Medicare Advantage plan portfolio. This means their 2025 MAPD (Medicare Advantage plans with Prescription Drug coverage) are terminating 12/31/2025.

They are introducing new plans in select Idaho Counties. If you have one of their 2025 plans and want help switching to a new plan for 2026, call us.

Regence Blue Shield of Idaho is exiting the Idaho Medicare Advantage market on 12/31/2025. If you have one of their 2025 plans and want help switching to a new plan for 2026, call us.

Select Health will no longer be offering their plans in Bonneville and Franklin Counties. If you have one of their 2025 plans and want help switching to a new plan for 2026, call us.

Pacific Source has adjusted their 2026 plan offerings. If your 2025 plan will be terminated, call us. We will help you find a new plan.

United Healthcare and Humana have made changes to their 2026 plans. If their changes are disagreeable with you and want help switching to a different plan, call us.

Looking Forward.

We are concerned about what we are seeing with Idaho Medicare Advantage market. For 2026, Idaho will have two local/regional insurance companies offering Medicare Advantage plans (Pacific Source and Blue Cross of Idaho). The other three are national firms and have had their own issues (which have been actively reviewed in national media).

If you have a ‘guaranteed issue’ to join a Medigap plan and the budget, we encourage you consider this option.

If you want help reviewing your 2026 Medicare options, remember we remain licensed with all plans available to you (except the I-SNP which has its own unique membership qualifications).

We are here to help.

Please read ALL correspondence from your current insurer during the 10/1/2025 to 12/31/2025 period.

This means the ‘Annual Notice of Change’ (ANOC) you received from the insurance company offering your 2025 Medicare Advantage plan. IF your plan is not offered in 2026, you will receive a ‘notice of termination’. This means you should change to a different Medicare Advantage plan, switch to a Medicare Supplement plan, or return to Original Medicare (Part A and B coverage).

When reading the ANOC, look for changes in your out of pocket costs. This includes but is not limited to the following.

The plan’s premium.

Do you now have a ‘deductible’ to meet before your plan will pay for covered health care services?

If you live in eastern Idaho check to see if your 2026 requires you to see a PA before you can see a licensed physician?

Does your plan require permission from your primary care physician to see a specialist?

When you use ‘outpatiend’ or ‘ambulatory’ hospital surgical services, are you paying line item costs in lieu of a fixed copay that covers everything?

Is your daily rate for a hospital stay over $500? Check out of network hospital costs for a PPO plan too.

How much did your MOOP go up (for both in-network and out of network services)?

Are your prescription medications covered for 2026?

Are your refill costs for tier 2 through 5 medications going up?

Did your quarterly OTC benefit drop?

Are your physician(s) in the plans network for next year?

Did the value of your vision coverage drop?

Will you have to pay a separate premium for comprehensive dental care?

Does the description of your 2026 dental care take more than three paragraphs to describe?

There are More Chronic Special Needs plans (C-SNP) in 2026.

These are not ‘Medicaid’ plans.

They focus on care for people with Diabetes mellitus; Chronic heart failure; Cardiovascular disorder (cardiac arrhythmias, coronary artery disease, peripheral vascular disease, chronic venous thromboembolic disorder).

When to Consider a C-SNP.

Diagnosis of a Relevant Chronic Condition

When a beneficiary is newly diagnosed with a qualifying chronic condition (e.g., type 2 diabetes, heart issues), especially if it is expected to require ongoing management.
Early enrollment can provide access to specialized care management and resources from the start.

Increasing Complexity or Poor Control of your health issue.

If the disease is not well controlled despite standard treatment (e.g., HbA1c levels remain high for diabetes).
If complications begin to arise, such as neuropathy, retinopathy, or cardiovascular risks in diabetes.

Frequent Healthcare Utilization.

When the beneficiary is experiencing frequent hospitalizations, emergency room visits, or specialist consultations related to their chronic illness.
C‑SNPs offer enhanced care coordination and case management to reduce these events.

Need assistance Coordinating Care Among Multiple Providers.

When multiple specialists and providers are involved, making care coordination challenging.
C‑SNPs are structured to provide integrated care and reduce fragmentation.

Patient’s Desire for Additional Support Services.

When the beneficiary wants extra help with medication management, education, and social supports.
C‑SNPs often provide additional benefits like health coaching, nutrition counseling, and transportation assistance.

Enroll in a plan during Medicare Annual Enrollment or Special Enrollment Period.

Enrollment can only occur during Medicare’s annual election period (Oct 15–Dec 7), or special enrollment periods triggered by qualifying events.
Timing enrollment during these windows ensures access when needed.

Summary.

Beneficiaries with newly diagnosed or established chronic conditions who have increasing complexity, poor control, frequent healthcare utilization, or need for care coordination should consider a C‑SNP.
Enrollment is ideally timed during Medicare’s open enrollment or qualifying special periods.
Early involvement in a C‑SNP may help improve outcomes by providing more tailored, coordinated care.

If C-SNP catches your attention, be sure your health condition qualifies you for enrollment. The physician treating you for the health issue will need to complete some documentation confirming the heath issue.

Is it time for you to reconsider a Medicare Supplement (Medigap) plan?

Medigap Plans open up your choice of hospitals/physicians/other providers to all that accept Medicare insurance in the US. Prior authorizations and referrals are minimal.

Once you are in a Medigap plan, you do not have to fuss with changing plans annually. Your coverage remains the same and the network remains the same (the pool of providers that accept Medicare insurance in the US).

Would you like to be treated at the Mayo Clinic(s)? They are open to you with this type of plan..

IF your 2025 plan was cancelled for 2026, you have a ‘guaranteed issue’ right to enroll in a Medigap plan. This means if you submit an application to join the plan, the insurance company is required to accept the application and issue the policy. This process is explained in your ‘termination letter’.

If you do not have a ‘guaranteed issue’, you will have to answer health history questions on the application. Based on these answers, your application can be accepted or denied.

This is why having a ‘guaranteed issue’ is important if you prefer a Medigap plan. You have this right if your 2025 plan has been terminated.

Consider Medigap Plan G Hi-deductible.

This plan has a lower monthly premium (currently less than $75) than the more popular Plan N and G. The premium typically goes up each year.

It also has has an annual deductible. This figure is controlled by Medicare and goes up a bit annually.

This is how the plan works. Once your annual cost sharing (for Part A and B services) hits this deductible, this plan pays the rest of your Medicare covered Part A and B expenses.

The 2025 deductible is $2,870. This figure is typically much less than most Idaho Medicare Advantage plan’s MOOP.

Think about this.

This also means you do not have an insurance company limiting your choice of providers. Your network includes all providers that ‘accept Medicare in the US’. You just make the appointment with the provider you wish to use.

Your physician must still follow the Medicare rules about the services provided. For example, Medicare does not cover ‘cosmetic’ surgery.

Other Medigap plans pay more of your leftover cost sharing (Plan G or Plan N).

Plan G is known as the ‘Cadillac’ for health care insurance in the USA. People eligible for Medicare prior to January 1, 2020 are eligible to enroll in Plan F.

Plan G pays all left over cost sharing except the annual Part B deductible ($257 in 2025). Plan F has a higher premium than Plan G, but pays for the Part B deductible.

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.

A note about TV ads for Medicare Advantage plans.

We encourage Idaho residents to pause for a bit when you see and hear messaging about Medicare plan commercials on TV or in the mail you receive.

Be aware some national based insurance and as well as local/regional companies may be moving away from independent brokers. Some are eliminating commissions on new enrollments in some/all their plans.

Responding to a TV commercial or mailing means you will be missing out on the ‘compare/contrast’ service you get from a broker which is licensed with all plans available to you.

If you choose the TV path for plan enrollment, I encourage you to read chapter 4 of the plan’s ‘Evidence of Coverage’ before enrolling. This document is often referred to in the plan’s ‘Summary of Benefits’ as a place to find additional information about specific covered services.

If you choose to respond to the ad with a phone call, be sure and ask:

Are you a real person or an AI bot?

Does your company use AI bots for customer service? If they answer no, ask if their customer service rep’s are based in the US or are they offshore

Ask them to confirm coverage of your prescription medications and is the pharmacy you presently use is a preferred pharmacy in their network. Be sure and ask for your monthly and annual out of pocket cost for your refills. Request a copy of any report they ran and are quoting.

Also ask them if your physicians and hospitals are in their plan’s network.

If you are concerned about a more serious health issue (cancer, heart, COPD, kidney issues, etc.) ask them how many physicians are in the plan’s network that specializes in your issue and if they are accepting new patients.

Request a copy of the plan’s ‘Evidence of Coverage’. Be sure and review this before enrolling in any plan. Your goal is to avoid making an impulse decision and you are completing your education before choosing a plan. Do your homework.

A note about HMO plans.

This type of Medicare Advantage plan has a defined network of doctors/hospitals/other providers. If plan members want their insurance company to pay for their non-emergent health care services, they need to use the providers in the plan’s network. There are some exceptions to this and are found in the plan’s Evidence of Coverage (EOC) document.

These plans typically have ‘prior authorizations’ on covered health care services. This means your physician must get approval from the insurance company before they can proceed implementing their health services for you. The insurance company can deny prior authorizations.

Providers in a plan’s network are listed in the plan’s ‘provider directory’. Changes can be made real time throughout the year. This resource is found on the insurance company’s website.

HMO-POS is a variation of the basic HMO plan.

POS stands for ‘point of service’. This means the plan may permit plan members to use ‘out of network’ providers.

A plan which offers out of network dental services may be an HMO-POS plan.

If a plan has this designation to expand their network of dental providers, it does not mean you can use out of network doctors/hospitals/etc. Be sure and reference the plan’s provider directory AND the EOC for details.

What else do you need to know about HMO plans.

Each HMO plan may have a different combination of hospitals/physicians/other providers in their network. These are listed in a plan’s ‘provider directory’. This is available on the insurance company’s web site.

HMO plans may have lower out of pocket costs for plan members when compared to PPO plans.

We see some plans with unique non-Medicare covered extra services.

Both policy holders and insurance companies can change plans annually.

When policy holders read their ‘annual notice of change’, they will be made aware of how next year’s version of their current plan will change. This important document shows up in early October.

If the policy holder is ok with the changes for next year, they will be automatically re-enrolled in their same plan. If they wish to change to a different plan, it must be done by December 7th.

‘Special enrollment periods’ (SEP) are available for people meeting the conditions of the SEP. They are discussed here. We encourage you to be familiar with these situations and take advantage of them if you qualify.

The HMO market is quite competitive and changes annually.

The Idaho HMO market can be categorized into 3 different sub-markets.

Each can be defined by the population of Medicare enrollees in a specific County AND availability of medical resources to support plan members.

Counties in tiers 1 and 2 typically have more plans to consider and their plans may be richer in benefits.

Why we need to pay attention to what happens in our County.

Insurance companies can move new plans into certain counties and remove plans from other counties and do this annually. They can also change the details of next year’s version of current plans.

What can change? Some years little/nothing to just about everything.

Changes can affect your pocketbook, your choices of providers, covered medications, plan services, and just about everything else.

Occasionally we see a new plan which takes advantage a disruption in the market. We believe 2025 is such a year and is evident in certain Counties.

The insurance companies challenge themselves to design plans which meet the market need, are competitive, cover their expenses, and make a profit.

Is an HMO plan a good fit for you?

If a person is fine getting their health care from the hospitals and physicians in the plan’s network, HMO plans can be a good fit.

If you are diagnosed with a serious health issue, would you prefer to be treated at one of the top hospitals that specialize in your health issue? If your answer is ‘yes’, a PPO plan or a medigap plan may be a better choice.

Details of PPO plans you should be aware of.

This type of plan has a network of providers available to plan members.

Members may also be able to use other providers which are not in the plan’s network.

Providers that do not ‘accept Medicare’ will not be in any plan’s network. If you choose to use their services, they will expect you to pay for services provided. This means your plan will not pay for services received.

Some providers do not accept appointments from people insured by a Medicare Advantage plan. These same providers may accept people insured with Medicare Part A and B but not enrolled in a Medicare Advantage plan.

Read chapter 4 of your plan’s ‘Evidence of Coverage’ (EOC) to learn what your ‘out-of-network’ cost share (and other rules that may be in place).

This PDF document can be downloaded from any insurance company’s website. It can be found in the section where ‘plan details’ are reviewed.

The language we often see in this document reads:

As a member of our plan, you can choose to receive care from out-of-network providers. However,
please note providers that do not contract with us are under no obligation to treat you, except in
emergency situations.

What else should I know about PPO plans?

PPO plans have an additional feature which cap’s your share of the left-over costs you when you use ‘out-of-network’ providers. This ‘cap’ is different from the ‘cap’ when you use ‘in-network-providers’.

This cap is also called the plans maximum out of pocket limit (MOOP).

Medicare defines both MOOP figures annually. They typically go up.

For 2025, the Medicare MOOP for in-network-providers is $9,350; the ‘out-of-network’ figure is $14,000. Insurance companies can set each of their plan’s MOOP to the Medicare maximum figure or something lower. This is a figure people should be looking at when selecting a plan.

When you use ‘out of network’ providers, your Maximum out of pocket limit (MOOP) will switch to the ‘out of network MOOP’ for your plan. This figure can be noticeably higher than the ‘in-network’ MOOP.

We favor plans with a low monthly premium, low MOOP, low out of pocket costs when plan services are used, a good network of hospitals/doctors, and ‘extras’.

Brokers licensed with all plans help you find these plan(s).

Are Medicare Advantage plans losing favor with Hospitals/physicians?

Take a moment and read the announcement from Mayo Clinic here. A similar announcement was made in September of 2023. Read the 2024 article on this same subject here. There is another dozen which terminated some/all insurance carriers offering Medicare Advantage plans at this writing in 2025.

Will I have fewer restrictions on which doctors/hospitals I can use if I stay with Original Medicare (do not enroll in a Medicare Advantage plan)?

Yes.

Click your county name from the list below. You will have a good introduction to your other choices.

Where do I go from here?

If you would like to learn more about your Medicare health care plan options, we can help you.

All brokers are required to follow Medicare’s rules before doing so. This means we must have a signature on the Medicare document called a ‘Scope of Appointment’. This is available here.

Please print, sign and send us the document. This can be sent via email attachment, texted with the signed document attached or faxed. Call us if you have questions.

We look forward to helping you.

Schedule for updating individual County web pages for 2026.

We anticipate completing updating web page content for tier 1 and 2 Idaho markets by late October 2025, Their 3 and 4 markets by the end of November. We categorize tiers by the number of Medicare beneficiaries living in each Idaho county.

Why does this take so long? Because we have not received all plan documentation yet…and this simply takes time to analyze plan details so accurate content can be developed.

Southwestern Idaho Medicare Advantage Plans

Ada County plans are reviewed here.

Adams County Plans are reviewed here.

Boise County plans are reviewed here.

Canyon County plans are reviewed here.

Elmore County plans are reviewed here.

Gem County plans are reviewed here.

Owyhee County plans are reviewed here.

Payette County plans are reviewed here.

Washington County plans are reviewed here.

Valley County plans are reviewed here.

Medicare Advantage Plans in Northern Idaho Counties

Benewah County plans are reviewed here.

Bonner County plans are reviewed here.

Boundary County plans are reviewed here.

Clearwater County plans are reviewed here.

Idaho County plans are reviewed here.

Kootenai County plans are reviewed here.

Latah County plans are reviewed here.

Lemhi County plans are reviewed here.

Lewis County plans are reviewed here.

Nez Perce County – plans are reviewed here.

Shoshone County – plans are reviewed here.

Medicare Advantage Plans in Central Idaho Counties

Blaine County plans are reviewed here.

Butte County plans are reviewed here.

Camas County plans are reviewed here.

Custer County plans are reviewed here.

Medicare Advantage Plans in South Central Idaho Counties

Cassia County plans are reviewed here.

Gooding County plans reviewed here.

Jerome County plans are reviewed here.

Lincoln County plans are reviewed here.

Minidoka County plans are reviewed here.

Twin Falls County plans are reviewed here.

Medicare Advantage Plans in Eastern Idaho Counties

Bannock County plans are reviewed here.

Bear Lake County plans are reviewed here.

Bingham County plans are reviewed here.

Bonneville County plans are reviewed here.

Caribou County are reviewed here.

Clark County plans are reviewed here.

Franklin County plans are reviewed here.

Fremont County plans are reviewed here.

Jefferson County plans are reviewed here.

Madison County plans are reviewed here.

Oneida County are available here.

Power County plans are reviewed here.

Teton County plans are available here.

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

Thank you for reading the article.

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