Oneida 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 (chronic health issues, and people which qualify for both Medicaid and Medicare).

Plans for the rest of the Oneida County Medicare beneficiaries.

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

Why? 

More of the Oneida 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 Oneida 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.

More on this 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.

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)

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 Oneida 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.

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.

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.

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’.

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’.

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 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 Oneida 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 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 Oneida County.

Click here to see a map of the hospitals 50 miles around downtown Malad City (zip code 83252).

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

Notice 1 of the 9 facilities appearing on this map are rated in this category and it is located in Northern Utah. Three of the other hospitals are also in Northern Utah.  These facilities may not be in all of the plan’s ‘network’ available to you.  If you pick a Medigap plan, they 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.

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 (show you the reports which show cost differences between plans AND the pharmacies within plan).

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 Oneida County?

Humana

Molina

United Healthcare.

Teton County Medicare Plans: 2026 Guide

This page was last modified on Aug 3, 2026 @ 12:32 PM.

This guide helps Teton County residents, including those living in Driggs, Victor, Tetonia, and surrounding communities, compare:

• Medicare Advantage plans available in Teton County
• Medicare Supplement (Medigap) options
• Special Needs Plans (SNPs)
• Important differences between Medicare Advantage and Medigap
• Healthcare provider and hospital access
• Key costs and coverage limitations to consider
• Hospitals located within approximately 100 miles of Victor, Idaho

Which Medicare health insurance plan you choose depends on more than the monthly premium.

Your healthcare needs, budget, preferred doctors and hospitals, prescription medications, and where you may need to receive medical care should also be considered.

If you are unfamiliar with Medicare Advantage terminology, you can first read our Medicare Advantage plan terminology guide and then return to this page.

________________________________________________________________________________________________

Who We are

Idaho Medicare Insurance Choices is an Idaho based insurance brokerage firm which specializes in Medicare insurance.  Residents in all 44 Counties is the market we serve.  Learn more about us here. 

Boise is our base.  Using the phone and video sharing resources are some of the resources used when working with residents in Idaho’s other 43 Counties.  We are available 8am – 8pm Monday through Saturday.    

Idaho residents have benefited from our services since 2012.    

We are licensed with all Teton County Medicare health plans listed on Medicare’s ‘Plan Finder Tool‘.  Understanding differences between  Part D plans is an additional no cost service we offer.   

Your Medicare Advantage Plan Choices Include: 

• HMO plans
• PPO plans
• Special Needs Plans (SNPs)

Some Medicare Advantage plans include Part D prescription drug coverage, while others do not. Plan availability, provider networks, premiums, benefits, and cost-sharing can vary by plan.

Medicare Advantage Plans Without Part D Drug Coverage

Some Medicare Advantage plans available in Teton County do not include Part D prescription drug coverage. These plans may offer a $0 monthly plan premium or a Medicare Part B premium reduction, sometimes called a “Part B giveback.”

These plans may be worth considering for some Veterans who receive prescription drug coverage through the VA. However, you should carefully evaluate the plan’s provider network and your potential cost sharing if you expect to use the Medicare Advantage plan for healthcare services.

Plan availability, premiums, and Part B premium reductions can change annually. Review the current plan details before enrolling.

Special Needs Plans (SNPs)

Special Needs Plans are Medicare Advantage plans designed for people who meet specific eligibility requirements. Not everyone with Medicare qualifies for these plans.

Chronic Condition Special Needs Plans (C-SNPs)

C-SNPs are designed for people who have one or more qualifying severe or disabling chronic conditions. Depending on the plans available in Teton County, qualifying conditions may include:

• Diabetes
• Chronic heart failure
• Certain cardiovascular disorders

These plans may provide benefits and care coordination specifically designed around the health needs of members with qualifying chronic conditions. Eligibility requirements vary by plan.

Dual Eligible Special Needs Plans (D-SNPs)

D-SNPs are designed for people who are eligible for both Medicare and Medicaid.

The D-SNP options available to you can depend on your level of Idaho Medicaid eligibility and the requirements of the individual plan. Before enrolling, confirm your eligibility and review the plan’s provider network, prescription drug coverage, benefits, and cost-sharing requirements.

HMO and PPO Medicare Advantage Plans

Teton County residents may have access to both HMO and PPO Medicare Advantage plans. The differences in provider access can be particularly important when considering where you expect to receive healthcare services.

HMO Plans

HMO plans generally require members to receive non-emergency care from healthcare providers that participate in the plan’s network. Depending on the plan, referrals may be required for certain specialists or services.

Before enrolling, confirm that your preferred physicians, hospitals, and other healthcare providers are in the plan’s network.

PPO Plans

PPO plans can provide more flexibility to receive covered services from out-of-network providers, although your out-of-pocket costs may be higher.

One misconception is that a PPO gives unrestricted access to physicians and hospitals.

In reality:

• out of network providers are not required to accept a Medicare Advantage PPO patient even if the plan offers out-of-network benefits,
• prior authorization may still apply,
• and payment rules are set by the individual insurance company (and can change annually); they can differ from Original Medicare.

This distinction is particularly important for beneficiaries who want access to major referral centers.

If you prefer a PPO plan, before scheduling care outside the plan’s network, confirm that the provider will accept your plan and understand your potential cost sharing.

Current Teton County Medicare Advantage Plan Costs

The figures below were updated on Aug 3, 2026 @ 12:32 PM.

The following provides a snapshot of premiums and maximum out-of-pocket (MOOP) limits for selected Medicare Advantage plan options available to Teton County residents in 2026. Plan availability, premiums, benefits, provider networks, and cost sharing can change each year.

*Emergency and urgently needed services are covered according to Medicare and plan rules.

Important: The maximum out-of-pocket (MOOP) amount is not a deductible. It is the maximum amount you may be required to pay during the plan year for covered Medicare Part A and Part B services that count toward the plan’s MOOP. Prescription drug costs generally do not count toward the Medicare Advantage medical MOOP.

A lower monthly premium does not necessarily mean lower overall healthcare costs. When comparing plans, consider the monthly premium together with deductibles, copayments, coinsurance, the MOOP limit, provider network, and your expected use of healthcare services.

Before enrolling, verify the current plan details and confirm that your preferred healthcare providers participate in the plan’s network.

Comparing Medigap and Medicare Advantage in Teton County

Teton County residents comparing their Medicare coverage options may want to consider Medicare Supplement (Medigap) plans as an alternative to Medicare Advantage.

Medigap plans work with Original Medicare and can provide several important advantages:

• Access to Medicare-participating healthcare providers nationwide
• No provider network requirements
• No referrals required to see specialists
• Original Medicare generally does not require prior authorization for most Medicare-covered services
• Greater predictability of out-of-pocket costs for Medicare-covered services

Comparing Popular Medigap Plan Options

*Premiums and the High-Deductible Plan G annual deductible can change. Review current Idaho Medigap premiums and the current annual deductible when comparing plans.

**Plan F is available only to people who were eligible for Medicare before January 1, 2020.

Learn recently implemented two new rules people interested in a Medigap plan should be aware of.  Call us if you have questions.

A visual map of hospitals within one hundred miles of Victor, Idaho

Click here to see this map.

As you look at these facilities, notice which have a Medicare star rating of 4 or 5 stars.

If you wish to include the hospitals in the Salt Lake City area, change the ‘search radius’ to 200 miles.  .

This data base is maintained by Medicare and lists all hospitals in the USA which accept ‘Medicare’ insurance.

All hospitals listed may not be ‘in-network’ of the Medicare Advantage plans available to Teton County residents.  Also, doctors/hospitals can choose not to accept patients with a PPO plan.  This is documented in each Medicare Advantage plan’s ‘Evidence of Coverage’ document.

It you have a ‘Medigap’ plan, these hospitals will accept your plan.

A Critical Difference Most People Miss

Medicare Advantage plans:

• • Limited networks –  A report authored and published (10/27/2025) by the Kaiser Family Foundation“ shed further light on the depth of networks of physicians and hospitals found in Medicare Advantage plans available throughout the US.  The report title “Medicare Advantage Enrollees Have Access to About Half of the Physicians Available to Traditional Medicare Beneficiaries”.   
• May not be accepted by top hospitals

Medigap plans:

• Work anywhere that accepts Medicare
• Provide stable, predictable access

Why This Matters (Real Example)

If you’re diagnosed with a serious condition like cancer:

• You may want access to top hospitals and specialists; check this report then this one

Not all Medicare Advantage plans are accepted at these facilities.

Prescription Drug Coverage Differences

• Specific medications covered and the overall number of medications can vary between plans
• Which drug tier your medication(s) has been categorized can also vary by plan; this will affect your fill and refill cost
• Pharmacy pricing can be different

Always run a full drug cost analysis before enrolling.

Insurance Companies in Teton County

Current insurers include:

• Humana
• Molina Healthcare
• UnitedHealthcare

Do You Need Help Choosing?

Medicare plans have several details to be aware of —and small differences can have large financial impacts.

A good Medicare advisor should:

• Compare total costs (not just premiums)
• Check your doctors and hospitals
• Analyze your prescriptions
• Help you enroll correctly
• Be there to answer and support you throughout the calendar year.

Talk to an Idaho Broker specializing in Medicare

We have been helping Teton County residents since 2015.

If you want help comparing your options:

• Call us
• Get a personalized plan comparison
• Understand your real costs before enrolling

About the Author

Chuck Weir
Boise native | Boise State University (BA, MBA)

40+ years in business, including healthcare and advisory work

Has been helping Idaho residents with Medicare education and plan selection since 2012.

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

There are 10 Medicare Advantage plans for you to consider.  

These plans are broken down into three categories. 

Some of these have specific qualification rules for enrollment.  This means these may or may not be available to you.

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

Why? 

Because the premiums and cost sharing of Medicare Advantage plans have increased to the point where these Medigap plans are attractive. 

There are many positive benefits that come with these two plans.

A few of these are:

the doctors/hospitals in Boise, Canyon County, Kootenai County, Salt Lake City, Seattle, and the rest of the US are available to you; you just make the appointment

referrals are not needed to see a specialist  

the limit on your share of the cost for your Medicare covered services is $2,950, which is about half of the ‘Maximum out of Pocket Cost’ for most Medicare Advantage plans available to you.                                                    

The ten plans available in Latah County are broken down into different categories.  These are: 

                 Plans without prescription drug coverage

There is one plan in this category. 

According to the plan details found on the Medicare.gov website (plan finder tool), the monthly Premium is  $0.

 Medicare Part B ‘credit’ (also called ‘giveback) is $90.

If the ‘giveback’ is important to the Veteran and they plan to get health care through the plan, they need to pay close attention to plan cost sharing differences. We can help you with this.

Aso, veterans, who will be using covered health care services from a plan, need to pay attention to the plan’s network (what doctors/hospitals are available), and cost sharing.  Not all physicians in the area which ‘accept Medicare’ are available to plan members.   

Do you qualify for one of the six Special Needs plans (C-SNP and D-SNP)?

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 Latah County Medicare beneficiaries have three HMO and three  PPO plans to consider.

HMO Plans.

There are two plans to consider.

Monthly premiums range from $0 to $59.

Plan MOOP’s range from $5900 to $6700.

 PPO Plans.

There is one plan available and it’s monthly premium is $19. 

Plan MOOP’s range is $7,900 for in-network usage and $13,900 when out of network resources are used.

If you have an interest in this plan, be sure and consider the two plans mentioned below.

With the rising cost of Medicare Advantage plan premiums AND cost share, the  High-Deductible version of Plan G (HD-G) or the High-Deductible (HD-F…if you qualify for enrolling) are attractive alternatives.  

Why one of the Medigap High-Deductible plans?   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
• The potential issue of recurring cancellation of an insurance company’s Idaho Medicare Advantage plans is eliminated; in 2025 over 70,000 Idaho residents had their Idaho Medicare Advantage plan cancelled by their insurance company.  This issue forced these policyholders to find a new plan for 2026.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 less cost sharing when you use care.

The chart below profiles the differences between the Medigap plan choices. 

• *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.

Call us if you have questions.

Other issues to consider when selecting a 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? 

The decision about getting treatment outside of your plan’s network may come to mind.   

Remember, if you choose an HMO plan, you have access to the plan’s network of facilities.   This typically means a sub-set of the ‘providers’ which ‘accept Medicare insurance’

If you choose a PPO plan, you can use the plan’s in-network facilities or go out of network. 

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.  There are other reports for 2023 and 2024. 

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.”

If you are diagnosed with Cancer…

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

Why consider this?  If may produce better results than traditional approaches.

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.

How to find hospitals in and around  Latah County.

Click here to find hospitals in a 50 mile radius around Moscow.

Notice that none of the hospitals listed have a 4 or 5 ‘star rating’ by Medicare AND five of the nine hospitals are in Washington.  This means they may not be in the provider directory of the Medicare Advantage plans available to you.  

The nearest 4 star hospital in Idaho is Kootenai Health in Coeur D’ Alene.

We recommend people consider hospitals with this rating if they will be treated with more serious health issues. 

You can bump up the search radius around zip code 83843 to find more hospitals.  Be sure and look to see if the new hospitals are still in Latah County and in the provider directory of any Latah County Medicare Advantage plan you are considering; if they are ‘out of state’, they may not be in the provider directory. 

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.

These resources may be available to you if you have the right Idaho Medicare insurance (Original Medicare with or without a Medigap plan or a PPO plan, if they will accept your PPO plan).

Some of these hospitals may not accept Medicare Advantage plans.   If you have a Medigap most will accept your insurance.

Medicare assigns Hospitals a ‘star rating’.  We recommend you focus on four and five-star rated hospitals AND skilled nursing facilities.

There are several organizations which rate hospitals too.  Each of these services may use different metrics to rank hospitals.  We favor the Health Grades resource as it focuses on results of services performed in the surgical suite.  

Learn more about this subject here.

Medications covered by each plan.

Dot your I’s and cross your T’s.

We recommend you 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. Reports can be produced which show you your fill/refill cost for your specific prescription medications and if each of the plans available to you cover all your medications.  They will also show you the refill cost of up to five pharmacies you select.  

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 Latah County?

Molina Healthcare of Idaho

United Healthcare.

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. 

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 Feb 20, 2026 @ 7:27 PM