Idaho Medicare Supplement Plans
Idaho Medicare Supplement plans and Idaho Medigap plans mean the same thing. These terms are interchangeable.
When you have an Idaho Medicare Supplement plan, you have the flexibility of using any doctor(s)/hospital(s) in the US that accept Medicare insurance. These include the Mayo Clinics, MD Anderson, Houston Methodist Hospital, Evergreen Health Medical Center, etc.
This also means the local, regional, and the top hospitals and physicians in the US are available to you. You just make the appointment.
In addition to this, your Idaho Medigap plan goes with you when you travel throughout the United States. If you move, your same plan stays with you.
Are referrals necessary? Yes (with some physicians, like neurosurgeons, neurologists, etc.).
They want to be sure they can help you before they accept an appointment. Your primary care physician may have to request tests be done and forwarded to them before your appointment will be accepted. Many other physicians will accept your appointment.
Tools are available to help you find hospitals that excel at different types of surgery and other health issues. Many of them accept Medicare insurance.
Prior authorizations are minimal.
This means you do not have an insurance company standing between you and your physician to approve the services you need.
How does this help you?
Eliminating ‘prior authorizations’ means your physician moves forward with scheduling/performing the necessary medical work to address your health issue.
If you are not familiar with ‘prior authorizations’ and how they have been an issue for health care in the US, read this article.
When you have a Medicare Supplement plan there are few prior authorizations in place.
Read where they are used here.
Idaho is different than most states in the US with respect to the rules in place for both Medicare Supplement policy holders and the insurance companies offering these plans. This is important; so be sure you understand this.
Effective March 1, 2022, Idaho rules affecting both insurance companies and Idaho Medigap policy holders changed. On this date and going forward, ‘issue age’ and ‘birthday window’ rules were put into place. Please read the information found here as it further describes the rules/regulations that are in place.
The highlights of this change include:
- Residents with an Idaho Medicare Supplement plan do not have to answer health history questions (go through underwriting) if they change companies during their ‘birthday window‘. People usually do this to lower their monthly premium. If you change companies outside of this ‘window’, you will have to answer the underwriting questions. Based on your answers, the insurance company can either accept or deny your application.
- A person’s ‘birthday window’ begins on their birth date (month/day) and ends 63-days later.
- A policy holder can make a ‘lateral move’ (get the same plan from a different company), move to a less comprehensive plan, or move up to a more comprehensive plan. If the policy holder wishes to move to a more comprehensive plan (Plan G to a Plan F, a Plan N to a Plan G, etc.) they will have to answer the health history questions on the new company’s application.
Call if you have questions.
There are twelve different Idaho Medigap plans.
Each plan covers a different combination of your share of the cost for Part A and B covered services. This reference provides a good visual of what each of the 12 Idaho Medicare Supplement plans cover. This reference shows you your share of the cost when you use Medicare Part A and B services.
Having a variety of plan options means you can find the plan that meets your needs and retirement budget. Call us if you want help interpreting this chart.
Two of these plans have a ‘deductible’ in place.
These plans (G Hi-deductible and F Hi-deductible) are often overlooked. In our opinion, they offer good value.
The concept of this ‘deductible’ is similar to the Maximum out of pocket limit (MOOP) found with Medicare Advantage plans.
Be aware HMO Medicare Advantage plans maximum MOOP for 2025 is $9,350. For Medicare Advantage PPO plans, the in-network MOOP cannot exceed $9,350, but the combined in-network and out-of-network MOOP can be as high as $14,000. The insurance companies offering this plan type set the MOOP for the plans they offer; they cannot exceed the figures just mentioned. Medicare can adjust these figures annually.
With this type of Idaho Medicare Supplement plan, the plan member pays 100% of the leftover Medicare Part A and B costs for the services you use until your out of pocket cost hits the deductible. This deductible is $2,870 for 2025 and it goes up a bit annually. CMS controls the size of the annual change.
Think about this. Your out of pocket costs for Medicare covered health care services are limited to your plan’s annual premium + the part of your plan’s annual deductible you met. If you did not use any Medicare covered services for the year, your cost is limited to your monthly premium * 12. If you were a high consumer of health care services and hit your annual deductible, your costs are your plans annual premium + the plan’s annual deductible.
These plans typically have a lower premium than the other ten Medicare Supplement plans.
Five plans offer more comprehensive coverage (C, D, F, G, and N).
Plan C and F are restricted to people enrolled (or eligible) for Medicare prior to January 1, 2020. We prefer Plan F over C. Their monthly premiums are similar.
Plan D is offered by a few of the 25+ companies offering Medigap plans to Idaho residents. Coverage is similar to Plan G.
Plan N often has a lower premium than Plan G, but policy holders have fewer covered services compared to Plan G. This may be a financial burden as the Plan N policy holder ages (and start to use more health care services).
Remember, if you choose a Medigap plan with less comprehensive coverage and later in life, want to move up to a plan with more comprehensive coverage, you will have to answer the underwriting questions. This means the insurance company can deny your application (based on your answers and prescription medication take).
We do not recommend Idaho residents consider Idaho Medicare Supplement plans K, L, and M.
Why? Because of low national enrollment in these plans. If you add the number of active policies for all three plans together, they are less than 2% of all active Medicare Supplement plans in the US. These figures came from the 2023 Medicare Supplement Loss Ratio report found here.
We are cautious about the remaining 2 Idaho Medicare Supplement plans (A and B).
Why? Skilled nursing care isn’t covered by either plan. Should a person need this service, the out-of-pocket cost can be a financial burden. People may be better off with a hi-deductible Plan G or a Plan G or N.
You have a good choice of national, regional, and Idaho based companies offering these plans.
With Idaho having the ‘birthday rule’ in place, we place less emphasis on the name of the company and their ‘national rating’.
Companies with the lower plan premium, an AM Best rating of A- (or better), and have been in the health insurance business at least 4-years get our attention. These companies are typically on our ‘recommend’ list.
A few insurance companies include a gym membership with their plan. The depth and variety of their network can differ noticeably. Usage rules can vary too.
Household discounts are offered by a few companies too.
Some plans either include discounts on dental, vision and other services, or offer these plans separately and come with their own premium.
If these sound attractive, we recommend you look at the plan rules, quality and depth of provider network for these ‘extra’ services.
Be aware many insurance companies offer dental plans. They are easy to find using ‘search’ facilities on the internet.
Unless you are a frequent user of dental services, we have found just paying cash for the services as you use them may be a more economical solution.
Keep in mind when a company includes ‘services not covered by Medicare; the actual cost of these included services is factored into the calculation of the plan’s premium. Also, the insurance company offering ‘extras’ can drop these services (or change the details of these extra features) at their discretion.
Idaho Medicare Supplement plan reference materials you should read.
There are two key resources you should read.
The first is the ‘Choosing a Medicare Supplement Policy’ document published by the Centers for Medicare and Medicaid Services (CMS).
We prefer this document as it is well written, has a concise table of contents, and is easy to understand. We suggest you use this as your primary reference on this subject. Another source of this same information can be found here.
Additional information about current demographics of Medigap enrollment/customer satisfaction is available here. This offers a thorough analysis of the Medigap market. Enrollment by plan for Idaho is also included in this report.
What else you need to know.
If you have a Medicare Supplement plan and are moving to Idaho.
- Call us to switch your Part D (prescription drug plan) to one that is available to Idaho residents.
- Get a quote on your Idaho Medicare Supplement plan. Idaho premiums may be lower than your current premium. Remember a Medicare Supplement plan has the same coverage no matter which insurance company you buy it from.
We can help you with both items above.
Idaho Medicare Supplement plan enrollment rules.
Medicare Supplement plans have different enrollment rules (when compared to Medicare Advantage and Prescription drug plans). If you have an interest in a Medicare Supplement policy, please be sure you understand these rules. We can help you with this.
These rules are documented on pages 14-15 of the ‘Choosing a Medicare Supplement policy’ available here. Guaranteed issues are reviewed on pages 21-24. This is equally important information to know.
How the ‘birthday window’ helps Idaho Medicare Supplement plan members.
Idaho Medicare Supplement policy holders can change plans/insurance companies annually during a time which begins with the persons birthday and lasts for 63 more days. Underwriting is skipped if the change is made during this period. Additional must read information is available here.
We feel this was an important law change that helps Idaho Medicare Supplement policy holders.
Why? Because, after a few years, the compounding effect of annual premium increases can make the initial monthly premium noticeably higher. By having the opportunity to change companies/plans you may be able to lower your premium by moving to a different company.
When new companies enter the Idaho Medicare Supplement marketplace, it is not unusual they offer lower premiums when compared to companies already in the state.
How much do Idaho Medicare Supplement plans cost?
Current premiums and new regulations the Idaho Legislature added to Federal rules for Medicare Supplement insurers is available here.
Notice the monthly premium difference between the insurance companies offering these plans varies by up to 250%+. I have guidelines on initial company selection and when to switch companies.
I would not recommend plans/companies I would not enroll in myself.
The Idaho Department of Insurance regulates insurance companies offering Medicare Supplement plans to Idaho residents. This responsibility includes reviewing the annual reports each insurance company is required to file and approve/disapproving annual premium increases.
Which plan(s) should you consider?
The plan you prefer to have if you are diagnosed the health issue(s) you are most concerned about.
The choices you have on where you get treatment is another positive when you have a Medigap plan. We prefer considering the top 250 hospitals in the US as a starting point; then look at those that excel at treating your health issue.
Also, remember you skip underwriting (answering the health history questions on the insurance company’s application) if you apply for a plan within 6-months after your Medicare Part B effective date.
This date is on your Medicare card.
If you apply afterwards, you will have to answer the health history questions on any insurance company’s application.
Be aware if you enroll in Part B when you are initially eligible, then drop it and re-enroll later in life, the initial ‘effective date’ is your date of record.
You can also skip underwriting if you have a ‘guaranteed issue’ (referenced above).
What is the difference between Medicare Agents and Medicare brokers?
The discussion found here and will help you understand this. Let me answer your questions on this document.
A few of the insurance companies offering Idaho Medicare Supplement plans only use ‘captive agents’. This means each company has their own agents which only represent their plans.
Check out our license with the State of Idaho.
We are licensed to sell Medicare products in the State of Idaho.
We only help Idaho residents with their Medicare insurance choices (Medicare Supplement, Medicare Advantage, and Medicare prescription drug plans).
The above link points you regarding our license with the State of Idaho. Be sure and scroll down to the bottom of the page and click on the word ‘search’. Let me answer your questions on this content.
We remain licensed with all Medicare Advantage plans available in all 44 Idaho Counties except the I-SNP plan. This plan is reserved for people living in an institution and enrolled/eligible for this specific type of Medicaid special needs plan. This company uses ‘captive agents’ to represent their plans.
Also, we choose which insurance companies we license with for Medicare Supplement plans.
Why do we do this?
Some of the insurance companies have premiums noticeably higher than others. We feel people looking for a Medicare Supplement plan will avoid these companies because they can get the same coverage from a different company at a more reasonable cost.
Some insurance companies offering Idaho residents Medicare Supplement and prescription drug plans use captive agents only. This means they do not use brokers.
Some drug plans have a ‘Medicare star rating’ below ‘3’. We choose not to represent plans with a star rating below 3.
Closing Comments
Are Medicare Supplement plans right for everyone? No. Medicare Advantage plans aren’t either. People are unique in their needs, retirement budget, and preferences on where they get their health care.
If you plan to work with a broker and are considering an Idaho Medicare Supplement or a Medicare Advantage plan, contact us. We have been helping Idaho residents with their choices since 2012.
Read the information found here to learn which Medicare Advantage and prescription plans we are licensed with.
We are here to help. Call us when you are ready.
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