Butte County Medicare Medicare Advantage plans

Written on March 1, 2026. Posted in Medicare FAQs.

Butte County Medicare Advantage Plans (Medicaid Residents Only)

If you are enrolled in Medicaid, Butte County residents can access Medicare Advantage plans, which may combine Medicare and Medicaid benefits. These may include:

Prescription drug coverage
Dental, vision, and hearing benefits
Care coordination services

Learn more about these plans here.

Molina Healthcare of Idaho currently offers Medicare Advantage plans for Medicaid-eligible Butte County residents. Residents should contact Molina to learn about plan options and enrollment.

2027 may bring additional Medicare Advantage plan choices for the rest of the Butte County Medicare population.

Butte County Medicare plans for the rest of the County Medicare beneficiaries

Protect Yourself Without High Premiums

If you want to avoid surprises from medical bills, high-deductible Plan G may be the most practical way to protect yourself while keeping monthly premiums manageable.

This plan works alongside Original Medicare coverage for Butte County residents, helping cover costs Medicare doesn’t fully pay, including copays, coinsurance, and deductibles.

The key Medicare document on Medigap plans is here. The chart on page 7 will help you understand the differences in coverage between the 12 plans.

High-Deductible Plan G has a lower premium. Here is how it works.

High-deductible Plan G operates like standard Plan G, with one key difference:

You pay Medicare’s leftover approved costs until you meet the annual deductible.
2026 deductible: $2,950; this is a Medicare controlled figure that goes up a bit annually
After that, the plan pays remaining Medicare-approved costs

This keeps monthly premiums lower while still protecting you from major medical bills. For Butte County Medicare beneficiaries above Medicaid income levels, high-deductible Plan G is often the most practical and low-risk solution.

Current monthly premiums for Idaho Medigap plans is here.

Comprehensive Medigap Plans

If you want more predictable out-of-pocket costs, you can choose from 10 comprehensive Medigap plans:

Plan A, B, C, D, F, G, K, L, M, N

Important: Outside your Initial Enrollment Period, you may need to pass medical underwriting to qualify. High-deductible Plan G often remains the easiest, most reliable option for Butte County residents who want coverage without extra hurdles.

Original Medicare Coverage for Butte County Residents

All Butte County Medicare beneficiaries start with Original Medicare, which includes:

Part A: hospital coverage
Part B: medical coverage
Part D is optional (prescription drug coverage), but highly recommended.

Original Medicare pays most approved healthcare costs but leaves you responsible for:

Deductibles
Copays
Coinsurance

It also does not cover routine dental, vision, hearing, or prescription costs. Many people just pay cash for these services as these plans may cost the policy holder more because of their premium, deductibles, copays, and waiting periods.

For residents who want a practical way to protect their selves from Medicare covered health care costs, high-deductible Plan G provides supplemental coverage while keeping monthly premiums manageable.

Affordable Part D Options for Butte County Medicare Beneficiaries

Prescription drug coverage (Part D) is not included with Original Medicare or Medigap plans. In Idaho for 2026, there are 10 stand-alone Part D plans available statewide.

Some of the most affordable options include:

Wellcare Value Script – $9.60 per month
Humana Basic Rx – offers a $0 monthly premium for eligible beneficiaries

Together, these two plans have over 50% of the Idaho Part D market. This figure came from this website.

Residents can use the Medicare Plan Finder tool to see which pharmacies participate in each plan and estimate prescription costs. Annual Enrollment occurs October 15–December 7, which is the best time to compare Part D plans and ensure your prescriptions are covered at the lowest possible cost. We can help you with this.

Enrollment Timing

Understanding enrollment periods is critical for Butte County Medicare beneficiaries:

Enrollment Period	Applies To	Dates
Initial Enrollment Period (IEP)	New Medicare beneficiaries	3 months before turning 65, birthday month, 3 months after
Annual Enrollment Period (AEP)	All Medicare beneficiaries	October 15 – December 7
Medicare Advantage Open Enrollment	Current Medicare Advantage members (Medicaid only)	January 1 – March 31

High-deductible and comprehensive Medigap plans are best purchased during the IEP to avoid medical underwriting.

Why High-Deductible Plan G Is a Practical Choice

High-deductible Plan G is ideal for Butte County Medicare beneficiaries who:

Are above Medicaid income
Want lower monthly premiums
Prefer simple, predictable coverage for catastrophic expenses
Want nationwide access without referral hassles

Even if you rarely see a doctor, this plan protects you from unexpected hospital bills while keeping monthly costs manageable.

FAQs: Butte County Medicare

Q: Are Medicare Advantage plans available to everyone?
A: No. Only residents enrolled in Medicaid qualify for Medicare Advantage.

Q: Which plan is most practical for residents above Medicaid income?
A: High-deductible Plan G is often the easiest and most cost-effective option.

Q: Can I upgrade to a comprehensive Medigap plan anytime?
A: Outside your Initial Enrollment Period, you may need to pass medical underwriting.

Q: Do Medigap plans include prescription drugs?
A: No. You need a standalone Part D plan or a Medicare Advantage plan if you’re Medicaid-eligible.

Q: Can I see any doctor with a Medigap plan?
A: Yes — any provider that accepts Medicare nationwide.

Final Thoughts

Residents of Butte County who are not on Medicaid, high-deductible Plan G provides a practical, low-cost solution for protecting

Medicare Advantage plans compete with each other to earn your business. These plans can differ in how much they charge for their premium, copays/coinsurances, the doctors/hospitals available to you, your cost for medication fills/refills AND the ‘extra’ non-Medicare covered services they can add to their plans. We can help you find the plan that meets your needs and retirement budget.

against unexpected medical bills.

Comprehensive plans are available if you want broader coverage, but underwriting may apply if joining a plan outside the Initial Enrollment Period.

For Medicaid-eligible residents, Medicare Advantage plans through Molina Healthcare of Idaho provide combined benefits for simplified care.

Choosing the right Butte County Medicare coverage depends on your income, health, and preferences. High-deductible Plan G offers a straightforward, affordable protection, making it a smart starting point for most residents.

Call us when we can help.

This page was last modified on Mar 1, 2026 @ 10:29 PM.

Idaho Hi-Deductible Medigap Plan G

Written on January 24, 2026. Posted in Medicare FAQs.

Medigap Plan F Hi-deductible is an easy way to place a cap on your annual out of pocket costs if you stay with Original Medicare. — HD Medigap Plan G and HD Medigap Plan F are attractive alternatives to Idaho Medicare Advantage plans AND Medigap Plan F, G and N. Why? Read the rest of this article. Call us with your questions.

Idaho High Deductible Medigap Plan G premiums:

As of 7/19/2026:

G Hi-deductible premium: less than $78/month.

G less than $225/month.

N: less than $170/month.

Medigap Plan F Hi-deductible is also available at less than $78/month.

Idaho Medigap rates are set by each company offering them. There is often a wide difference between monthly premiums for the same plan. We help you find a solid company with the lowest rates!.

High Deductible Medigap plan G is ideal for Idaho residents who:

Want long-term flexibility and a lower monthly premium (than Medigap Plan F, G, or N). Flexibility means all providers (physicians, hospitals, skilled nursing facilities, physical therapists, other medical professionals, etc.) in the US that ‘accept Medicare Insurance’ (98% non-pediatric do) are available to you.
Referrals from your primary care physician are seldom needed.
Prior authorizations are minimal AND you do not have an insurance company standing between you and your Medicare providers.
This resource (on the Medicare.gov site) helps you find these resources anywhere in the US.

Additional information to consider!

Read this report (Kaiser Family Foundation) to see how the author determined about 48% of the providers in the US are in the network of Medicare Advantage plans. This means 52% of providers that ‘accept Medicare’ (in the US) do not participate in Medicare Advantage plans. These are national averages and are not applicable to local markets.
Are frustrated with the rules of Medicare Advantage networks, prior authorizations, or annual plan changes.
Are tired of being included in the pool of Idaho Medicare Advantage plan members whose plan is either cancelled, merged into a different plan, or has noticeably premium and/or cost sharing increases.
Want lower financial exposure than the MOOP found in Idaho Medicare Advantage plans. The2026 figures range between $3000 (the plan with this MOOP does not cover prescription medications) and $13,900.
IF you were eligible before or enrolled in Medicare prior to 1/1/2020, Hi Deductible Medigap Plan F is your option. HD F operates in the same manner as HD G and often has the same premium (or slightly higher).

While most Original Medicare services covered by Part A and B have cost sharing these same services can vary by each Medicare Advantage plan and can change annually.

Medigap HD G may appeal to those who value certainty.

High-Deductible Medigap Plan G (HD G)— Simply Explained.

HD‑G is a Medigap plan that works with Original Medicare (Parts A and B).

You pay Medicare cost-sharing until you reach the annual HD‑G deductible ($2,950 for 2026)…this figure is controlled by Medicare (not an insurance company) and goes up a bit annually.
After the deductible is met, HD‑G pays 100% of covered Medicare costs for the rest of the year.
All providers (doctors/hospitals/others) working in the USA AND ‘accept Medicare insurance’ is your network.
Some specialists (Neurologists for example) may want a referral from the patients primary care physician.
There are few prior authorizations when you stay with Original Medicare (are enrolled in Part A and B and do not enroll in a Medicare Advantage plan).
Medicare’s cost sharing is defined here and apply to all choosing to remain with Original Medicare (enrolled in Part A and B and not enrolled in a Medicare Advantage plan); each Medicare Advantage plan contains their plan specific costs/rules/network parameters.

Think of HD‑G as a safety net. It has a clear limit on your annual costs for Medicare covered services (the plan’s deductible) and offers you the flexibility to use all providers in the USA that ‘accept Medicare insurance’.

How HD-G Works With the Deductible.

Each year, HD‑G has a single, defined deductible (set by Medicare).

Once your cost sharing for Medicare covered services hits the deductible for the calendar year, all additional covered care is fully paid by the plan for the remainder of the year.

Coverage After the Deductible is met.

HD‑G covers exactly what standard Plan G cover. This includes:

Medicare Part A hospital deductible.
Hospital coinsurance and extended stays.
Skilled nursing facility coinsurance.
Medicare Part B coinsurance (20%).
Excess charges (providers billing above Medicare rates).
Foreign travel emergency coverage.

Coverage is nationwide, anywhere Medicare is accepted.

Please read the Medicare published document which describes Medigap plans. This is available here (Medicare.gov website).

High Deductible Medigap Plan G vs Standard Plan G.

Feature	Standard Plan G	HD‑G
Monthly premium	Higher ($200+)	Lower…less than $85/month
Out-of-pocket costs	Minimal (Medicare Part B Annual deductible)	Deductible is defined by Medicare, not an insurance company.
Risk management	First-dollar coverage (after Part B annual deductible is met).	Defined maximum exposure (HD-G deductible for the year).
Coverage	Medicare pays its share; Plan G pays your share.	Same as standard G once deductible met.

If you think in terms of risk ceilings, not just monthly cash flow, we recommend HD-G.

HD‑G vs Medicare Advantage: Key Differences.

Feature	Medicare Advantage	HD‑G
Premiums	Range from $0–$150+ (Depending on which Idaho County a person resides).	Moderate (less than $85 for residents in all Idaho Counties). Premium is set at the State (not County) level.
Deductible / MOOP	MOOP applies only after plan approves care.	One annual deductible; 100% coverage for Medicare covered services after deductible is met.
Networks	Restricted to providers insurance company invited and accepted their network offer; prior authorization often required for some services. Exceptions can apply for emergencies.	Any provider accepting Medicare. Prior authorizations minimal.
Benefit changes	Annual redesign possible	Medicare sets the foundation. Benefits stay stable year-to-year
Maximum cost to you.	HMO Medicare maximum plan limit: $9,250 limits; 2026 Idaho HMO plans range from: $3,000–$9,250; PPO Medicare limits: member limit use to ‘in-network providers’ maximum figure: $9,250; 2) if you use ‘out of network providers’ the maximum figure is; $13,900.	Defined deductible ($2,950 for 2026…defined by Medicare….not an insurance company); no surprises
Provider choice	Limited to defined network; if you have a PPO plan, your plan’s ‘Evidence of Coverage’ document is a must read for additional rules. Some hospitals do not accept Medicare Advantage plans unless they are defined as being in the plan’s network.	Full nationwide access, including top hospitals that ‘accept Medicare’. Think Mayo Clinics, Johns Hopkins Hospital, Stanford Health Care, top Cancer and Cardiology care, etc.

Key takeaway: Medicare Advantage limits cost-sharing to the plan’s MOOP but can limit provider access; HD‑G limits total financial risk to the annual deductible (often noticeably lower than the MOOP of most Medicare Advantage plans, and does includes all providers in the US that accept Medicare insurance (98% of the non-pediatric physicians do).

Understanding the Deductible vs MA MOOP

The Medicare Advantage (MA) maximum out-of-pocket (MOOP) and the HD‑G deductible are different:

MA MOOP: Only counts after the plan approves services and they are completed; when using an HMO plan, services are typically limited to the plan’s network; when using a PPO plan, ‘out of network’ services often cost more when compared to using ‘in-network providers’.
HD‑G deductible: Automatically accumulates as Medicare covers delivered services; applies anywhere Medicare is accepted; very few prior approvals needed. When the deductible is met, the policy holder does not pay for anymore for Medicare covered services for the rest of the calendar year.

In practice:

MOOP = “Maximum you could pay if the insurance company offering your plan agrees to cover all your care”.
HD‑G deductible = “Maximum you will pay as long as Medicare covers the care”.

HD‑G offers unrestricted access to any provider that accepts Medicare.

This opens the door to:

The Mayo Clinics are not available to Idaho Medicare Advantage plan members. If you want access to these resources, consider staying with Original Medicare and enroll in a Medigap plan. Call us with your questions. — The Mayo Clinics are available to Idaho residents that selected HD-G (and other Medigap plans).

Mayo Clinic
Cleveland Clinic
Johns Hopkins Medicine
Mass General Hospital
Stanford Health Care
and other top hospitals in the US.

Why this matters:

Many MA plans restrict access (by having defined networks the plan member can use) and/or require prior authorization.
The top 250 hospitals in the US may not be available to the Medicare Advantage member because of network rules or the reluctance of these facilities to ‘accept Medicare Advantage plans’. An example of this is here.
If you travel or live in multiple states, unrestricted access ensures you can see top specialists wherever you are. Some Medicare Advantage plans may have a similar feature. Be sure and check to see if the plan limits the amount of money you can spend on care AND how much more it will cost you when you are ‘out of network’.

HD‑G lets you choose providers based on quality and fit, not plan networks.

What this means for your decision:

Popularity alone doesn’t equal the best choice for everyone.
MA plans often offer lower visible premiums, but network restrictions, prior authorizations, and annual plan changes can create challenges when care is actually needed. Examples include one Idaho insurance company terminated over 70,000 policies effective 12/31/2025; other Companies offering Idaho plans are not offering all of the plans they did in 2025; residents of other Idaho Counties were left with fewer plan choices in 2026; and, 2 other insurance companies (Regence Blue Shield of Idaho and Select Health) left the Idaho Medicare Advantage plan market on 12/31/2025. Idaho residents affected by this change had to find new health insurance for 2026.
HD‑G offers stable coverage, nationwide provider access, and a defined annual risk, which may be more valuable for people seeking autonomy and certainty.

Who Matches Up With HD‑G.

Idaho residents who understand the benefits of staying with Original Medicare (Part A and B), the value added HD-G offers, and the financial side of this plan meets their budget.
People who want local as well as nationwide provider access and freedom to see top hospitals
Those frustrated with MA networks, prior authorization requirements, and plans which can change annually.

Who May Not Be Right For HD‑G.

People preferring a $0/low monthly plan premium and are comfortable with the financial exposure which comes with the plan’s MOOP (these can be as high as $13,900).
Residents comfortable with the skills/resources found in the MA plan’s network.
Individuals who qualify for Medicaid or need substantial cost-sharing assistance.
People who want bundled extras (dental, vision, OTC benefits, etc.). We encourage people interested in MA plans with dental and/or vision coverage to read their plan’s Evidence of Coverage to learn the details of the plans coverage, exclusions, exceptions, and other limitations.

Switching to HD‑G.

New to Medicare: Enroll in this plan within 6-months of your Medicare Part B effective date to skip underwriting. Enrollment past this date means answering the health history questions on the application. Based on these answers, prescription medications a person takes, and other health history are used by the insurance company to determine if they will accept or deny the application.
Leaving Medicare Advantage: Idaho requires underwriting unless the person has a ‘guaranteed issue’ or ‘special enrollment period. Some exceptions apply.
Switching from another Medigap plan: Review Idaho’s rules here.

Professional guidance is recommended for transitions.

Call us if you have questions.

What about High Deductible Medigap Plan F (HD F)?

It is still available to interested Idaho residents, provided they enrolled (or was eligible for Medicare) prior to 1/1/2020.

Why the change?

The Medicare Access and CHIP Reauthorization Act of 2015 states that insurers can no longer sell Medigap Plan F, High Deductible F and Plan C to people new to Medicare on/after 1/1/2020. Individuals already enrolled in these plans could keep them.

What was the concern with these plans? They covered the Medicare Part B annual deductible.

What is the difference between High Deductible Plan G and High Deductible Plan F?

They are the same with one exception. The HD G does not cover the Part B annual deductible. This figure is $283 for 2026.

Call us if you have questions about the above.

The Long-Term Perspective.

HD G is quiet, rational, and durable.

It’s designed to:

Stay out of your way
Work the same way year after year
Protect you when something serious happens
Let you choose providers based on quality, not contracts.

Bottom Line

High Deductible Plan G is not about paying the lowest monthly premium. It’s about:

Knowing your maximum risk
The flexibility to access top hospitals nationwide when you need this level of service
Avoiding network restrictions and prior authorization
Maintaining stability over time.

Call us with your questions.

We have been helping Idaho residents with Medigap plans since 2012.

This page was last modified on Jul 19, 2026 @ 9:54 AM

Benewah County Medicare

Written on April 19, 2025. Posted in Medicare FAQs.

We help Benewah County residents understand both Medicare and the differences between their Medicare Advantage and Medigap plan choices. If you are new to Medicare, a Veteran or someone with a question, we are here to help.

2026 Benewah County Medicare Advantage plans.

There is a synopsis of changes to the Idaho Medicare Advantage marketplace here. If you are not aware of these changes, please take a few minutes and read this material.

An overview of your 2026 County’s Medicare Advantage plans should be updated on this website by 10/15-20/2026. Be sure and check back for this important information.

What are we waiting for? Provider directories which include which hospitals are in the plan’s network. We have most of the Evidence of Coverage documents now.

Because of the extensive changes made in the Idaho market, we recommend you defer making 2026 plan changes until you have all the information about your choices. This means do not make an impulse decision when viewing ads on TV or from mailers you are receiving.

2025 Benewah County Medicare health plans.

We are an Idaho based Medicare insurance brokerage firm licensed with all Benewah County Medicare Advantage plans.

We have 2025 Part D licenses with Aetna, United Health Care and Humana. The remaining 2 companies (Wellcare and Cigna) either do not use brokers in 2025 or we chose to not license with them because of low Medicare plan star ratings. These Part D plans are for people not enrolling in a Medicare Advantage plan (staying with Original Medicare).

Additional information on his subject is documented here.

For 2025, Benewah County has 9 Medicare Advantage plans for residents to consider.

Here is the high level break down of these plans:

A plan targeted for Veterans.

One plan is targeted for Veterans that gets their prescription med’s from the VA. Veterans may find this plan attractive as it is a back up for health care services you get from the VA. All health care services offered by Medicare are included in this plan including ‘Emergency services’. The plan may contain other ‘no-cost’ benefits.

Plans for people with specific chronic health issues.

2 plans are unique and reserved for residents which 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). If you have either of these health issues, send us the above mentioned ‘scope of appointment’ document and we will share with the important details of this plan choice.

If you have a Medicaid status of QMB+, QMB or SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.

Plans for people with Medicaid status of ‘enhanced’ or ‘QMB’.

3 others are reserved for people classified as ‘Enhanced’ Medicaid. If you have this qualification, we suggest you consider these plans? Why? Because you get a ‘care coordinator’ that helps pave the way for you to get the medical appoints you need AND these plans may have ‘extra’ benefits that go beyond what either Medicare OR Medicaid offers. These plans are also called a ‘Medicare Medicaid Coordinated plan’.

The next plan is for people assigned a ‘QMB’ Medicaid status. If this includes you, we encourage you to focus on this plan. Why? The care coordination covered by either Medicaid or Medicare is taken care of by the plan. The plan may also include ‘extra benefits’ at little/no cost.

Plans for the rest of Benewah County residents.

2 plans are available for the rest of Benewah County residents. Both of these are HMO plans. We you understand their differences and enroll in the play you choose. We recommend veterans also consider these plans.

There is another type of Medicare plan you should be aware of.

When you choose this plan type, all doctors/hospitals that accept Medicare insurance in the USA are available to you. This means you do not have the network restrictions/rules found in Benewah County Medicare Advantage plans.

Also, you do not have an insurance company standing between your physician to get permission to move forward with your treatment plan. Physicians/hospitals may prefer these plans because they know they will be paid in a timely manner.

You will have fewer ‘prior authorizations’ to deal with.

Learn more about Idaho Medigap plans here.

What are the differences between the remaining two Benewah County Medicare Advantage plans.

Plan premiums, your share of the left over costs when you use plan covered services, the plan’s Maximum out of pocket limit (MOOP), your med fill/refill cost, etc. We will help you understand the details of the differences.

Why the MOOP is important.

Put plans on your short list that have a lower MOOP. This decision may save you money if you use Medicare covered health care services during the plan year.

Be aware your Medicare Advantage plan pays its lion’s share of the cost for services you use. You pay the rest. Your share of these costs can vary noticeably between plans.

Think of the MOOP as your limit (or cap) for your share of health care costs for Part A and B services you use during the calendar year. The higher your plan’s MOOP, the more you could end up paying for the services you use.

The insurance company offering your Medicare Advantage plan sets the plans MOOP where they want it. It must be at or below Medicare’s limit. This figure can change annually.

What are the actual MOOP figures?

Medicare’s maximum MOOP for this year’s HMO plans is $9,350.

Insurance companies offering Medicare Advantage plans set their plan’s MOOP based on each of their plan’s business goals.

Once you hit your plan’s MOOP, your insurance company pays the rest of your share of the cost when you use Part A/B services.

The range of MOOP for your County’s HMO Medicare Advantage plans is $4,500 to $4,900.

We prefer plans that meet a person’s needs, have a low MOOP, AND plans with a monthly premium below $70.

Why $70? You can get a Medigap plan described above for a lower premium AND you will not have an insurance company standing between you and your doctor to get the ‘next step’ in your health care accomplished. There are far fewer ‘prior authorizations’ that your physician/hospital have to contend with.

If you understand how the math works when calculating your MOOP, skip the paragraph below.

Let’s say your plan’s MOOP is $7,000 for the year.

In January you are admitted to the hospital for surgery. Your bill for the 5-day hospital stay is $1,750. Your post-op visits to your physician and physical therapist(s) are $475.

When you subtract these figures from your plan’s MOOP the result is how your new MOOP. When, after you use additional services, and your MOOP hits zero, your plan pays the rest of your share of the cost for Medicare A & B services.

If you have a plan with a ‘lower MOOP’ you have the opportunity to keep more money in your pocket.

**The insurance company offering your MAPD plan sets the cost sharing for each Part A and B service.**

Cost sharing for services used, the plan’s MOOP, monthly premium, and the financial savings you get when you use the plan’s non-Medicare covered services are some of the differentiators between plans.

Specific plans may have prior authorizations on certain covered services.

Rules may be imposed on specific coverages. You find these rules in your plan’s ‘Evidence of Coverage’.

Prior Authorization is an example.

What does this mean? Your insurance company can approve or deny the service request. If the service is denied, your prescribing physician has to go to ‘plan B’ and start the process over.

The number of days ‘skilled nursing care’ has their daily co-pays in place is something you need to pay attention to. Why? Because if you need this service and have the ‘wrong’ plan, it can be the quickest way for you to hit your plan’s MOOP.

Dental coverage is another example where rules are important to know.

Implants or braces may be covered by some plans, but not others.

There may be a limitation on the number of cleanings too (2-year when you may need 4); periodontal services, if covered, may have their own limitation, etc.

The dollar value the insurance company offers you for dental coverage can vary widely between plans.

When reviewing 2025 dental coverage for some plans we noticed something we have not seen before. It reads ‘Submitted claims are subject to a review process which may include a clinical review and dental history to approve coverage’. To us, this is an example of why people interested in dental coverage included in a Medicare Advantage plan need to read the fine print before choosing a plan.

Doctors/hospitals/other providers.

Availability of physicians, hospitals, physical therapists, skilled nursing facilities, durable medical equipment providers and all other provider types vary by plan. Read this article to learn more.

The insurance companies offering Medicare Advantage plans put together their networks of these people/facilities for their plan members. Medicare requires insurance meet a minimum adequacy requirement when they put their networks together. This means there is a good probability not all physicians/providers in your geographic area that ‘accept Medicare’ insurance are not in your plan’s network.

You have the tools available to find out how many of a certain type of specialists are in the plan’s network vs how many that ‘accept Medicare’ are in the same area . If you have existing health issues, would it be important for you to know how many specialists which treat this for you are in the plan you select? We can show you the tools to do this.

The above can change during the calendar year. This announcement is an example of why networks can change during the year. Another example is found here and here.

Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies is competing for other financial needs of the hospital.

Proton Therapy is an example of newer technology to treat cancer.

Read this article if you are unfamiliar with this. At this writing, 45 hospitals (out of over 4500) offer this solution. Facilities near Idaho include:

Huntsman Cancer Institute (Salt Lake City) (began offering this service in 2021)

The Mayo Clinic Cancer Center (Phoenix…rolled out this service on 2016)

Loma Linda University Cancer Center (began offering this service in 1990)

California Protons Cancer Therapy Center (San Diego) (began offering this service in 2017).

If you are interested in this service, you might check where each of the above facilities are ranked in the top 250 hospitals.

Would you prefer to use the services of the top 250 hospitals in the country?

These facilities may have the the top specialists working for them and the latest technologies to treat different health issue(s).

Some of these facilities do not accept Medicare Advantage plans (Part C), however they will open their doors to you if you have a Medigap plan.

Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.

There are physician rating services too. One is available here. We focus on physicians with a 4 or 5 star rating and have at least 10-ratings. You can use this same tool to find physicians that ‘accept Medicare insurance’.

We also recommend you use a ‘board certified physician‘.

Medications covered by each plan.

According to this source, there is a 20+/- % variance between the number of prescription medications covered by the plans available to you. Note none of these plans include 100% of the medications covered by Medicare.

This same resource documents the number of medications each plan has in each of the 5 (or 6) drug tiers AND the fill/refill cost by these same drug tiers. These figures can vary noticeably between plans.

Given the wide variance between plans on the above, it is easy to understand why there can be a 300% +/- variance in your projected annual out of pocket cost between your plan choices for the medications you take.

This is a key reason you should not enroll in any Medicare Advantage plan until you understand your cost for your prescription medications. If you are working with a broker/agent that just tells you your medications are covered, we suggest you work with someone else that will share the whole picture.

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

The Centers for Medicare and Medicaid Services (CMS) has requirements insurance company(s) offering Medicare plan(s) must meet when they put together their list of covered medications.

Below is a cut/paste from (Section 30.2.5) the current Medicare Prescription Drug Benefit Manual.

“Part D sponsor formularies must include all or substantially all drugs in the immunosuppressant(for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic classes. CMS instituted this policy because it was necessary to ensure that Medicare beneficiaries reliant upon these drugs would not be substantially discouraged from enrolling in certain Part D plans, as well as to mitigate the risks and complications associated with an interruption of therapy for these vulnerable populations.“

We feel this is an important statement everyone enrolled/wishing to enroll in a Medicare prescription drug plan should be aware of.

Benewah County Medicare Advantage plans for Veterans

You have access to this new Clinic in Twin Falls or the hospital in Boise.

Veterans have Medicare Advantage plans to consider.

These plans do not include prescription drug coverage and are offered by private insurance companies which compete with each other for your business.

Some of these plans help you pay for your monthly Part B premium (the plan’s call this feature a Part B giveback). Each plan sets their ‘giveback’ for the member’s Part B monthly premium.

This year your County’s plans have a giveback between $0 to $100/month.

The Part B payback figures can change annually and is controlled by the insurance company offering the plan.

The Veterans out of pocket costs for plan covered health care services can vary widely between plans. This is also true for the ‘non-Medicare’ covered benefits that are often found in these plans (gym membership, dental coverage, etc.). Which hospitals and physicians available to the plan member can also vary by plan.

Which plan is right for you?

Do you want access to doctors/hospitals anywhere in the US?

A veteran may prefer a PPO plan if you want to open your choice of hospitals and doctors to include those beyond Idaho’s borders.

Be aware when plan services are provided by ‘out of network’ providers, the plan members share of the cost for services can be noticeably higher when compared to using ‘in network doctors/hospitals/etc’. Getting ‘out of network’ services may greatly increase the Veterans probability of hitting their MOOP.

Call us if you want help thinking this through.

Do you just want a plan that is a backup to VA health care and are on with the plan’s network of hospitals/doctors/other providers?

An HMO plan should meet your needs. Participating hospitals and doctors can vary by plan and this can change annually.

Are you getting a plan to take advantage of the Part B give back and/or the ‘extras’ that come with some of these plans?

Some Veterans may have no intention of getting health care from one of these plans. They just enroll in a plan so they can get the low/no-cost ‘extra’ benefits which can come with these plans as well as the Part B buyback. This can save the Veteran money.

We noticed some plan(s) with a high Part B giveback also come with high cost sharing when plan health care service is used. Keep this in mind if you may need to use your Medicare Advantage plan. You may be better off with a plan that has a ‘lower Part B buyback’.

Why the interest by insurance companies in the Veterans niche?

A couple of obvious reasons could include they want to say thank you to the Veteran for their service.

Another can be is these plans can be more profitable to the insurance company if the Veteran continues to get their health care from the VA.

If you want help with plan selection…

Call us. I am a veteran (Vietnam) and have been helping others with Medicare, plan selection, and enrollment since 2012.

Benewah County residents on Medicaid and enrolled in Medicare.

Blue Cross of Idaho is exiting the IMPlus and MMCP Idaho market on 5/31/2025.

Idaho Department of Health and Welfare (IDHW) clarified this announcement on February 5, 2025 and is available here. Answers to ‘frequently asked questions’ is available here.

If you are presently enrolled in either of these plans, you will be receiving correspondence from both Idaho Department of Health and Welfare and Blue Cross of Idaho.

UnitedHealthcare will be entering the Idaho IMPlus market on 6/1/2025 and the MMCP market on 1/1/2026.

Molina continues to serve Idaho residents with these important products.

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.

Additional pertinent information about Idaho Medicaid and your plan choices.

There are several different types of plans available to Idaho residents enrolled in Medicaid. If the Idaho Department of Health and Welfare categorized you in the ‘Basic’ category, you have a different set of Medicare Advantage plans to choose from (compared to individuals categorized as ‘Enhanced’).

If you are eligible for an I-SNP OR a C-SNP plan, you have different plans to consider.

Click here to learn more about your options.

We are licensed with C-SNP, D-SNP, QMB and Medicare Medicaid Coordinated plans (MMCP).

Explaining plan differences and helping you with enrollment are other services we help you with.

Benewah County Medicare Advantage plans available to the rest of the Medicare beneficiaries.

When you look the plan’s Summary of Benefits’ document, you may notice some plan(s) have $0/low premiums and include attractive extra no cost benefits. These plan(s) may separate their self from other plans because of this.

If you are attracted to these plan(s) be sure and consider your financial exposure if you will use plan(s) health care services. The plan’s ‘out of network limit’ may be higher than other plans.

Insurance companies may offer Medicare Advantage plans in a market niche designed for people which seldom need health care services. If the company is successful attracting this type of consumer, their expenses may be lower (and also be more profitable).

We are licensed with all plans available to Benewah county residents. Helping you understand plan differences so you can choose the plan that is right for you is our goal. When you are comfortable with the plan you choose, we help you with enrollment.

What insurance companies offer Medicare Advantage plans in Benewah County?

Blue Cross of Idaho

Molina Health Care

United Healthcare

Other tidbits to be aware of

Hospitals in your immediate area.

Benewah County has 1 hospital within its borders. There are several others within 50 miles of St. Maries.

Get a visual of their location by clicking here. Be sure and enter zip code 83861; adjust the ‘radius’ to 50.

Some of these hospitals are not in Idaho and may not be in the network of Medicare Advantage plans available to you. If you enrolled in a Medigap plan, they will be.

Always pay attention to the CMS star rating of any hospital you would consider using.

Having resources with a ‘4 or 5’ Star rating can be important to you when you get regular care, emergency and scheduled surgical procedures.

All the hospitals listed in the above search may not be in every plan.

Read the fine print on extra Benefits included in Benewah County Medicare Advantage plans.

Dental Coverage:

Please review the verbiage on dental care found in the Evidence of Coverage.

If you listen to the TV commercials, this is sounds like a great and often needed ‘extra’.

You really need to pay attention to the details as they can vary widely between the plans that include this feature.

For example, some plans restrict coverage to preventative care (a few cleanings annually, x-rays you can get have their own schedule, etc.).

The plan may cover certain periodontal services. If covered, the plan may limit the number of times specific service(s) can be used during the year. Some plans include class II and III services. If they do, there may be restrictions on specific services covered and may explicitly exclude certain dental billing codes. Please read your plan’s ‘Evidence of Coverage’ for specific details.

Do you need to use the plans network of dentists?

Plans may have a network of dentists you can use. Some permit the use of any licensed dentist in the US for services. Plans may state cosmetic services are not covered. It you use an ‘out of network dentist, you may pay for all services. Some plans may not.

We suggest you read dental coverage section of the ‘Evidence of Coverage’ document just to be sure you understand the plan’s rules. Your plan may not pay for services you use which are excluded from your plan. If you have any question about whether a service is covered, call your plan’s customer service. You may have to get specific billing codes from your dentist just to be sure you get the right answer.

We like plans that let you use any licensed dentist in the US and cover all non-cosmetic dental services.

Vision Coverage.

The depth of this coverage varies by plan. The same issues pointed out for dental coverage can apply to this service too. Be sure and look at the cost for an annual checkup, network restrictions, how much the plan will pay for glasses, frames, contacts, etc.

Over The Counter benefit.

Some plans have a catalog of ‘drug store‘ items you can order from and they are delivered to you at no cost. It is possible the items you want will not be included in the plan’s catalog of covered items. Plan’s have a quarterly limit on how much it gives you to spend on these items. The amount of the quarterly limit can vary widely between plans.

Gym Memberships.

You need to pay attention to the depth/variety of facilities that are available and close to you. Some plans include a ‘Silver and Fit’, ‘Silver Sneakers’, a membership with their own network of facilities. Some plans may charge ‘extra’ for this feature. Read the plan’s rules for this service and which facilities in your area are available to you.

Hearing Aids.

Many Medicare Advantage plans have 3rd party business partners that handle this extra benefit. This means you are using that vendor to spend your hearing allowance.

If you are unfamiliar with these products and are a member at Costco, you might visit them. They can provide you the foundation you need to understand product differences.

Plans can be different on what specific products (and services) are available to you.

Would a Medicare coach be helpful?

Will the people behind the TV ads include this service for you?

Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.

This page was last modified on Feb 2, 2026 @ 11:28 AM

Bear Lake County Medicare plans

Written on January 4, 2025. Posted in Medicare FAQs.

These eleven plans are broken down into three categories. These are:

Veterans, which get their prescription medications from the VA

Residents with special needs (Medicaid, chronic health issues, and people with institutional level of care)

Plans for the rest of the Bear Lake County Medicare beneficiaries.

When you review your options, we encourage you to consider the 2 low premium Medigap plans too.

Why?

More of the Bear Lake County Medicare plans are requiring permission to see a specialist. Waiting for this may slow your treatment plan.

The Medicare Advantage plans available to you may have fewer licensed physicians in their plan’s network than those available to you if you remained with ‘Original Medicare’.

The Kaiser Family Foundation published a report on this point dated 10/25/2025 and it is available to read here.

The title of this informative document is: “Medicare Advantage Provider Networks Limit Enrollees to About Half of the Physicians in Their Area That Are Available to Beneficiaries in Traditional Medicare, on Average.”

More hospitals in the US are no longer accepting Medicare Advantage plans. Read this report and this one too. Both were recently published.

Medigap plans are becoming more attractive for some.

With 2026 premiums and cost sharing of some Bear Lake County Medicare Advantage plans increasing to the point where these lower premium Medigap plans are attractive and competitive.

There are many positive benefits that come with these two plans which are not available from Medicare Advantage plans. A few of these are:

the doctors/hospitals in the Salt Lake City area, Boise, Seattle, and surrounding areas (including the rest of the US) are available to you; you just make the appointment;

you do not need referrals to see a specialist,

the limit on your share of the cost for your Medicare covered services is $2,950; remember this figure when you read about the ‘Maximum out of Pocket Cost’ for the Medicare Advantage plans available to you. These are reviewed below.

The eleven plans are broken down into different categories

Plans without prescription drug coverage

There are 3 plans in this category.

Premiums are $0.

The Medicare Part B ‘credit’ (also called ‘giveback’) ranges from: $30 to $100.

Veterans, who chose one of these plans for health care services, need to pay attention to the plan’s provider directory as it identifies which hospitals, physicians, etc. are available to plan members. Not all physicians in the area which ‘accept Medicare’ may not be available to plan members.

There are four Special Needs plans (C-SNP, and D-SNP) in 2026.

These include:

C-SNP (Chronic health care Special Needs plans)

C-SNPs are designed to provide benefits tailored to people with specific chronic health issues . Qualifying conditions include Diabetes mellitus; and/or Chronic heart failure; and/or Cardiovascular disorder (cardiac arrhythmias, coronary artery disease, peripheral vascular disease, chronic venous thromboembolic disorder). The plan qualification process includes:

Doctor Verification: The plan provider will work with your doctor to verify your chronic condition before you are fully approved for the plan.
Special Enrollment Period: You can use a one-time special enrollment period to join a C-SNP at any time of the year, not just during the annual fall enrollment period.

If you have one of these health issues and feel it you are not making progress getting it managed, one of these plans might help.

D-SNP (Dual eligible Special Needs plans).

If the Idaho Department of Health and Welfare has classified you as having ‘Enhanced Status’ you have Medicaid/Medicare coordinated (MMCP) plans to consider. Individuals awarded with QMB status have their own unique plans available. If you have a different Medicaid status, the plans discussed below are available to you.

All other Bear Lake County Medicare beneficiaries have 2 HMO and 2 PPO plans to consider.

HMO Plans.

Monthly premiums range from $0 to over $70.

Plan MOOP’s range (your ‘cap’ on your annual share of the costs for plan covered health care services) is $5900 to $6700.

As a general reminder, confirm the physicians, hospital(s), and other providers are in any plan(s) ‘provider directory’ before you enroll in a plan. If you work with a broker, they do this for you.

Your cost sharing when plan services are used vary by the service you use. Pay attention to these figures and other rules that apply to any ‘extras’ which may be included in plans. The plan’s ‘Evidence of Coverage’ document explains this and is available on the insurance company’s website.

Why review this document? Because it tells you the ‘rest of the story’. The higher level documents (marketing material, messages you hear in TV ads, the Summary of Benefits document typically offer a subset of plan covered services.

We can help you understand the differences between your plan choices, and when you are ready, help with enrollment too.

PPO Plans.

2026 monthly premiums for this County’s PPO plans range from $64 to over $80.

Mayo Clinic and other top-rated hospitals in the US are available to Idaho Medigap policy holders. The Mayo Clinics are no longer accepting appointments from Idaho Medicare Advantage enrollees. — Mayo Clinic and other top-rated hospitals in the US are available to Idaho residents enrolled in a Medigap plan. The Mayo Clinics **are no longer accept appointments from Idaho Medicare Advantage members.**

These plans have two MOOP figures.

You must consider both when selecting a plan.

Be sure and check these figures as they set the ‘cap’ for your share of the cost for plan covered health care services.

These figures can be important when comparing plans.

If you choose the ‘out of network’ option, be aware some hospitals in the US do not accept appointments from people insured with Medicare Advantage plans. The information found here is an up-to-date report on this subject.

Also be aware of the phrase in section 2 of the plan’s ‘Evidence of Coverage’. It reads: “However, providers that don’t contract with us are under no obligation to treat you, except in emergency situations.” This document is available on the insurance company’s website.

With the rising cost of Medicare Advantage plan premiums AND cost share, Medigap Plan G High-Deductible (HD-G) or Plan F High-Deductible (HD-F) are attractive alternatives.

Don’t let the words ‘high deductible’ scare you.

The figure is usually less than 1/2 of a Medicare Advantage plan’s ‘Maximum out of pocket limit’.

We recommend you understand the difference between the Hi Deductible Medigap Plans before considering a new Idaho Medicare Advantage plan. We are seeing more Idaho residents chose these plans.

Why? Because you have:

Freedom to choose any physician/hospital which ‘accepts Medicare insurance’ (most do)
Few ‘prior authorizations; you do not have an insurance company standing between you and your physician to get to the next step in your health care;
Few/no referrals are needed; you just make the appointment
Stable coverage year after year
Nationwide access to health care; this means you minimize the growing issue of hospitals not accepting Medicare Advantage plans
More predictable costs when you use care.
Medigap HD-G is tied directly to Original Medicare’s cost structure. Cost sharing for Part A and B covered services is here. This means Medicare (CMS) is setting your cost share, not individual insurance companies.

Remember, Medicare is paying the ‘lions’ share of your health care costs (for Part A and B covered services) and you are paying the balance. This concept is the same with a Medicare Advantage plan.

The ‘Deductible’ compared to the ‘Maximum out of pocket limit’.

2025 deductible: $2,870
2026 deductible: $2,950

This is different from Medicare Advantage, where the insurance company sets the out-of-pocket cost maximum limit.

The insurance company can change each of their plan’s cost sharing figures annually.

Medicare sets the maximum this ‘out of pocket limit’ can be.

The insurance company sets their own figure, provided it does not exceed the permitted maximum for the year.

If you joined Medicare before January 1, 2020, you qualify to join Hi Deductible Plan F. This plan also covers the annual Part B deductible where Plan G will leave exposed to this potential expense. This year that figure is $283. Often the monthly premium for the F and G versions of this hi-deductible plan are the same.

Call us if you have questions.

Premium Comparison (for Idaho)

Both Medigap HD-G and HD-F 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 noticeably less cost sharing when you use care.

Plan Type	Monthly Premium	Out-of-Pocket When You Use Care
HD-G	Lower < $85	$2950 deductible, then full coverage
Plan G	Higher; varies by insurance company.	Cost sharing is less than $290/year
Plan N	Less than Plan G	Some additional copays and cost sharing
Plan F*	More than Plan G	$0 cost sharing for Part A&B services.

*Plan F is only available to people who became eligible for Medicare before January 1, 2020. Call us if you have questions about this choice.

Other issues to consider when selecting a Bear Lake County Medicare plan.

If your doctor ran tests on you to diagnose the reason you are visiting them, and unfortunately the diagnosis came back as a serious health issue. Would you start thinking about where you want to be treated and by whom?

If you are diagnosed with Cancer…

Proton Therapy is an example of newer technology for treating some cancers. Read this article if you are unfamiliar with this technology. At this point, forty six hospitals (out of over 4500) offer this solution. One of them is in Northern Utah. This video does a good job of describing how this works. A map of facilities that offer this resource is available here.

Some medications treating cancer are covered by Medicare Part B. These medications can be expensive. If a person is treated with these medications (and are covered by Medicare), it will contribute to reaching the plan’s MOOP (or ‘deductible if they enrolled in a hi-deductible Medigap plan).

Resources are available to help you find the top hospitals in the US.

The top 250 hospitals in the US may have the latest technologies to treat different health issue(s)…and the physicians that know how to use them. Some of these resources in the Western Part of the US include:

Mayo Clinic Hospital (Phoenix)

Cedars-Sinai Medical Center (West Hollywood)

Northridge Hospital Medical Center (Northridge)

Providence Holy Cross Medical Center (Mission Hills)

Scripps Mercy Hospital San Diego (San Diego)

Stanford Hospital (Stanford)

Sutter Roseville Medical Center (Roseville.

Some of these hospitals may not accept the Medicare Advantage plans. If you have a Medigap most will accept your insurance. Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on four and five-star rated hospitals AND skilled nursing facilities. Learn more about this subject here. There are physician rating services too. One is available here. We focus on physicians with a four or five star rating and have at least ten ratings. We also recommend you use a ‘board certified physician‘.

This tool will point out hospitals in/around Bear Lake County.

Click here to see a map of the hospitals 50 miles around downtown Montpelier (zip code 83254). We recommend Bear Lake County Medicare beneficiaries focus on 4 or 5-star rated facilities. Notice 1 of the 7 facilities appearing on this map are rated in this category and is located in Utah. This facility may not be in all plan’s ‘network’ available to you. If you pick a Medigap plan, it will be.

Medications covered by each plan.

According to this source, there can be a 25+/- % variance between the number of prescription medications covered by Idaho Medicare Advantage plans. Note none of these plans include 100% of the medications covered by Medicare. This same resource documents the number of medications each plan has in each of the 5 (or 6) drug tiers AND the fill/refill cost by these same drug tiers. These figures can vary noticeably between plans.

Dot your I’s and cross your T’s.

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

The Centers for Medicare and Medicaid Services (CMS) have requirements insurance companies(s) offering Medicare plan(s) must meet when they put together their list of covered medications. Below is a cut/paste from (Section 30.2.5) the current Medicare Prescription Drug Benefit Manual. “Part D sponsor formularies must include all or substantially all drugs in the immunosuppressant(for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic classes. CMS instituted this policy because it was necessary to ensure that Medicare beneficiaries reliant upon these drugs would not be discouraged from enrolling in certain Part D plans, as well as to mitigate the risks and complications associated with an interruption of therapy for these vulnerable populations.“ We feel this is an important statement everyone enrolled/wishing to enroll in a Medicare prescription drug plan should be aware of.

What insurance companies offer Medicare Advantage plans in Bear Lake County?

Humana

Molina

United Healthcare.

Would a Idaho based Medicare coach be helpful?

A coach can firm up your understanding of Medicare, explain differences between your choices, and help you with enrollment. They will also be there year after year to help you. Will the people behind the TV ads include this service for you? Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.

This page was last modified on Mar 1, 2026 @ 11:17 AM

Custer County Medicare

Written on January 3, 2025. Posted in Medicare FAQs.

2026 Custer County Medicare Advantage plans.

There is a synopsis of changes to the Idaho Medicare Advantage marketplace here. If you are not aware of these changes, please take a few minutes and read this material.

An overview of your 2026 County’s Medicare Advantage plans should be updated on this website by 10/15/2026. Be sure and check back for this important information.

What you need to know about Idaho 2025 Custer County Medicare plans!

For 2025, Custer County has 5 Medicare Advantage plans for residents to consider. Some of these plans have a $0 monthly premium.

Below is the high level break down of these plans:

1 plan does NOT include prescription drug coverage; Veterans may find this plan attractive.

2 plans are reserved for residents which 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).

If you have a Medicaid status of QMB+, QMB or SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.

2 HMO plans are available for the rest of Custer County residents. We recommend veterans also consider these plans.

There is another type of Medicare plan you should be aware of.

These are Medigap plans.

When you choose this Medigap plan, all doctors/hospitals that accept Medicare insurance in the USA are available to you. This means you do not have the network restrictions/rules found in Custer County Medicare Advantage plans.

You will have fewer ‘prior authorizations’ to deal with.

Learn more about Idaho Medigap plans here.

What are the differences between the two Custer County Medicare Advantage?

Monthly premiums range from $0 to $66.

One item is the plan’s Maximum out of pocket limit (MOOP). Read the information below to learn why this is a key differentiator between plans.

The MOOP is a key figure you should be aware of. Put plans on your short list that have a lower MOOP. This decision may save you money if you use Medicare covered health care services during the plan year.

Be aware your insurance company pays its lion’s share of the cost for services you use. You pay the rest. Your share of these costs can vary noticeably between plans.

Medicare sets the maximum figure(s) a plan can have, and they can change it annually.

The insurance company offering your plan sets the plans MOOP where they want it. It must be at or below Medicare’s limit. This figure can change annually.

What are the actual MOOP figures?

Medicare’s maximum MOOP for this year’s HMO plans is $9,350.

Insurance companies offering Medicare Advantage plans set their plan’s MOOP based on each of their plan’s business goals.

The range of MOOP for your County’s HMO Medicare Advantage plans is $4,900 to $6,300.

We prefer plans that meet a person’s needs, have a low MOOP, AND plans with a monthly premium below $70.

If you understand the math when calculating your MOOP skip the paragraph below.

Let’s say your plan’s MOOP is $7,000 for the year.

In January you are admitted to the hospital for surgery. Your bill for the 5-day hospital stay is $1,750. Your post-op visits to your physician and physical therapist(s) are $475.

When you subtract these figures from your plan’s MOOP, the result is how much left you have to pay until your MOOP hits zero. When, after you use additional services, and your MOOP hits zero, your plan pays the rest of your share of the cost for Medicare A & B services.

If you have a plan with a ‘lower MOOP’ you have the opportunity to keep more money in your pocket.

**The insurance company offering Custer County Medicare plans sets the cost sharing for each Part A and B service.**

Specific plans may have prior authorizations on certain covered services.

You find this information in your plan’s ‘Evidence of Coverage’ document. This is available on the insurance company’s web site and can be downloaded.

Your insurance company can approve or deny the service requested by the ‘prior authorization’. If the service is denied, your prescribing physician has to go to ‘plan B’ and start the process over. This is one of the reasons we prefer plans that do not have insurance companies standing between you/your physician to get to the ‘next step’ in your health care. The article found here brings this point to life.

Dental coverage is another example where rules are important to know.

For example, dental (if included in a plan) may exclude certain coverages. This can be done by dental billing code(s) or by limitations on specific services you need that are in coverage class I, II, and III. Implants or braces may be covered by some plans, but not others. There may be limitation on the number of cleanings too (2-year when you may need 4); periodontal services, if covered, may have their own limitations, etc. The dollar value the insurance company offers you for dental coverage can vary widely between plans.

Doctors/hospitals/other providers.

The above can change during the calendar year. This announcement is an example of why networks can change during the year. Another example is found here and here.

Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies is competing for other financial needs of the hospital.

Proton Therapy is an example of newer technology to treat cancer.

Read this article if you are unfamiliar with this. At this writing, 45 hospitals (out of over 4500) offer this solution. Facilities near Idaho include:

Huntsman Cancer Institute (Salt Lake City) (began offering this service in 2021)

The Mayo Clinic Cancer Center (Phoenix…rolled out this service on 2016)

Loma Linda University Cancer Center (began offering this service in 1990)

California Protons Cancer Therapy Center (San Diego) (began offering this service in 2017).

If you are interested in this service, you might check where each of the above facilities are ranked in the top 250 hospitals.

Do you want access to the top 250 hospitals in the country?

The Mayo Clinics are not available to Idaho Medicare Advantage plan members. If you want access to these resources, consider staying with Original Medicare and enroll in a Medigap plan. Call us with your questions.

Would you consider using the services of the top hospitals in the Seattle area? How about the the Mayo Clinics or the rest of the hospitals and physicians (that ‘accept Medicare’) in the US.

The top 250 hospitals in the US may have the latest technologies to treat different health issue(s)…and the physicians that know how to use them. These resources are available to you if they accept Medicare insurance (Part A and B). Some of these facilities do not accept Medicare Advantage plans (Part C). Others open their doors if you stayed with Original Medicare (Part A and B…and not enrolled in a Medicare Advantage plan). If you have a Medigap plan it will help you pay the left-over costs that Medicare does not completely cover.

Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.

We also recommend you consider using a ‘board certified physician‘.

Hospitals in your immediate area.

There is a hospital in Challis. However, there are no other hospitals within 50 miles of downtown Challis (83226).

Get a visual of it’s location by clicking here .

Expand the search radius around Challis to 100 miles. Now there are 5 more hospitals to consider. Note that none of these facilities have a ‘star rating‘ by Medicare.

We recommend Idaho residents consider using the services of hospitals with at least a 4-star rating.

Be aware all of the hospitals within 100 miles of Challis may not be in-network of all the Medicare Advantage plans available to Custer County residents. If you have a Medigap plan, all of the listed hospitals (and the rest in the US) are available to you.

Medications covered by each plan.

This is a key reason you should not enroll in any Medicare Advantage plan until you understand your cost for your prescription medications by available plans. If you are working with a broker/agent that just tells you your medications are covered, we suggest you work with someone else that will share the whole picture.

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

The Centers for Medicare and Medicaid Services (CMS) has requirements insurance company(s) offering Medicare plan(s) must meet when they put together their list of covered medications.

Below is a cut/paste from (Section 30.2.5) the current Medicare Prescription Drug Benefit Manual.

Medicare Supplement Plans.

As mentioned above, these plans give you the choice of any doctor/hospital/other providers (in the US) that accept Medicare insurance. Over 90% of physicians in the US accept Medicare insurance (Part A and B) and most of the hospitals do too.

When you have a Medicare Supplement plan, typically the hospital as well as physicians you work with have far fewer ‘prior authorizations’ and denial of claims issues to deal with. You and your physician are making the decision on the ‘next step’ in your health care. You do not have an insurance company standing between you and your physician to get the ‘next step’ in your health care done.

Read the articles supporting the above comments here, here, and here.

Do you want a plan that pays for most all of the left-over cost for Part A and B in the US?

We recommend you consider a Medigap Plan G.

The monthly premium for this plan varies by the insurance company offering the plan. The coverage is the same, the only difference is the name of the company on your policy and their monthly premium. Premiums range from below $200/month to over $250 for this same plan. When you work with a broker, they help you navigate you way through the ‘who to do business’ issue.

Why pick Plan G?

Because this plan pays all of your left-over costs that Medicare does not pay except the annual Part B deductible. This deductible is a Medicare controlled figure, and it goes up a bit each year. Your share of the other left-over costs is documented here.

Something else to keep in mind is Medicare typically bumps up the cost of Part A and B services. They do this annually. Your Medigap plan automatically pays your share of these increased costs.

The other Medigap plans typically have a lower premium than Plan G…but you have more ‘left over costs’ that you will pay. Check out page 11 of the document found here. This shows all of the Medicare covered health care services by each of the different 12 Medigap plans.

If you prefer a lower premium Medigap plan…

If you want a lower premium and are willing to pay for leftover costs, there are other Medigap plans to consider. These are Plans A, B, D, K, L, M, ad N. Plans C and F are reserved for people enrolled in Medicare prior to 1/1/2020.

A Medicare insurance broker, that is licensed with all/most all plans available to you, helps you navigate your way through this maze and select the insurance company and plan which meets your needs and budget.

We have been helping Idaho residents with this task since 2012.

Call us if you want help.

Read the fine print on extra Benefits included in Medicare Advantage plans.

Dental Coverage:

Please review the verbiage on dental care found in the Evidence of Coverage.

If you listen to the TV commercials, this sounds like a great and often needed ‘extra’.

You really need to pay attention to the details as they can vary widely between the plans that include this feature.

For example, some plans restrict coverage to preventative care (a few cleanings annually, x-rays you can get have their own schedule, etc.). The plan may cover certain periodontal services. If covered, the plan may limit the number of times specific service(s) can be used during the year.

Some plans include coverage for class II and III services. If they do, there may be restrictions on specific services covered and may explicitly exclude certain dental billing codes. Please read your plan’s ‘Evidence of Coverage’ for specific details.

Do you need to use the plans network of dentists?

Plans may have a network of dentists you can use; some permit the use of any licensed dentist in the US for services.

Plans may state cosmetic services are not covered. It you use an ‘out of network dentist, you may pay for all services. If your plan permits use of out of network services, your cost may be higher. .

We suggest you read dental coverage section of the ‘Evidence of Coverage’ document.

Your plan may not pay for services you use which are excluded from your plan. If you have any question about whether a service is covered, call your plan’s customer service. You may have to get specific billing codes from your dentist just to be sure you get the right answer.

We like plans that let you use any licensed dentist in the US and cover all non-cosmetic dental services.

Vision Coverage.

Over The Counter benefit.

Some plans have a catalog of ‘drug store‘ items you can order from. The products you select are typically delivered to you at no cost.

It is possible the items you want will not be included in the plan’s catalog of covered items. Plan’s have a quarterly limit on how much it gives you to spend on these items. The amount of the quarterly limit can vary widely between plans.

Gym Memberships.

You need to pay attention to the depth/variety of facilities that are available and close to you. Some plans include a ‘Silver and Fit’, ‘Silver Sneakers’, a membership with their own network of facilities. Some plans may charge ‘extra’ for this feature. Read the plan’s rules for this service…and which facilities in your area are available to you.

Hearing Aids.

Many Medicare Advantage plans have 3rd party business partners that handle this extra benefit. This means you are using that vendor to spend your hearing allowance.

Visiting the Costco hearing department may provide the education you need to understand product differences.

Plans can be different on what specific products (and services) are available to you.

Would a Medicare coach be helpful?

Medicare Advantage plans compete with each other to earn your business. <yoastmark class=

Will the people behind the TV ads include this service for you?

Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.

This page was last updated on Oct 4, 2025 @ 4:16 PM.

Lemhi County Medicare

Written on January 3, 2025. Posted in Medicare FAQs.

2026 Lemhi County Medicare Advantage plans.

There is a synopsis of changes to the Idaho Medicare Advantage marketplace here. If you are not aware of these changes, please take a few minutes and read this material.

An overview of your 2026 County’s Medicare Advantage plans should be updated on this website by 10/15-25/2026. Be sure and check back for this important information.

What are we waiting for? Provider directories which include which hospitals are in the plan’s network. We have most of the Evidence of Coverage documents now.

What you need to know about 2025 Lemhi County Medicare Advantage plans!

For 2025, Lemhi County has 5 Medicare Advantage plans for residents to consider. Some of these plans have a $0 monthly premium.

Below is the high level break down of these plans:

1 plan does NOT include prescription drug coverage; Veterans may find this plan attractive.

If you have a Medicaid status of QMB+, QMB or SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.

2 HMO plans are available for the rest of Lemhi County residents. We recommend veterans also consider these plans.

There is another type of Medicare plan you should be aware of.

These are Medigap plans.

When you choose one of the 12 Medigap plans, all doctors/hospitals that accept Medicare insurance in the USA are available to you.

This means you do not have the network restrictions/rules found in Lemhi County Medicare Advantage plans. Also, you do not have an insurance company standing between your physician to get permission to move forward with your treatment plan.

Physicians/hospitals prefer these plans because they know they will be paid in a timely manner. Also, there are fewer ‘prior authorizations’ for them to deal with.

Learn more about Idaho Medigap plans here.

What are the differences between the 2 Medicare Advantage Prescription Drug plans for residents not enrolled in Medicaid?

One item is the plan’s Maximum out of pocket limit (MOOP). Read the information below to learn why this is a key differentiator between plans.

Be aware Medicare pays its lion’s share of the cost for services you use. You pay the rest. Your share of these costs can vary noticeably between plans.

Medicare sets the maximum figure(s) a plan can have, and they can change it annually.

The insurance company offering your plan sets the plans MOOP where they want it. It must be at or below Medicare’s limit. This figure can change annually.

What are the actual MOOP figures?

Medicare’s maximum MOOP for this year’s HMO plans is $9,350.

Insurance companies offering Medicare Advantage plans set their plan’s MOOP based on each of their plan’s business goals.

The range of MOOP for your County’s HMO Medicare Advantage plans is $4,900 to $6,300.

We prefer plans that meet a person’s needs, have a low MOOP, AND plans with a monthly premium below $70.

If you understand the math when calculating your MOOP skip the paragraph below.

Let’s say your plan’s MOOP is $7,000 for the year.

In January you are admitted to the hospital for surgery. Your bill for the 5-day hospital stay is $1,750. Your post-op visits to your physician and physical therapist(s) are $475.

If you have a plan with a ‘lower MOOP’ you have the opportunity to keep more money in your pocket.

**The insurance company offering your MAPD plan sets the cost sharing for each Part A and B service.**

Specific plans may have prior authorizations on certain covered services.

You find this information in your plan’s ‘Evidence of Coverage’ document. This is available on the insurance company’s web site and can be downloaded.

Dental coverage is another example where rules are important to know.

Doctors/hospitals/other providers.

The above can change during the calendar year. This announcement is an example of why networks can change during the year. Another example is found here and here.

Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies is competing for other financial needs of the hospital.

Proton Therapy is an example of newer technology for treating cancer.

Read this article if you are unfamiliar with this alternative to x-ray treatment (photon).

At this writing, 45 hospitals (out of over 4500) offer this solution. Facilities near Idaho include:

Huntsman Cancer Institute (Salt Lake City) (began offering this service in 2021)

The Mayo Clinic Cancer Center (Phoenix…rolled out this service on 2016)

Loma Linda University Cancer Center (began offering this service in 1990)

California Protons Cancer Therapy Center (San Diego) (began offering this service in 2017).

If you are interested in this service, you might check where each of the above facilities are ranked in the top 250 hospitals.

Are you interested in the top 250 hospitals in the country?

Would you consider using the services of the top hospitals in the Seattle area…or the Mayo Clinics?

Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.

We also recommend you use a ‘board certified physician‘.

Hospitals in your immediate area.

The nearest hospital to downtown Challis is 48 miles away. Get a visual of this area by clicking here.

Expand the search radius around Challis to 100 miles. Now there are 5 more hospitals to consider. Note that none of these facilities have a ‘star rating‘ by Medicare.

We recommend Idaho residents consider using the services of hospitals with at least a 4-star rating.

Medications covered by each plan.

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

The Centers for Medicare and Medicaid Services (CMS) has requirements insurance company(s) offering Medicare plan(s) must meet when they put together their list of covered medications.

Below is a cut/paste from (Section 30.2.5) the current Medicare Prescription Drug Benefit Manual.

We feel this is an important statement everyone enrolled/wishing to enroll in a Medicare prescription drug plan should be aware of.

Medicare Supplement plans.

Read the articles supporting the above comments here, here, and here.

Do you want a plan that pays for most all of the left-over cost for Part A and B in the US?

We recommend you consider a Medigap Plan G.

Why pick Plan G?

Something else to keep in mind is Medicare typically bumps up the cost of Part A and B services. They do this annually. Your Medigap plan automatically pays your share of these increased costs.

If you prefer a lower premium Medigap plan…

When you work with a Medicare broker that is licensed with all/most all plans available to you, they help you navigate your way through this maze and select the insurance company and plan which meets your needs and budget.

We have been helping Idaho residents with this task since 2012.

Call us if you want help.

Would a Medicare coach be helpful?

Medicare Advantage plans compete with each other to earn your business. <yoastmark class=

Will the people behind the TV ads include this service for you?

Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.

This page was last updated on Oct 11, 2025 @ 7:06 AM.

Caribou County Medicare Plans

Written on January 3, 2025. Posted in Medicare FAQs.

Caribou County Medicare beneficiaries have 11 Medicare Advantage plans to consider.

These plans are broken down into three categories. These are:

Veterans, which get their prescription medications from the VA

Residents with special needs (Medicaid, chronic health issues, and people with institutional level of care)

Plans for the rest of the Caribou County Medicare beneficiaries.

When you review your options, we encourage you to consider the 2 low premium Medigap plans too.

Why?

More of the Caribou County Medicare plans are requiring permission to see a specialist. Waiting for this may slow your treatment plan.

The Medicare Advantage plans available to you may have fewer licensed physicians in their plan’s network than those available to you if you remained with ‘Original Medicare’.

The Kaiser Family Foundation published a report on this point dated 10/25/2025 and it is available to read here.

The title of this informative document is: “Medicare Advantage Provider Networks Limit Enrollees to About Half of the Physicians in Their Area That Are Available to Beneficiaries in Traditional Medicare, on Average.”

More hospitals in the US are no longer accepting Medicare Advantage plans. Read this report and this one too. Both were recently published.

Medigap plans are becoming more attractive for some.

With 2026 premiums and cost sharing of some Caribou County Medicare Advantage plans increasing to the point where these lower premium Medigap plans are attractive and competitive.

There are many positive benefits that come with these two plans which are not available from Medicare Advantage plans. A few of these are:

the doctors/hospitals in the Salt Lake City area, Boise, Seattle, and surrounding areas (including the rest of the US) are available to you; you just make the appointment;

you do not need referrals to see a specialist,

The eleven plans are broken down into different categories

Plans without prescription drug coverage

There are 3 plans in this category.

Premiums are $0.

The Medicare Part B ‘credit’ (also called ‘giveback’) ranges from: $30 to $100.

We can help you under stand plan differences and, when you are ready, help with enrollment in the plan you choose.

There are four Special Needs plans (C-SNP, and D-SNP) in 2026.

These include:

C-SNP (Chronic health care Special Needs plans)

Doctor Verification: The plan provider will work with your doctor to verify your chronic condition before you are fully approved for the plan.
Special Enrollment Period: You can use a one-time special enrollment period to join a C-SNP at any time of the year, not just during the annual fall enrollment period.

If you have one of these health issues and feel it you are not making progress getting it managed, one of these plans might help.

D-SNP (Dual eligible Special Needs plans).

All other Caribou County Medicare beneficiaries have 2 HMO and 2 PPO plans to consider.

HMO Plans.

Monthly premiums range from $0 to over $70.

Plan MOOP’s range (your ‘cap’ on your annual share of the costs for plan covered health care services) is $5900 to $6700.

We can help you understand the differences between your plan choices, and when you are ready, help with enrollment too.

PPO Plans.

2026 monthly premiums for this County’s PPO plans range from $64 to over $80

These plans have two MOOP figures.

You must consider both when selecting a plan.

Be sure and check these figures as they set the ‘cap’ for your share of the cost for plan covered health care services.

These figures can be important when comparing plans.

We can help you understand the differences between your plan choices, and when you are ready, help with enrollment too.

With the rising cost of Medicare Advantage plan premiums AND cost share, Medigap Plan G High-Deductible (HD-G) or Plan F High-Deductible (HD-F) are attractive alternatives.

Don’t let the words ‘high deductible’ scare you.

The figure is usually less than 1/2 of a Medicare Advantage plan’s ‘Maximum out of pocket limit’.

We are seeing more Idaho residents chose these plans.

Why? Because you have:

Freedom to choose any physician/hospital which ‘accepts Medicare insurance’ (most do)
Few ‘prior authorizations; you do not have an insurance company standing between you and your physician to get to the next step in your health care;
Few/no referrals are needed; you just make the appointment
Stable coverage year after year
Nationwide access to health care; this means you minimize the growing issue of hospitals not accepting Medicare Advantage plans
More predictable costs when you use care.
Medigap HD-G is tied directly to Original Medicare’s cost structure. Cost sharing for Part A and B covered services is here. This means Medicare (CMS) is setting your cost share, not individual insurance companies.

The ‘Deductible’ compared to the ‘Maximum out of pocket limit’.

Medicare sets this deductible and it goes up a bit annually. Individual insurance companies offering these plans cannot adjust this figure. Once your annual out of pocket cost for the Part A and B services hit the plans ‘deductible’, you are done paying for Part A and B costs for the calendar year. Note, Medicare Part B services has it’s own deductible too. This needs to be met too. The probability you will not met this and you reach the hi-deductible requirement for this Medigap plan is quite smal).

2025 deductible: $2,870
2026 deductible: $2,950

This is different from Medicare Advantage, where the insurance company sets the out-of-pocket cost maximum limit (provided it does not exceed Medicare’s permitted ‘maximum figure’.

Call us if you have questions.

Premium Comparison (for Idaho)

Plan Type	Monthly Premium	Out-of-Pocket When You Use Care
HD-G	Lower < $85	$2950 deductible, then full coverage
Plan G	Higher; varies by insurance company.	Cost sharing is less than $290/year
Plan N	Less than Plan G	Some additional copays and cost sharing
Plan F*	More than Plan G	$0 cost sharing for Part A&B services.

*Plan F is only available to people who became eligible for Medicare before January 1, 2020. Call us if you have questions about this choice.

Other issues to consider when selecting a Caribou County Medicare plan.

If you are diagnosed with Cancer…

Proton Therapy is an example of newer technology for treating some cancers. Read this article if you are unfamiliar with this technology. At this point, forty six hospitals (out of over 4500) offer this solution. One of them is in Northern Utah. This video does a good job of describing how this works. A map of facilities that offer this resource is available here.

Resources are available to help you find the top hospitals in the US.

The top 250 hospitals in the US may have the latest technologies to treat different health issue(s)…and the physicians that know how to use them. Some of theses resources in the Western Part of the US include:

Mayo Clinic Hospital (Phoenix)

Cedars-Sinai Medical Center (West Hollywood)

Northridge Hospital Medical Center (Northridge)

Providence Holy Cross Medical Center (Mission Hills)

Scripps Mercy Hospital San Diego (San Diego)

Stanford Hospital (Stanford)

Sutter Roseville Medical Center (Roseville.

Some of these hospitals may not accept the Medicare Advantage plans.

If you have a Medigap most will accept your insurance.

Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on four and five-star rated hospitals AND skilled nursing facilities. Learn more about this subject here.

There are physician rating services too. One is available here. We focus on physicians with a four or five star rating and have at least ten ratings. We also recommend you use a ‘board certified physician‘.

This tool will point out hospitals in/around Caribou County.

Click her e to see a map of the hospitals 50 miles around downtown Soda Springs (zip code 83276).

We recommend Caribou County Medicare beneficiaries focus on 4 or 5-star rated facilities.

Notice 1 of the 6 facilities appearing on this map are rated in this category and it is located in Wyoming. This facility may not be in all of the plan’s ‘network’ available to you. If you pick a Medigap plan, it will be.

Medications covered by each plan.

Dot your I’s and cross your T’s.

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

What insurance companies offer Medicare Advantage plans in Caribou County?

Humana

Molina

United Healthcare.

Would a Idaho based Medicare coach be helpful?

This page was last modified on Mar 2, 2026 @ 7:30 AM.

Idaho County Medicare

Written on January 3, 2025. Posted in Medicare FAQs.

2026 Idaho County Medicare Advantage plans.

There is a synopsis of changes to the Idaho Medicare Advantage marketplace here. If you are not aware of these changes, please take a few minutes and read this material.

An overview of your 2026 County’s Medicare Advantage plans should be updated on this website by 10/15-25/2026. Be sure and check back for this important information.

What are we waiting for? Provider directories which include which hospitals are in the plan’s network. We have most of the Evidence of Coverage documents now.

What you need to know about 2025 Idaho County Medicare Advantage Plans!

For 2025, Idaho County has 8 Medicare Advantage and 12 Medigap plans for residents to consider. Some of these plans have a $0 monthly premium.

Below is the high level break down of these plans:

1 plan does NOT include prescription drug coverage; Veterans may find this plan attractive.

If you have a Medicaid status of QMB and SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.

1 plan is available for residents with a QMB Medicaid status.

1 Medicare Medicaid Coordinated plan (MMCP) is available for residents with an ‘enhanced’ Medicaid status.

2 HMO plans are available for the rest of Idaho County residents. We recommend veterans also consider these plans.

1-PPO plan is available also. PPO plans have a defined network for members to use; they can also go ‘out-of-network’. Higher out of pocket costs will apply plus there is a higher MOOP. Veterans should also look at this plan.

The above information came from this source.

There is another type of Medicare plan you should be aware of.

These are Medigap plans.

You will have fewer ‘prior authorizations’ to deal with.

Learn more about Idaho Medigap plans here.

What are the differences between the 3 Medicare Advantage plans for residents not enrolled in Medicaid?

One item is the plan’s Maximum out of pocket limit (MOOP). Read the information below to learn why this is a key differentiator between plans.

Be aware the Medicare Advantage plan pays its lion’s share of the cost for services you use. You pay the rest. Your share of these costs can vary noticeably between plans.

Medicare sets the maximum figure(s) a plan can have, and they can change it annually.

The insurance company offering your plan sets the plans MOOP where they want it. It must be at or below Medicare’s limit. This figure can change annually.

PPO plan(s) have a different maximum MOOP than HMO plans.

What are the actual MOOP figures?

Medicare’s maximum MOOP for this year’s HMO plans is $9,350.

The maximum for PPO plans for out of network service use is $14,000. In network use the figure is $9,350.

Insurance companies offering Medicare Advantage plans set their plan’s MOOP based on each of their plan’s business goals.

The range of MOOP for your County’s HMO Medicare Advantage plans is $4,900 to $6,300.

The PPO plan is $6,900 when in-network services are used; if the member goes out-of-network (even just once) this figure bumps up to $14,000.

The above figures came from this source.

If you understand the math when calculating your MOOP skip the paragraph below.

Let’s say your plan’s MOOP is $7,000 for the year.

In January you are admitted to the hospital for surgery. Your bill for the 5-day hospital stay is $1,750. Your post-op visits to your physician and physical therapist(s) are $475.

If you have a plan with a ‘lower MOOP’ you have the opportunity to keep more money in your pocket.

**The insurance company offering your MAPD plan sets the cost sharing for each Part A and B service.**

PPO plans have two sets of figures for plan covered services. One is if the member uses ‘in-network’ providers; the other is if they use ‘out-of-network’ providers. Out-of-network cost sharing is typically higher than if the same services were from in-network providers.

Specific plans may have prior authorizations on certain covered services.

You find this information in your plan’s ‘Evidence of Coverage’ document. This is available on the insurance company’s web site and can be downloaded.

Dental coverage is another example where rules are important to know.

Doctors/hospitals/other providers.

The above can change during the calendar year. This announcement is an example of why networks can change during the year. Another example is found here and here.

Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies is competing for other financial needs of the hospital.

Proton Therapy is an example of newer technology for treating cancer.

Read this article if you are unfamiliar with this. At this writing, 45 hospitals (out of over 4500) offer this solution. Facilities near Idaho include:

Huntsman Cancer Institute (Salt Lake City) (began offering this service in 2021)

The Mayo Clinic Cancer Center (Phoenix…rolled out this service on 2016)

Loma Linda University Cancer Center (began offering this service in 1990)

California Protons Cancer Therapy Center (San Diego) (began offering this service in 2017).

If you are interested in this service, you might check where each of the above facilities are ranked in the top 250 hospitals.

Are you interested in the top 250 hospitals in the country?

Would you consider using the services of the top hospitals in the Seattle area…or the Mayo Clinics?

Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.

We also recommend you use a ‘board certified physician‘.

Medications covered by each plan.

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

The Centers for Medicare and Medicaid Services (CMS) has requirements insurance company(s) offering Medicare plan(s) must meet when they put together their list of covered medications.

Below is a cut/paste from (Section 30.2.5) the current Medicare Prescription Drug Benefit Manual.

We feel this is an important statement everyone enrolled/wishing to enroll in a Medicare prescription drug plan should be aware of.

Would a Medicare coach be helpful?

Medicare Advantage plans compete with each other to earn your business. <yoastmark class=

Will the people behind the TV ads include this service for you?

Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.

This page was last updated on Oct 11, 2025 @ 7:04 AM

Clearwater County Medicare plans

Written on January 3, 2025. Posted in Medicare FAQs.

2026 Clearwater County Medicare Advantage plans.

There is a synopsis of changes to the Idaho Medicare Advantage marketplace here. If you are not aware of these changes, please take a few minutes and read this material.

An overview of your 2026 County’s Medicare Advantage plans should be updated on this website by 10/15-25/2026. Be sure and check back for this important information.

What are we waiting for? Provider directories which include which hospitals are in the plan’s network. We have most of the Evidence of Coverage documents now.

What you need to know about 2025 Clearwater County Medicare Advantage plans!

For 2025, Clearwater County has 9 Medicare Advantage plans for residents to consider.

A plan targeted for Veterans.

1 plan is targeted for Veterans that gets their prescription med’s from the VA. Veterans may find this plan attractive as it is a back up for health care services you get from the VA. All health care services offered by Medicare are included in this plan including ‘Emergency services’. The plan may contain other non-Medicare covered benefits.

Plans for people with specific chronic health issues.

2 plans are unique and reserved for residents which 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). If you have a Medicaid status of QMB+, QMB or SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.

Plans for people with Medicaid status of ‘enhanced’ or ‘QMB’.

3 other plans are reserved for people classified as ‘Enhanced’ Medicaid. If you have this qualification, we suggest you consider these plans. Why? Because you get a ‘care coordinator’ that helps pave the way for you to get the medical appoints you need AND these plans may have ‘extra’ benefits that go beyond what either Medicare OR Medicaid offers. These plans are also called a ‘Medicare Medicaid Coordinated plan’. The next plan is for people assigned a ‘QMB’ Medicaid status. If this includes you, we encourage you to focus on this plan. Why? The care coordination covered by either Medicaid or Medicare is taken care of by the plan. The plan may also include ‘extra benefits’ at little/no cost.

Plans for the rest of Clearwater County residents.

2 plans are available for the rest of Clearwater County residents. Both of these are HMO plans. We help you understand their differences and enroll in the play you choose. We recommend veterans also consider these plans.

Clearwater County has another type of Medicare plan you should be aware of.

These plans are called Medigap (also called Medicare Supplement) plans.

When you choose this type of plan, all doctors/hospitals that accept Medicare insurance in the USA are available to you.

This means you do not have the network restrictions/rules found in Clearwater County Medicare Advantage plans.

Also, you do not have an insurance company standing between your physicians to get permission to move forward with your treatment plan.

Physicians/hospitals may prefer these plans because they know they will be paid in a timely manner.

You will have fewer ‘prior authorizations’ to deal with.

Learn more about Idaho Medigap plans here.

Two of these plans limit your annual out of pocket costs for Part A and B covered services to less than $2,900.

This figure is controlled by Medicare and typically goes up a bit annually. If your cost share for Medicare Part A and B used services for the calendar year hits this figure, your Medigap plan pays the rest of your left-over Medicare Part A and B health care costs. Keep this figure in mind when you read the discussion below on ‘out of pocket limits’ in Medicare Advantage plans.

What are the differences between the two Clearwater County Medicare Advantage plans for residents not enrolled in Medicaid?

One item is the plan’s Maximum out of pocket limit (MOOP). Read the information below to learn why this is a key differentiator between plans.

Be aware your Medicare Advantage plan pays its lion’s share of the cost for services you use. You pay the rest. Your share of these costs can vary noticeably between plans. Think of the MOOP as your limit (or cap) for your share of health care costs for Part A and B services you use during the calendar year. The higher your plan’s MOOP, the more you could end up paying for the services you use. Medicare sets the maximum figure(s) a plan can have, and they can change it annually. The insurance company offering your plan sets the plans MOOP where they want it. It must be at or below Medicare’s limit. This figure can change annually.

What are the actual MOOP figures?

Medicare’s maximum MOOP for this year’s HMO plans is $9,350. Insurance companies offering Medicare Advantage plans set their plan’s MOOP based on each of their plan’s business goals. Once you hit your plan’s MOOP, your insurance company pays the rest of your share of the cost when you use Part A/B services. According to this source, the range of MOOP for your County’s HMO Medicare Advantage plans is $4,900 to $6,300.

We prefer plans that meet a person’s needs, have a low MOOP, AND plans with a monthly premium below $70.

If you understand how the math works when calculating your MOOP after you use plan services, skip the paragraph below.

Let’s say your plan’s MOOP is $7,000 for the year. In January you are admitted to the hospital for surgery. Your bill for the 5-day hospital stay is $1,750. Your post-op visits to your physician and physical therapist(s) are $475. When you subtract these figures from your plan’s MOOP the result is your new MOOP. When, after you use additional services and your MOOP hits zero, your plan pays the rest of your share of the cost for Medicare A & B services. If you have a plan with a ‘lower MOOP’ you have the opportunity to keep more money in your pocket.

**The insurance company(s) offering Clearwater County Medicare Advantage plans sets the cost sharing for each Part A and B service.**

This simply means what you pay to see your physician, use hospital services, pay for your MRI/CAT imaging, cancer treatments, skilled nursing care, etc. are often different between plans. When you compare plans annually, you look at these figures and choose the plan that best fits your pocketbook and needs. These figures can change annually. Cost sharing for services used, the plan’s MOOP, monthly premium, and the financial savings you get when you use the plan’s non-Medicare covered services are some of the differentiators between plans.

Specific plans may have prior authorizations on certain covered services.

You find this information in your plan’s ‘Evidence of Coverage’ document. This is available on the insurance company’s web site and can be downloaded. Your insurance company can approve or deny the service requested by the ‘prior authorization’. If the service is denied, your prescribing physician has to go to ‘plan B’ and start the process over. This is one of the reasons we prefer plans that do not have insurance companies standing between you/your physician to get to the ‘next step’ in your health care. The article found here brings this point to life. The number of days ‘skilled nursing care’ has their daily co-pays in place is something you need to pay attention to. Why? Because if you need this service and have the ‘wrong’ plan, it can be the quickest way for you to hit your plan’s MOOP.

Hospitals in your immediate area

There is 1 hospitals within 25 miles of downtown Orofino (zip code 83554). Get a visual of its location by clicking here. Change the search area radius to 50 miles to check out your other options.Some of these hospitals are rated by The Center for Medicaid and Medicare Services (CMS) as 3 stars. We recommend hospitals with at least a 4-star rating.Having resources with higher ratings can be important to you when you get regular care, emergency and scheduled surgical procedures.All of these hospitals may not be in-network for the Medicare Advantage plans available to you.If you have a Medigap plan, they will be.

Doctors/hospitals/other providers.

You have the tools available to find out how many of a certain type of specialists are in the plan’s network vs how many that ‘accept Medicare’ are in the same area .

If you have existing health issues, would it be important for you to know how many specialists which treat this for you are in the plan you select? We can show you the tools to do this. The above can change during the calendar year.

This announcement is an example of why networks can change during the year. Another example is found here and here. Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies is competing for other financial needs of the hospital.

Proton Therapy is an example of newer technology to treat cancer.

Read this article if you are unfamiliar with this. At this writing, 45 hospitals (out of over 4500) offer this solution. Facilities near Idaho include:

Huntsman Cancer Institute (Salt Lake City) (began offering this service in 2021)

The Mayo Clinic Cancer Center (Phoenix…rolled out this service on 2016)

Loma Linda University Cancer Center (began offering this service in 1990)

California Protons Cancer Therapy Center (San Diego) (began offering this service in 2017).

If you are interested in this service, you might check where each of the above facilities are ranked in the top 250 hospitals.

Are you interested in the top 250 hospitals in the country?

Would you consider using the services of the top hospitals in the Seattle area…or the Mayo Clinics?

Some of these facilities do not accept Medicare Advantage plans (Part C). Others open their doors if you stayed with Original Medicare (Part A and B…and not enrolled in a Medicare Advantage plan). If you have a Medigap plan it will help you pay the left-over costs that Medicare does not completely cover. Hospitals are assigned a ‘star rating’ by Medicare.

We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.

Medications covered by Clearwater County Medicare Advantage plans.

According to this source, there is a 20+/- % variance between the number of prescription medications covered by the plans available to you.

Note none of these plans include 100% of the medications covered by Medicare.

This is a key reason you should not enroll in any Medicare Advantage plan until you understand your cost for your prescription medications.

If you are working with a broker/agent that just tells you your medications are covered, we suggest you work with someone else that will share the whole picture.

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

The Centers for Medicare and Medicaid Services (CMS) has requirements insurance company(s) offering Medicare plan(s) must meet when they put together their list of covered medications. Below is a cut/paste from (Section 30.2.5) the current Medicare Prescription Drug Benefit Manual. “Part D sponsor formularies must include all or substantially all drugs in the immunosuppressant(for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic classes. CMS instituted this policy because it was necessary to ensure that Medicare beneficiaries reliant upon these drugs would not be substantially discouraged from enrolling in certain Part D plans, as well as to mitigate the risks and complications associated with an interruption of therapy for these vulnerable populations.“ We feel this is an important statement everyone enrolled/wishing to enroll in a Medicare prescription drug plan should be aware of.

Clearwater County Medicare Advantage plans for Veterans

Veterans have several Medicare Advantage plans to consider. These plans do not include prescription drug coverage and are offered by private insurance companies which compete each other for your business. Each plan sets their ‘giveback’ for the member’s Part B monthly premium. This year this figure varies between $0 to $75/month for this year. These figures can change annually.

The amount of the Veterans out of pocket costs for plan covered health care services can vary widely between these plans. This is also true for the ‘non-Medicare’ covered benefits that are often found in these plans (gym membership, dental coverage, etc.). Which hospitals and physicians available to the plan member can also vary by plan.

A veteran may prefer a PPO plan if they want to open up their choice of hospitals and doctors to include those beyond Idaho’s borders. An HMO plan may fit a veteran that wants health care outside the VA and/or urgent and emergent care. We do need to pay attention to the HMO plan’s network of hospitals and doctors, as they can vary.

We recommend Veterans review their Clearwater County Veteran Medicare Advantage plans at least every 2-3 years.

This market niche is becoming more competitive between the insurance companies offering these plans. Some of these companies want to increase their market share by offering more attractive features than their competitors. These companies are changing their offerings annually to attract more potential new members.

We suggest veterans work with an Idaho broker that is also a veteran and is licensed with all of these plans.

We can help you with this when you are ready. Learn more about us here.

Clearwater County residents on Medicaid and enrolled in Medicare.

Blue Cross of Idaho is exiting the IMPlus and MMCP Idaho market on 5/31/2025.

Idaho Department of Health and Welfare (IDHW) clarified this announcement on February 5, 2025 and is available here. Answers to ‘frequently asked questions’ is available here.

If you are presently enrolled in either of these plans, you will be receiving correspondence from both Idaho Department of Health and Welfare and Blue Cross of Idaho.

UnitedHealthcare will be entering the Idaho IMPlus market on 6/1/2025 and the MMCP market on 1/1/2026.

Molina continues to serve Idaho residents with these important products.

Additional pertinent information about Idaho Medicaid and your plan choices.

If you are eligible for an I-SNP OR a C-SNP plan, you have different plans to consider.

Click here to learn more about your options.

We are licensed with C-SNP, D-SNP, QMB and Medicare Medicaid Coordinated plans (MMCP).

Explaining plan differences and helping you with enrollment are other services we help you with.

Clearwater County Medicare Advantage plans available to the rest of the Medicare beneficiaries.

Would a Medicare coach be helpful?

Medicare Advantage plans compete with each other to earn your business. <yoastmark class=

A coach can answer your question(s) and firm up your understanding of Medicare. Once this is done, they will explain the differences between your choices and help you through the enrollment process. They will also be there year after year to help you. Will the people behind the TV ads include this service for you? Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.

This page was last modified on Oct 11, 2025 @ 7:03 AM

Lewis County Medicare plans

Written on January 3, 2025. Posted in Medicare FAQs.

2026 Lewis County Medicare Advantage plans.

There is a synopsis of changes to the Idaho Medicare Advantage marketplace here. If you are not aware of these changes, please take a few minutes and read this material.

An overview of your 2026 County’s Medicare Advantage plans should be updated on this website by 10/15-25/2026. Be sure and check back for this important information.

What are we waiting for? Provider directories which include which hospitals are in the plan’s network. We have most of the Evidence of Coverage documents now.

What you need to know about 2025 Lewis County Medicare Advantage plans.

For 2025, Lewis County has 5 Medicare Advantage plans for residents to consider. Some of these plans have a $0 monthly premium.

Below is the high level break down of these plans:

1 plan does NOT include prescription drug coverage; Veterans may find this plan attractive.

If you have a Medicaid status of QMB+, QMB or SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.

2 HMO plans are available for the rest of Lewis County residents. We recommend veterans also consider these plans.

There is another type of Medicare plan you should be aware of.

These are Medigap plans.

You will have fewer ‘prior authorizations’ to deal with.

Learn more about Idaho Medigap plans here.

What are the differences between the two Lewis County Medicare Advantage Prescription Drug plans for residents not enrolled in Medicaid?

One item is the plan’s Maximum out of pocket limit (MOOP). Read the information below to learn why this is a key differentiator between plans.

Be aware Medicare pays its lion’s share of the cost for services you use. You pay the rest. Your share of these costs can vary noticeably between plans.

Medicare sets the maximum figure(s) a plan can have, and they can change it annually.

The insurance company offering your plan sets the plans MOOP where they want it. It must be at or below Medicare’s limit. This figure can change annually.

What are the actual MOOP figures?

Medicare’s maximum MOOP for this year’s HMO plans is $9,350.

Insurance companies offering Medicare Advantage plans set their plan’s MOOP based on each of their plan’s business goals.

The range of MOOP for your County’s HMO Medicare Advantage plans is $4,900 to $6,300.

We prefer plans that meet a person’s needs, have a low MOOP, AND plans with a monthly premium below $70.

If you understand the math when calculating your MOOP skip the paragraph below.

Let’s say your plan’s MOOP is $7,000 for the year.

In January you are admitted to the hospital for surgery. Your bill for the 5-day hospital stay is $1,750. Your post-op visits to your physician and physical therapist(s) are $475.

If you have a plan with a ‘lower MOOP’ you have the opportunity to keep more money in your pocket.

**The insurance company offering your Medicare Advantage plan sets the cost sharing for each Part A and B service.**

Specific plans may have prior authorizations on certain covered services.

You find this information in your plan’s ‘Evidence of Coverage’ document. This is available on the insurance company’s web site and can be downloaded.

Dental coverage is another example where rules are important to know.

Doctors/hospitals/other providers.

The above can change during the calendar year. This announcement is an example of why networks can change during the year. Another example is found here and here.

Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies is competing for other financial needs of the hospital.

Proton Therapy is an example of newer technology to treat cancer.

Read this article if you are unfamiliar with this. At this writing, 45 hospitals (out of over 4500) offer this solution. Facilities near Idaho include:

Huntsman Cancer Institute (Salt Lake City) (began offering this service in 2021)

The Mayo Clinic Cancer Center (Phoenix…rolled out this service on 2016)

Loma Linda University Cancer Center (began offering this service in 1990)

California Protons Cancer Therapy Center (San Diego) (began offering this service in 2017).

If you are interested in this service, you might check where each of the above facilities are ranked in the top 250 hospitals.

Are you interested in the top 250 hospitals in the country?

Would you consider using the services of the top hospitals in the Seattle area…or the Mayo Clinics?

Hospitals are assigned a ‘star rating’ by Medicare. We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.

We also recommend you use a ‘board certified physician‘.

Hospitals in your immediate area.

There is a hospital in down town Orofino. Get a visual of this area by clicking here.

Expand the search radius around Orofino to 50 miles. Now there are 6 more hospitals to consider. Note that 3 of these facilities have a ‘3-star rating‘ by Medicare. There is one 5-star facility in Pullman Washington.

We recommend Idaho residents consider using the services of hospitals with at least a 4-star rating.

Be aware all of the hospitals within 50 miles of Orofino may not be in-network of all the Medicare Advantage plans available to Lewis County residents. If you have a Medigap plan, all of the listed hospitals (and the rest in the US) are available to you.

Medications covered by each plan.

Are medications that treat serious health issues (cancer, etc.) covered by my plan?

The Centers for Medicare and Medicaid Services (CMS) has requirements insurance company(s) offering Medicare plan(s) must meet when they put together their list of covered medications.

Below is a cut/paste from (Section 30.2.5) the current Medicare Prescription Drug Benefit Manual.

We feel this is an important statement everyone enrolled/wishing to enroll in a Medicare prescription drug plan should be aware of.

Medicare Supplement plans.

Read the articles supporting the above comments here, here, and here.

Do you want a plan that pays for most all of the left-over cost for Part A and B in the US?

We recommend you consider a Medigap Plan G.

Why pick Plan G?

Something else to keep in mind is Medicare typically bumps up the cost of Part A and B services. They do this annually. Your Medigap plan automatically pays your share of these increased costs.

If you prefer a lower premium Medigap plan…

We have been helping Idaho residents with this task since 2012.

Call us if you want help.

Would a Medicare coach be helpful?

Medicare Advantage plans compete with each other to earn your business. <yoastmark class=

Will the people behind the TV ads include this service for you?

Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.

This page was last updated on Oct 11, 2025 @ 7:07 AM.