Nez Perce County Medicare Plans (2026 & 2027 Guide)
Nez Perce County residents comparing Medicare plans for 2026 have 10 Medicare Advantage (including MA, MAPD, CNSP, and DSNP) plans and twelve standardized Medicare Supplement (Medigap) plans to consider.
We are an independent Idaho based Medicare brokerage service helping Nez Perce County residents and the other forty-three Idaho counties since 2012. We are here to help you understand your options, compare plans, and enroll you in the coverage that fits your healthcare needs and budget.
There is no cost for our services. Call (208) 867-0296, 8am–8pm Monday through Saturday.
How we work with Nez Perce County Medicare beneficiaries
If you are in Boise, we can meet with you face to face at our office.
If you prefer, we can do everything over the phone using internet resources, email/text messaging/USPS and/or fax communications. This approach has worked well since we started working with Nez Perce County Medicare beneficiaries over 10-years ago. If you are comfortable with this approach, we look forward to working with you.
A reminder About the Annual Enrollment Period (AEP)…October 1 through December 7th.
If you are presently enrolled in a Medicare Advantage plan, please read this reminder about important steps you should complete before December 7th.
If you have Original Medicare (Part A and B) with a Medigap and/or a Prescription Drug Plan (Part D), please read this reminder about activities you should complete before December 7th.
Call us if you have questions. (208)-867-0296.
Medicare in Nez Perce County: what is changing for 2027
The end of 2026 about 1,500 Medicare Advantage members in Nez Perce County and about 900 Part D member plans will terminate.
‘Non-renewal’ letters should be in the mail by 10/2/2026. Check your mailbox for this letter.
See what to do if your plan is ending
2027 plan options at a glance
Nez Perce County will have 1 Medicare Advantage plan with drug coverage (down from 3 in 2026) and one without drug coverage (the same as in 2026).
In addition, 5 Special Needs Plans are offered for people who qualify.
Statewide, eight stand-alone Part D drug plans are available for 2027, down from ten, with monthly premiums from $5.30 to $238.
(CMS plan landscape data as of October 2026 is the source of the above data.)
Residents of Lewiston, Lapwai, Culdesac, or any other part of Nez Perce County who receive a Plan Non-Renewal Notice should secure new coverage by December 31 if they want to avoid a coverage gap on January 1.
These notices should be in your mailbox by 10/15/2026.
Veterans who get their prescription meds from the VA
Call us. We will explain your options.
If you received a non-renewal notice from your 2026 Medicare Advantage insurer
OR
You want to minimize your exposure to non-renewal notices and annual plan reviews for your health insurance in the future…
There is another type of Medicare health insurance plan that we encourage you to consider. They open access to any doctor or hospital in the Northwest (and the rest of the US) that accepts Medicare (most do). No need to get an insurance company’s approval to use resources outside of your community.
Example: if you presently use St. Joseph Medical Center, Tri-State Memorial Hospital, Gitman Medical Center, or Whitman Hospital and Medical Center, you can still use them as well as resources in Seattle, Southern California, Northern Utah, Boise and other hospitals in the US (Mayo Clinics, Cleveland Clinic, MD Anderson, etc.).
You just make the appointment.
If you have a serious health issue and your current physician has done the imaging/other tests, they will forward your test results to a specialist before they will accept your appointment.
Why? To be sure they can solve your health issue(s). If they cannot, or are booked up, they may refer you to another specialist.
Also, there are few ‘prior authorizations‘ to contend with these plans.
These features can also be important for ‘snowbirds’ that go to warmer climates during the colder Idaho months.
Check out which other hospitals in the US you can use here.
Premiums for these plans are currently in the $80 – $300 range. These do go up annually.
The plans which have a low cost sharing exposure (the Medicare Part B annual deductible, for example) will be in the upper end of the premium range mentioned above.
If you can accept higher cost exposure ($3,200, for the calendare year) the premium will be at the lower end of the range. This figure is typically less than half of the Maximum out of pocket limit (MOOP) found in most Idaho Medicare Advantage plans.
Pair this health plan with a standalone Part D plan, and your drug costs are protected too. Remember, when out-of-pocket spending on covered Part D drugs reaches $2,400, you pay nothing more for plan covered medications for the rest of the calendar year. If you happen to be taking an expensive medication, you can spread the cost over the remaining months of 2027.
Part D plan premiums start below $6/month in 2027.
If you would like help evaluating your 2027 options call.
Since you have guaranteed issue rights (because you have a non-renewal letter) you can skip underwriting when buying certain Medicare Supplement (Medigap) plans.
We have been helping Idaho residents with these same decisions since 2012.
If you need a refresher on these plans, the material found here will help.
Idaho SHIBA counselors are available to help you too. They are available at 1-800-247-4422, with a regional office in Coeur d’Alene.
According to CMS enrollment reports, there are 10,407 Nez Perce County residents enrolled in Medicare.
As of July 2026, 2,416 residents were enrolled in Medicare Advantage/Medicare Advantage with Part D plans — this is about 23% of the county’s Medicare population.
The NAIC annual report notes over 90,000 Idaho residents are enrolled in a Medigap plan.
Given this, most Nez Perce County Medicare beneficiaries therefore receive their medical benefits through Original Medicare rather than Medicare Advantage.
Which choice is better for you?
We think the answer comes down to three basic questions:
- Can I comfortably afford the coverage?
- Do I have access to the doctors, hospitals and specialists I may need for day to day as well as serious issues?
- What would I have to pay if I become seriously ill?
These questions are especially relevant in Nez Perce County, where residents may receive medical care on both sides of the Idaho-Washington state line and may need to travel for specialized care.
2026 Nez Perce County Medicare Advantage Plans
Medicare Advantage choices are relatively limited in Nez Perce County.
Residents of ZIP code 83501 have 10 Medicare Advantage plans available for 2026. However, six of the 10 are Special Needs Plans available only to people who meet specific eligibility requirements.
That leaves four general-purpose Medicare Advantage plans for most Medicare beneficiaries:
- 1 Medicare Advantage plan without Part D
- 2 HMO/HMO-POS MAPD plans
- 1 PPO MAPD plan
Medicare Advantage Without Part D
There is one plan in this category:
AARP Medicare Advantage Patriot No Rx ID-MA01 (HMO-POS)
- Monthly premium: $0
- Maximum out-of-pocket (MOOP): $6,700
- Part B giveback: $90 per month
There are no PPO plans without Part D.
The $90 monthly Part B giveback can put as much as $1,080 a year back into your budget.
That can be meaningful, particularly for someone living on a limited income. But don’t choose the plan based on the giveback alone. Compare the provider network, copayments, prior authorization requirements and potential out-of-pocket costs.
A Medicare Advantage plan without Part D may also be worth considering for some veterans who obtain their prescription drugs through the VA.
Medicare Advantage Plans With Part D — MAPD
There are three general-purpose MAPD plans available in ZIP code 83501.
HMO/HMO-POS Plans
2 plans
- Monthly premiums: $0–$59
- Maximum out-of-pocket: $5,900–$6,700
PPO Plans
1 plan
- Monthly premium: $29
- In-network maximum out-of-pocket: $7,900
A PPO provides an out-of-network benefit, but an out-of-network physician or hospital isn’t necessarily required to accept you as a patient.
If receiving medical care outside the area matters to you, find out whether the doctors and medical facilities you would realistically use will accept your particular plan.
For a more detailed explanation of MA, MAPD, HMO and PPO plans, visit our Idaho Medicare Advantage Plans guide.
Special Needs Plans in Nez Perce County
Six of the 10 Medicare Advantage plans available in ZIP code 83501 are Special Needs Plans:
- 4 D-SNPs — for people who meet the plan’s Medicare and Medicaid eligibility requirements
- 2 C-SNPs — for people who meet specified chronic-condition requirements
- 0 I-SNPs
These plans should be considered separately because they aren’t available to every Medicare beneficiary.
Should You Consider a C-SNP?
Having a medical condition that qualifies you for a Chronic Condition Special Needs Plan gives you another Medicare option. It doesn’t automatically mean you should change plans.
C-SNPs are designed around the needs of people with specified chronic medical conditions and may provide additional care coordination, benefits or services related to those conditions.
If you’re having difficulty obtaining appropriate care, finding specialists or coordinating your treatment, a C-SNP deserves a close look.
But if your condition is being successfully treated, you’re satisfied with your physicians and specialists, and your present coverage provides good access to them, compare carefully before changing something that is already working.
Ask:
- Are my current physicians and specialists in the new plan’s network?
- Is the hospital I use included?
- Are my prescriptions covered and what will they cost?
- Will my current treatments require prior authorization?
- What additional services or care coordination would I actually receive?
Qualifying for a C-SNP creates a choice. Make the decision based on what will improve or protect your healthcare.
If you qualify for Medicaid or have limited income, your Medicare choices and costs may also be quite different from those of other Medicare beneficiaries.
Learn more in our Idaho Medicaid, Extra Help and Special Needs Plans guide.
Where Will You Receive Medical Care?
This is an important question for a Nez Perce County resident.
Lewiston and Clarkston are neighboring communities even though they are in different states. Residents may also travel elsewhere in Idaho, Washington or Oregon for specialized medical care.
When comparing Medicare Advantage plans, don’t stop with:
“Is my current doctor in the network?”
Think about what happens if your health changes.
Where would you go if you needed cancer treatment, complicated cardiac care, neurology or major surgery?
Are those specialists and medical facilities in your plan’s network?
If they aren’t and you have a PPO, will they accept you as an out-of-network patient?
You may not know which specialist you’ll need several years from now. But you can decide today how much provider flexibility you want your Medicare coverage to give you.
Original Medicare + Medicare Supplement
Original Medicare combined with a Medicare Supplement (Medigap) provides a very different approach.
Instead of receiving your Medicare benefits through a private Medicare Advantage plan, Original Medicare remains your primary health insurance.
A Medigap plan helps pay some or most of the deductibles, copayments and coinsurance left by Original Medicare, depending upon which standardized plan you choose.
You aren’t limited to a Medicare Advantage plan’s local provider network. This can be valuable for a Nez Perce County resident who wants access to Medicare providers outside the immediate area.
But broader provider access comes with another consideration:
The monthly premium has to fit your budget.
There Are Two Kinds of Healthcare Access
When comparing Medicare coverage, consider both provider access and financial access.
Provider Access
Can you get to and use the physicians, specialists, hospitals and treatment centers you need?
Financial Access
Can you afford your insurance premiums and healthcare costs without putting unreasonable pressure on the rest of your household budget?
A conventional Medigap Plan G costing several hundred dollars each month may provide excellent coverage, but that premium can become a significant financial burden for someone living on a modest fixed income.
Medicare Advantage may substantially reduce the monthly insurance expense, but you accept the plan’s provider network, cost sharing and prior authorization requirements.
Neither issue should be ignored.
The objective isn’t to own the most comprehensive insurance policy.
It is to have Medicare coverage you can afford and will use when you need healthcare.
High-Deductible Plan G — Another Choice
There is another alternative worth considering.
High-Deductible Plan G (HD-G) uses Original Medicare and provides the same broad provider access as conventional Plan G, but with a substantially lower monthly Medigap premium.
For 2026, the HD-G deductible is $2,950.
You accept more healthcare expense when you use medical services in exchange for paying a much lower insurance premium each month.
For someone who wants Original Medicare’s provider access but finds the monthly premium for conventional Plan G difficult to afford, HD-G deserves to be part of the comparison.
Idaho’s Medicare Birthday Rule — What Nez Perce County Residents Should Know If They Enrolled In Their Current Medigap Plan Before March 1, 2022
Idaho’s birthday rule gives Nez Perce County residents who are currently enrolled in a Medicare Supplement plan a 63-day window each year — starting on their birthday — to switch to a Medigap plan with equal or lesser benefits, without medical underwriting or health questions asked.
This is particularly relevant if you enrolled in a Medicare Supplement plan before March 1, 2022. Carriers price identical Medigap plans very differently. Some Nez Perce County residents may be able to save $40+ per month by switching to the same standardized plan with a lower-cost carrier — with no change in benefits and no change in their doctors.
If you have not reviewed your Medigap premium recently, call us for a free, no-obligation rate comparison. We represent all major Idaho carriers and can compare current Nez Perce County rates on your behalf.
Call (208) 867-0296 · 8am–8pm Monday through Saturday.
Having Trouble Affording Medicare?
If Medicare premiums, prescription drugs or healthcare costs are putting pressure on your budget, don’t assume you won’t qualify for help.
Idaho has programs that can help eligible Medicare beneficiaries with Medicare premiums, prescription drug costs and, in some situations, other Medicare expenses.
Our Idaho Medicaid, Extra Help and Special Needs Plans guide explains these programs and the different levels of assistance in more detail.
You can also contact the Idaho Department of Health and Welfare at 1-877-456-1233 for information about eligibility and applying for assistance.
If your income is limited, find out whether help is available before deciding that needed healthcare or Medicare coverage is simply too expensive.
Don’t Choose a Plan Based on Premium Alone
A $0 Medicare Advantage premium doesn’t mean $0 healthcare costs.
Likewise, paying a substantial monthly Medigap premium doesn’t automatically make Medigap the better choice.
Consider the entire picture:
- Monthly premiums
- Potential out-of-pocket costs
- Prescription drugs
- Doctors and hospitals
- Specialist access
- Prior authorization
- Travel outside the area for healthcare
- Your household budget
- What happens financially if your health changes
Affordability + Provider Access + Financial Risk
Those three factors should drive the decision.
Medicare Advantage Plans Can Change
Medicare Advantage plans operate under annual contracts. Benefits, premiums, copayments, drug coverage and provider networks can change from one year to the next.
Read the Annual Notice of Change (ANOC) your insurance company sends each fall.
If your Medicare Advantage plan is discontinued, don’t automatically enroll in another Medicare Advantage plan.
Depending upon your circumstances, losing your plan may create a guaranteed-issue opportunity to purchase certain Medicare Supplement plans without medical underwriting.
These opportunities have time limits. Investigate your options before the guaranteed-issue period expires.
We Help Nez Perce County Residents Understand Their Choices
There isn’t one Medicare plan that’s right for everyone.
Someone living on a limited fixed income may place considerable value on the low monthly premium of Medicare Advantage.
Someone who regularly uses specialists outside the area may place greater value on Original Medicare and Medigap.
A veteran receiving prescriptions through the VA has another set of considerations.
Someone who wants Original Medicare’s provider access but is concerned about conventional Medigap premiums may want to compare High-Deductible Plan G.
And someone who qualifies for a Special Needs Plan should compare what that plan actually provides with the healthcare and coverage they already have.
There are no dumb Medicare questions.
If you live in Lewiston, Lapwai, Culdesac, Peck or elsewhere in Nez Perce County, call us.
We’ll help you understand the choices, compare the costs and think through how each option fits your healthcare needs and your budget.
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