Idaho Medicaid, Low-Income Subsidy and Special Needs Plans
CMS Required Statement for Idaho Brokers.
We offer every Medicare Advantage plan available in all Idaho Counties (where these plans are available), with one exception. Institutional special needs plans (I-SNP) are not available to brokers. If you qualify for such a plan, we suggest you contact the Idaho SHIBA office for help. They are available on 1-800-247-4422.
A note about Idaho Medicaid and Medicare.
We encourage you to learn the details of Idaho Medicaid before you get to far down the path of plan selection.
Why?
Because you have choices to make. If you understand these differences, you will be in a much better position to work with the people that can aide you in plan selection.
The words in ‘blue’ (below) point to articles which further explain what these words mean and how these plans work.
Please click on these and when finished reading that article, click on your ‘browsers back icon’ as it will return you to this page.
Blue Cross of Idaho is leaving The Idaho ‘Enhanced’ Medicaid marketplace on 6/1/2025.
Effective June 1, 2025, Blue Cross of Idaho (BCI) will no longer provide services for residents enrolled in their IMPlus and MMCP.
Why did the Idaho Department of Health and Welfare (IDHW) make this change? IDHW offers contracts to interested insurance companies which will offer plans and services to Idaho residents which qualify for these plans. Their contracts were recently put up for bid and Molina and United Health Care were selected as the 2 insurance companies going forward.
If this change affects you, you will receive a letter from both IDHW and Blue Cross of Idaho. You should receive this in early March. It will describe your options.
If you would like help thinking thru your choices, call us. We have helped other Idaho residents with their Medicaid health insurance plan choices for several years.
If you are enrolled in similar plans offered by Molina HealthCare of Idaho, you are not affected by this change.
Were you planning on enrolling in either of these plans between now and May 31, 2025? Call us if you would like to talk about your other options.
Questions answered here.
Idaho Department of Health and Welfare prepared this information for you.
If you want help understanding your options and prefer to work with an Idaho based broker experienced with your choices, call us on 208-867-0296. You can complete the ‘contact us’ form too and we will call you.
Plans for people with Diabetes or heart issues!
If you have been medically 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) one of these special Medicare Advantage plans is designed for you.
You do not need to be enrolled in Idaho Medicaid to enroll in one of these plans.
However, if you qualify/are enrolled in an IMPlus plan OR a Idaho Medicare Savings program (Medicaid status of QMB, SLMB, QI, QDWI) and your physician can confirm your diagnosis, you should consider these plans.
Why do this?
They have qualified physicians practicing throughout Idaho that specialize treating these health issues.
These plans cover Medicare Part A, B, and D services and may have other extra coverage you may find attractive when compared to what you presently have.
I am enrolled in an MMCP and am interested in these C-SNPs. What should I do?
You will need to switch to an IMPLUS plan. Make sure you understand these C-SNP plans and how your MMCP differs from an IMPLUS plan. You should find the information found here helpful. We can answer your questions on this content.
Remember, when you have an IMPLUS plan, you can get your Medicare covered services from a C-SNP, a Medicare Advantage prescription drug plan (MAPD), or through Original Medicare (Part A and B). We can explain these differences too!
You can switch to an IMPLUS plan if one is available in your county of residence. Idaho Department of Health and Welfare will help you with this.
Where do I have to live to be eligible for one of these C-SNP?
These plans are available in forty-one of Idaho’s forty-four Counties. Butte, Clark, and Power counties are the three Idaho counties where C-SNP are not available.
If you have Medicare AND Enhanced Idaho Medicaid.
If you live in one of the Idaho counties where MMCP plans are available, we suggest you familiarize this type of plan. We can help you with this.
Why choose this plan? This type of plan integrates both Medicare and Medicaid coverage into one single plan. There is no/little cost to you.
Private insurance companies offer MMCP’s. Their plans compete to earn your business. The companies can refresh their plan details annually with the goal of making their plan more attractive than their competitors.
Having this combined plan means you will have:
- The combined benefits of both Medicaid and Medicare in one plan. Having one accountable company to coordinate delivery of services and a single care management team to coordinate care makes it easier for the plan member AND the provider(s) offering their services.
- MMCPs cover the same Medicaid and Medicare services. They may have additional supplemental benefits over and above original Medicare and Medicaid. Their network of providers (doctors/hospitals/etc.) and covered medications may be different. The companies offering these plans compete to get your business. Their ‘extra benefits’ and covered medications may be a deciding factor when you choose one company’s plans over the other. These ‘extra benefits’ can change annually. We help you understand these plan differences.
- Medicaid pays your Medicare Part B premium.
- You will have access to the health plans network of providers.
I am already enrolled in an IMPlus plan. How do I switch to an MMCP?
If an MMCP is available in your county of residence, we can help you. We are licensed with the companies offering MMCP.
We can do this by applying to the vendor of the MMCP if one is available in your county of residence. Your plan will begin on the 1st day of the following month. This process will disenroll you from your IMPLUS plan. Note if you want to do this in the fourth quarter, your MMCP plan will begin on January 1 of the following year.
If a MMCP is not available in your county of residence but other Medicare Advantage plans are, we will help you think through your options.
Do I have other choices to consider?
Yes.
You can remain with ‘Original Medicare’ (Part A and B) OR select a different Medicare Advantage plan (if they are available in your county of residence). We are licensed with all of your options and can help you think through your choices. We are here to help.
Idaho Medicare Savings Programs.
If you have read material published by CMS (The Centers for Medicare and Medicaid Services), they break Idaho’s ‘Basic Medicaid’ category down in more finite classifications. There are reviewed here.
If you do not qualify for Enhanced Medicaid in Idaho, you may be eligible for a Medicare Savings Program. Learn the eligibility rules for these different programs here.
If your Medicaid status is SLMB, QI or QDEI you have the same Medicare Advantage the rest of Idaho residents also consider. Specific plans are available based on your county of residence. If your status is QMB, you have different plan(s) to consider.
If you fit in one of these Medicaid categories, we can help you find the right plan
Idaho residents with QMB Medicaid Status.
If you have this classification and do not have certain health issues mentioned above, you have Medicare Advantage plan(s) available based on your QMB classification. These plans are available in specific Idaho counties. You can also skip enrolling in a Medicare Advantage plan and just stay with Original Medicare.
Why would you consider a Medicare Advantage plan that targets people with a QMB status?
Because they focus on your specific Medicaid status. They pay for your Part B monthly premium, your leftover costs for Part A and B services, coordinate paying both Medicaid and Medicare providers for the services you use. These plan(s) may have other attractive ‘extras’ included in their plan. Part D coverage is included in this plan.
These plans may have lower out of pocket costs and attractive ‘extra benefits’ that other Medicare Advantage plans available to you do not provide.
CMS authored a document about this plan. This is available by clicking here.
We are licensed with these plans and can help you think through plan selection and enrollment.
Institutional Special Needs Plans (I-SNP)
Institutional special needs plans (ISNPs) are for people that live in a care facility or get nursing care at home. If you fit this description and you have had or expect to need this kind of care for 90 or more days from one of the facility types below an ISNP may be right for you. These include:
- A long-term care nursing facility.
- A regular or long-term skilled nursing resource.
- An impatient psychiatric or an intermediate care facility for people with intellectual disabilities.
We suggest you call the Idaho SHIBA office (1-800-247-4422) to learn what company(s) offer these plans.
Low-Income Subsidy (Extra Help) helps pay for prescription medications.
These Federal programs are designed to help pay part of your Medicare covered prescription drug costs and contribute to your drug plan’s monthly premium.
Who is eligible? People already on Medicaid and others with income and assets below specific limits. CMS publishes these limits annually. This information can be found here.
People can be automatically enrolled in ‘Extra Help’ if certain conditions apply. Learn more here.
There are multiple levels of ‘Extra Help’. What level you qualify for determines how much financial help you get for paying for your fills (and refills). This can include assistance paying for the plan’s monthly premium too.
If you qualify for this program and have a Medicare Advantage plan (MAPD), your monthly premium could be less. The same applies if you do not have a Medicare Advantage plan and have a prescription drug plan (PDP). Be aware you can apply for (or be automatically enrolled in) extra help any time during the year.
If you qualify, we can help you find the lowest cost MAPD or stand-alone PDP plan that matches your needs and budget. Call us after you have been awarded Extra Help status.
In closing…
If you made it this far, congratulations.
We help Idaho residents enrolled in Medicare and ‘Medicaid’.
Call us at your convenience.
This page was updated