CMS Required Statement for Caribou County residents interested in a Medicare Advantage plan.

We are licensed with all Idaho Medicare Advantage plans listed on the Medicare plan finder tool, except D- SNP, C-SNP, I-SNP (Special Needs  Medicaid plans).

6 of the 7 insurance companies offering Part D plans in Idaho use our services.  Regence Blue Shield of Idaho does not use brokers.

Additional information on his subject is documented here.

What you need to know!

For 2024, Caribou County has 2 Medicare Advantage and 10-Medigap plans for residents to consider.

Both are a PPO type of Medicare Advantage plan.  These do not include Medicare prescription drug coverage.  A Veteran typically benefits from this plan type because they get their prescription med’s from the VA.  They also give the Veteran the option to get their health care outside the VA.

If you are not a veteran, we recommend you also consider type a different plan type which is reviewed below.

Why are the rest of the insurance companies that offer Medicare Advantage plans in Idaho ignoring Caribou County?

Probably because of the population of Medicare beneficiaries in Caribou County is too low to attract the key players in this County.  Be aware insurance companies offer Medicare Advantage plans based on the County where a person lives.  Several Idaho Counties have 0 Medicare Advantage plans available to them.

If you are a veteran, call us.  We will help you understand the differences between these 2 plans and, if appropriate, help you enroll in the one you choose.

If you are not Veteran, we recommend you consider the plan type described below.

Call us if you have questions.

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

This plan limits your annual out of pocket costs for Part A and B covered services to less than $3,000.  This figure is controlled by Medicare and typically goes up a bit annually.

There is another plan which limits your annual out of pocket costs for Part A and B services to less than $300 a year.  This is a Medicare controlled figure and goes up a bit annually.

When you choose either plan, all doctors/hospitals that accept Medicare insurance in the USA are available to you and prior authorizations are minimal.  This means you do not have an insurance company standing between you and your physician to get you taken care of.

Call if you have questions.

This page was updated on Jan 24, 2024 @ 10:48 AM

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

For 2025, Latah County has 20 Medicare Advantage plans for residents to consider. 

Here is the high level break down:

          4 plans do NOT include prescription drug coverage; Veterans may find these plans attractive.

                  2 of these are PPO;

                  2 are HMO plans.        

         10 plans do include prescription drug coverage and services covered by Medicare Part A and B.  

                  7 are HMO plans;

                  3 are PPO plans. 

           The remaining plans are reserved for individuals which qualify for Medicaid special needs plans (I-SNP, C-SNP or D-SNP).

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 Latah 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 Medicare Advantage plans?

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.

This 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.

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 years HMO is $9,350. 

The MOOP maximum for PPO plans cannot exceed $14,000.   

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 $4,900 to $6,400. 

The range for PPO plans is $5,000 to $9,550. 

We prefer plans that meet a persons needs AND has a low MOOP.

You can check out the above figures by using the resource found here. 

The example below will help you understand how your plan’s MOOP works.   

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 plan 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 plan coverages may have limitations.

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

Prior Authorization is an example.

Prior authorization may be required on specific plan covered services.  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.

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.

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 for treating cancer.  

This is an updated treatment and is an alternative for existing radiation therapy.

We encourage you to read this article if you are unfamiliar with this technology .  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?

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 may available to you if they accept your Medicare Advantage plan. If you have a Medigap plan, there should be no issue with this provided the facility accepts Medicare.

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. 

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

We recommend you consider a Medigap Plan G. This plan will leave you with little left-over costs (the annual Part B deductible).

Are there lower premium Medigap plans which have some copays?

Yes.

There are 2 different Medigap plans we like that meet these criteria.   They have a Medicare controlled ‘annual deductible’.  Yes, it goes up a bit annually.

This ‘deductible’ is similar in concept to the MOOP described above. 

The deductible for this year is found here. 

Once your share of your costs for the services you use hits this figure, this Medigap plan pays the rest of your Part A and B left over costs for the calendar year. 

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 plan which meets your needs and budget.   

Latah 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 Latah 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.

Latah 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.  

Latah 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).

Hospital selection for care is important to some.  

We look at 2-different hospital measurement tools to help find which hospitals stand out.  The 1st is the Medicare star rating.  Learn more here about the metrics that are captured to come up with this rating.  We prefer hospitals receiving a 4 or a 5-star rating. 

The 2nd tool uses many more metrics to differentiate how the hospitals do what they do.  Several of these focus on the results of the work done in the surgical suite.  If you are interested in learning which hospitals produce better results on a consistent basis by type of surgery, check this resource out.   

Learn more about the company behind this annual report here. 

Check out the other facilities within 50 miles of zip code 83814 by clicking here. When you get to this web page, select ‘hospitals’, enter your zip code and adjust the radius to 50-miles.

What insurance companies offer Medicare Advantage plans in Latah County?

Blue Cross of Idaho

Regence Blue Shield of Idaho

United Healthcare

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 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…or services you use may cost you more when compared to your cost if you use an in-network dentist. 

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. 

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

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

Would a Medicare coach be helpful?

A coach can answer your question(s), help firm up your understanding of Medicare, 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 ad’s include this service for you?

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

We started this business in 2012 explicitly to help Idaho residents work their way through this maze. 

There is no fee when you use our services.

This page was last modified on May 24, 2025 @ 12:51 PM

Idaho Medigap rates vary noticeably by company and change annually.

Over 20 insurance companies offer Medigap plans to Idaho residents.

There are separate rate charts for people that use tobacco and those that do not.  Rates are available for people under age 65 as well as for people 65 and above.

Click here to see the current Idaho Medigap rates. This information is typically updated monthly.

Idaho Medigap rates are based on Community Rating 

This means each insurance company sets their own monthly premium (rates) for each plan they offer in Idaho.  Also, every one that enrolls in one of their ‘community priced plans’ pays the same premium.  The premiums are presented on the underage 65 chart AND the 65 and over premium chart.  

Remember some basics about Medigap plans.

Keep in mind if you are enrolled in a Plan F (or any of the other 9 Medigap plans), the Medicare coverage is the same no matter who you buy the plan from. 

Some insurance companies include ‘extras’ in their plans. 

Some companies MAY include extra benefits (gym membership, help with dental/vision coverage, a discount if more than one person living in the same home, etc.).   If these extras catch your attention, closely review the details of these offerings.  For example, are the exercise facilities you will use in the plan’s network.  Is your dentist is in the plan’s network?  

How does ‘community rating’ compare to ‘issue age’ rating?

‘Issue age’ rating means:

1).  There is a premium rate chart which is maintained by each company offering Medigap plans in Idaho.

 2).  There are 4 charts for rates; 1 is for people under age 65; the other is for people 65 and above.  People that use tobacco can have a different premium than people that do not.

3). You find your age on this chart for the plan you prefer.  This is the person’s ‘base’ rate and is your monthly premium when you initially join a plan.  This rate can change annually as each company is entitled to a ‘rate’ increase.  Most companies guarantee this initial (base) rate to remain the same for the first 12 months a person is enrolled in the selected plan. 

4).  When you look at these rate charts, you notice the rates increase a few percentage points with each year of age. This means Idaho Medigap rates at age 65 can be noticeably lower than rates for a person aged 80.

Community rating means everyone wishing to enroll in a specific plan offered by a specific company pays the same premium.  This means a person aged 65 pays the same premium as a person aged 85 (or any other age). 

Each company will have a separate premium chart for individuals below age 65 AND a separate premium chart for people 65 and above.   If a person uses tobacco their premiums will be higher than people that do not. 

The net effect of ‘community rates’ is when people join a Medigap plan at age 65, their premium is much higher when compared to ‘issue age’ rating. This also means people age 78/higher can have lower premiums when compared to ‘issue age’.

What should a person do that has been enrolled in an ‘issue age’ policy for several years?

If the premium difference between a ‘community’ rated plan and their ‘issue’ age plan is meaningful lower simply change insurance companies and get the same coverage.   You no longer have to pass underwriting to switch insurance companies/plans.  Some rules do apply. 

How would a person do this?

We suggest they work with an Idaho based broker that is familiar with the Idaho Medigap marketplace.

They can guide you through the process.

We have been helping Idaho residents do this since 2012.  Call us if you want help. 

What else do I need to know about the Idaho law change that introduced ‘Community rating’ and eliminated issuance of ‘issue age’ policies? 

Idaho changed to ‘Community Rating’ on 3/1/2022. A refresher on ‘Community Raring’ is available here.

Did you just move to Idaho?  

I have a Medigap plan. Are Idaho Medigap rates lower?  

Probably!

If you have had your Medigap plan 4 or more years, your Idaho Medigap rates could lower than your current plan.  If you switch company’s to get the same plan, a gym membership and/or a ‘household discount’ may be included in the plan.  You can do this without going through underwriting.  

Switching to a different company and get the same plan is easy when you work with a broker. Call us if you would like help thinking this through.  We watch this market monthly.

 I have a Medicare Advantage plan. What should I do?

You have an important decision to make.

First, you are entitled to switch to a Medigap plan WITHOUT going through underwriting.

A Federal law offers a ‘guaranteed issue’ to individuals in this situation.  This means you skip underwriting.  

There is a time limit you have to get this done (after you move).  Read the information found on pages 21-24 of the document found here. Call us…we can help you think this through. We have been helping new Idaho residents in this situation for over 10-years.

Second, if you are not aware, Medicare Advantage plans are based on the County where you live. Also, you have a 63-day window after your move (Federal law) to enroll a plan available in the Idaho County you are moving to.  Be aware certain Idaho Counties do not have Medicare Advantage plans available to residents.

Learn more about Medicare Advantage plans available in Idaho here.

Are Medigap plans in Idaho now a commodity like product?

With the 2022 law change in Idaho, we think Idaho Medigap plans are approaching ‘commodity’ status.  To us, this means the main difference between your choices is simply the plan’s premium.  We do use other criteria to separate companies on our ‘recommend’ list.  These are reviewed below.  

These products have the same basic features and the companies offering them compete on price.  Many of these companies tout their ‘customer satisfaction’ rating.  We find their comments with overall national satisfaction surveys.

“A whopping 94% of the people with a Medicare supplement policies say they are satisfied with their health insurance policies“.  

With the Idaho law permitting existing Medigap policy holders to switch insurance companies annually (during their ‘birthday window’) without going through underwriting we feel it just makes sense to switch companies with the premium difference is meaningful to you. 

Idaho typically has new companies enter our market annually.  Often these companies will have the lowest monthly premium they ever will have.    

Would you pay 25 – 130+% for the same product when shopping elsewhere?

A Plan G (or any of the other 9 Medigap plans) are the same products no matter which company offers them. The main difference is the monthly premium…and if they offer ‘extra benefits’ not covered by Medicare, it makes sense to consider these (if they are useful to you).  

We prefer insurance companies that have been in the Medigap business at least 4 years, have over 10,000 policies in force, have a medical loss ratio no more than 1 point above the national average (for the prior year) and have an AM Best rating of A- (or better).  Not all of the insurance companies offering Medigap plans in Idaho meet this criteria…and we do not recommend them. 

What about household discounts?

A few companies offer a ‘household discount’.

When this is deducted from their premium, we compare the net figure to other company’s premium. When we do this, some the other companies, not offering a household discount, can have lower premiums. This is why we encourage Idaho residents to look beyond the ‘teaser ad’s’ some companies use to get your attention

A note about plans that include a gym membership.

 You have some additional work to do before enrolling with any company including this ‘extra’ feature. Not all ‘gym memberships’ are the same.  

Be aware, the insurance company can drop this ‘extra’ at any time.  

We will help you compare all companies offering this extra and consider the one with the net lowest premium…provided they meet the criteria mentioned above. 

If you stop using the gym, there may be other companies with lower monthly premiums for your same plan. If this difference is meaningful to you, it may make sense to save the money by changing to a different company.

We can help you sort through this.

Will Idaho Medigap rates change?

Yes. Each company is entitled to submit an annual request for a rate increase.  The Idaho Department of Insurance reviews these requests and approves/denies based on the company’s ‘medical loss ratio’ and other factors. 

In 2024 many companies in the Idaho Medigap market had increases in the 8%+. A few were lower. 

If you experience a ‘large’ annual rate increase, call us. We will help you find creditable companies with lower premiums.  If you are an existing customer and were holding a policy with a larger than ‘normal’ increase, we will notify you and let you know your other options.

Suggestion. 

If you have experienced 3 annual rate increases it is time to check your options.  

When you work with us

We have specialized in Idaho Medicare insurance since 2012. We monitor the Idaho Medigap market monthly and update our records when rates change, when new companies enter our market and when existing companies leave the market.  

Once you become a customer, we keep you aware of new opportunities to save on your premium. If you choose to change companies to save on the premium difference, we help you with that too.

Idaho residents, call us when you want help.

This page was last modified on Jul 11, 2024 @ 3:55 PM

Several 2025 Nez Perce County Medicare Advantage plans caught our attention.

There are plans for people that 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 and SLMB+ with the above-mentioned health issues, the plans mentioned above are also available.  

There are other Nez Perce County Medicare HMO and PPO plans on our recommendation list.  Which medications, hospital preferences, and health issues a person has/does not have are determining factors on which are appropriate. 

What else you need to know!

For 2025, Nez Perce County has 21 Medicare Advantage plans for residents to consider.  This is 11 fewer than 2024. 

Here is the high level break down:

            4 plans do NOT include prescription drug coverage; Veterans may find these plans attractive.

                  2 of these are PPO;

                  2 are HMO plans.                 

11 plans include prescription drug coverage and services covered by Medicare Part A and B.  

                  7 are HMO plans;

                  4 are PPO plans. 

           The remaining plans are reserved for individuals who qualify for Medicaid special needs plans (C-SNP or D-SNP).

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 Nez Perce 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 these Nez Perce County Medicare Advantage plans?

Monthly premiums range from $0 to over $140.

The MOOP (Maximum out of pocket limit) 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.

Pay attention to your share of the costs for the services you know you will use.  There are documented in the plan’s ‘Evidence of Coverage’ (EOC) document.  You can download this from the insurance company’s website.  Each plan has this document available.

Then look at the cost sharing for the services that would be needed if you were diagnosed with a serious health issue.

Look at the hospitals in the plans network.  If you are diagnosed with a serious health issue, would you want to be treated at one of these facilities?  Would you prefer to have access to one of the major hospitals (and physicians) in the Pacific Northwest (or the entire US)?   

What is your cost share for filling/refilling the prescription medications you take?  There is typically a 300% +/- annual difference in medication costs between plans for the same set of medications.

What are the extra (non-Medicare covered services) included in the plan.  What is covered?  Are the providers you currently use for these services in the plans network?  What are the limits your plan will pay for these services?

The insurance company offering each Nez Perce County Idaho 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 plan coverages may have limitations.

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

Prior Authorization is an example.

Your  insurance company can approve or deny the service request from your physician.  An example is surgery to fix something.  If the service is denied, your prescribing physician must go to ‘plan B’ and start the process over. 

The article found here presents the issues of over utilization of this feature.  Some progress is being made to correct the shortcomings of the initial implementation.  

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 reading the plan’s EOC is important.

An example we noticed, when reviewing 2025 EOC(s), reads: ‘Submitted claims are subject to a review process which may include a clinical review and dental history to approve coverage’.  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. 

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

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 alternative 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 OR the top hospitals by type of surgery?

Resources are available to help you find these.

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.  This group of hospitals may not accept the Medicare Advantage plans available to you.

Hospitals are assigned a ‘star rating’ by Medicare.  We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities and are included in the top 250 hospital list.  Learn more about Medicare Star ratings here. 

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.   

We also recommend you consider 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. 

If you are uncomfortable with: 

the 2025 changes to your 2024 plan (paying more for covered services, changes to your dental plan, medication refill costs, your MOOP increased, the number of days the daily copay for skilled nursing care increased, key physicians are no longer in the plan’s network, your exercise facilities are no longer in your network, etc.);

the limitation of your choice of doctors/hospitals with an HMO plan;

if you have (are attracted to) a PPO plan, you may have noticeably higher out of pocket costs when you use out of network services.   Did you notice how much the MOOP is when you use ‘out of network services’ (even just once)?  You may also have a risk that out of network providers will not accept your PPO plan OR it’s terms.  

and the increasing number of hospitals in the US not accepting Medicare Advantage plans

you might consider changing plans or type of plan.

Remember, if you are already enrolled in a Medicare Advantage plan you can change to a different Medicare Advantage plan between January 1 and March 31 as well as between October 15th and December 7th. 

During this same time period, you can return to Original Medicare (drop your Medicare Advantage plan) and enroll in a Medicare Supplement plan.   You may have to pass ‘underwriting’.

Medicare Supplement plans.

These plans give you the choice of any doctor/hospital/other providers (in the US) that offer services to people enrolled in Medicare (both Part A and B).  Over 90% of physicians in the US accept Medicare insurance (Part A and B) and most of the hospitals do…and prefer people with this insurance when compared to Medicare Advantage plans. 

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 cost sharing in the US?

We recommend you consider a Medigap Plan G.  We consider this plan ‘the gold standard’ for health insurance for people on Medicare. 

Nez Perce County Medicare Advantage plans for Veterans.

Veterans enrolled in Medicare Part A and B can enroll in a Medicare Advantage or a Medigap plan. 

Why would a Veteran consider a Medicare Advantage plan? Because:

• You will have flexibility to get your health care services from the VA and the network of providers in your Medicare Advantage plan. Available services include urgent, emergency, and regular health care.  You can still get services from the VA.
• Take advantage of the Part B buyback offered by some of these plans.  This means the insurance company MAY offer to pay part of the Veterans Part B monthly premium.  At this writing, this ‘give back’ varies from $0 to $75 a month for plans available in Idaho.  These figures are determined by the insurance company offering the plan and can change annually. 
• Get the $0/low cost ‘extra’ features not covered by Medicare. Some plans have attractive features that may benefit the Veteran.
• Many of these plans have a $0 monthly premium.  

We feel any veteran that qualifies for health care from the VA should also enroll in Medicare Part B and consider enrolling in a Medicare Advantage plan.  The ‘extra’ benefits often included in these plans can also lower out of pocket cost for the Veteran.

Nez Perce County residents on Medicaid and enrolled in Medicare.

If you are on Medicaid and enrolled in Medicare and recently received a Medicaid cancellation notice, we can help you. 

You have new options for replacing your health and medication insurance. 

We help you understand the differences between your Medicare Advantage and your Medicare Supplement choices.  Then we explain the specific plans available in each category. 

Others like you recently benefited from our help.

If you not affected by this Idaho Department of Health and Welfare audit…

There are several different types of plans available to Idaho residents enrolled in Medicaid. These include people eligible for ‘Basic’ or ‘Enhanced’ Medicaid or are eligible for an ISNP or a CSNP. Click here to learn more about your options.

Medicare Advantage plan(s) available in Nez Perce County for the rest of us. 

Focus on which hospitals are included in any plan’s network. 

If you are diagnosed with a serious health issue, would you want the top hospitals and the top specialists working on you…or is this not a concern of yours?

According to hospital rating resources, there can be noticeable differences in the results in the surgical suite.  You can learn more about hospital differences by referencing the 2 resources below.  These are:

Click here to learn more about the top 250 hospitals in the US.  This resource also points out which types of surgeries each hospital excels at.  Not all of these hospitals will accept Medicare Advantage insurance. If you have a Medigap plan and the hospital ‘accepts Medicare’, you are welcome. 

This resource reviews most all of the 4500+ hospitals in the US.  We find this resource quite useful for residents in smaller population Counties in Idaho.  

Medicare Hospital Star ratings are important to know and understand. 

Medicare assigns ‘Star’ ratings to hospitals.  Learn more about CMS hospital rating here. 

We encourage Idaho residents to consider using facilities with either a 4 or 5-Star rating. 

Check out the star ratings of hospitals within 25 miles of zip code 83524 by clicking here.  Adjust the radius to look beyond 25 miles OR enter a different zip code to see hospitals in other parts of Nez Perce County.

Hospital(s) without a star rating may have not reported their results or did not meet the minimum number of procedures to be rated for the current period.   We suggest you consider skipping these hospitals. 

All of these hospitals listed in the above searches may not be in every Medicare Advantage plan available to you.  

Provided the facility you wish to use accepts your PPO plan’s terms; they should be available to you.    If you have an interest in a PPO plan, there are a few important items to be aware of.  Call us to learn more.

Are plan premiums important?

Yes!  This is a steady monthly outflow of cash from your pocketbook.

Monthly premiums for Medicare Advantage plans in Ne Perce County from $0 to over $135.   

If you are interested in a Medicare Advantage plan with a premium above $70/month, an Out-of-Pocket Limit above of $7,000 or have copays for stays in a Skilled Nursing Facility after day 60, be sure you understand your other choices.  These include the other lower premium Medicare Advantage plans as well as Medigap plans. Learn more about your Medigap options here. 

What insurance companies offer Medicare Advantage plans in Nez Perce County?

Blue Cross of Idaho

Molina

Regence Blue Shield of Idaho

United Healthcare

Other tidbits to be aware of

Additional details about the plans available in Nez Perce County

Some plans let you go ‘out of network’ at higher cost sharing for services used.  These plans also have a higher ‘out of pocket maximum’.  This figure can be over $13,000.

The insurance companies offering these plans negotiate reimbursement rates with the resources included their network.   Doctors/hospitals participation in a Medicare Advantage plan’s network can change during the plan year and annually.  Read this announcement which happened in Kootenai County. 

Some plans include the resources in Ada and Canyon County in addition to hospitals in Northern Idaho.

You find additional 4 and 5 Star rated hospitals located in Ada and Canyon Counties.

If you want the flexibility to choose any hospital and physician in the US.

We suggest you consider a Medicare Supplement plan.  They offer more flexibility than you will find with a Medicare Advantage plan.

Having a plan with a broader selection of hospital(s) available may offer more peace of mind if you are diagnosed with serious health issues. 

Be aware CMS star ratings change as data is collected often.  Current information can affect a hospital’s star rating.  We suggest you always check the current star rating of any hospitals you may use. 

We will help you think through your options.  

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, dental coverage 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. If you use an ‘out of network dentist, you may pay for all services…or services you use may cost you more when compared to your cost if you use an in-network dentist. 

We suggest you read the 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 plans catalog of covered items.  Plans 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.  

We noticed some plans cut the value of this benefit for 2025.

Gym Memberships

You need to pay attention to the depth/variety of facilities that are available and close to you. Read the plan’s rules for this service…and which facilities in your area are available to you.

We noticed some of the facilities that had been participating in some of the plan’s networks did not renew their 2025 participation.

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 depending on the specific brands they offer and extra benefits available to you.  

Would a 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 May 24, 2025 @ 12:53 PM