Idaho Medigap rates vary noticeably by company and change annually.

 

Key Idaho Medigap rates available now. 

As of 4/6/2026:

                                             G  less than $225/month.

                                             G Hi-deductible: less than $75/month.

                                             N: less than $170/month.

The above premiums are available to Idaho residents 65 and over that do not use tobacco.  The premium for tobacco users is slightly higher.  If you are under age 65, call us for your premium.  

The companies offering the above mentioned figures have not yet had their 2026 premium increase.  When their increase is effective, the above rates will no longer be available.   

If your current plan premium is meaningfully higher than the above figures, you can switch companies without going through underwriting  during your ‘birthday window’.  If you choose to make a change outside of this ‘window’, you may have to answer the ‘health history’ questions on the company’s application.  Depending on your answers, the application can be accepted or denied. 

Remember, if you change plans, your new premium will not change for 12 months.

Call to get your other questions answered and schedule the appointment.

When will my 2026 premium change notice show up?

The premium increase usually coincides with your policy’s renewal date, not necessarily the calendar year. If you bought your plan in July, expect a notice around May or June.  Some insurance carriers increase premiums during your birthday month instead of the anniversary.

Premium increases:  what has been approved so far.  

As of 4/6/2026, 13 of the 21 insurance companies offering Medigap plans in Idaho have filed and been awarded their 2026 increases.  The remaining eight will occur before the end of the year.  The mean (arithmetic average) of Plan G premiums for these 13 companies is $263.   Seven of these companies set their 2026 Plan G premium above $270.

My 2026 increase makes my premium over $40/month higher than the Plan G rate mentioned above.   Can I change companies now?

Yes.  If you can pass underwriting, we can do it now.  If you are within your ‘birthday window’ now (or will be before the above premiums change, yes.  Call to get your questions answered and schedule the appointment.

 

Idaho Medigap rates are now based on Community Rating 

Community rating is one of the three approved methods for setting monthly premiums for Medigap plans.   Idaho switched to this method on 3/1/2022.

Each insurance company offering Medigap plans in Idaho has four premium charts.  These are:

There are two main categories which are separated between people which use tobacco products and those which do not.  Premiums for individuals which use tobacco are typically higher than those which do not.

Within each of the groups there are two other categories.  These are people age 65/over and those who are under age 65.  Individuals under age 65 qualified for Medicare because of a disability.  They have their own premium chart and these premiums are up to 50% higher than rate charts for people 65 and over.   

If an ‘issue age’ policy holder wants to change plans/insurance companies now, their new policy will follow ‘community rate’ rules. 

The reason an ‘issue age’ policy holder would want to switch is because the ‘community rated plan’ premium is meaningfully lower than their ‘issue age’ plan.

Learn more about Idaho’s law change and answers to ‘frequently asked questions’ here. 

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

‘Issue age’ rating means:

1).  Like ‘community rated’ plans, each company has four different charts and are broken down in the same manner as ‘community rated’ premium charts. 

2).  You find your age on an ‘issue age’ chart for the insurance company and 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 twelve months a person is enrolled in the selected plan. 

3).  When you look at these rate charts, you notice the rates increase slightly with each year of age. This means Idaho Medigap rates at age sixty-five can be noticeably lower than rates for a person aged eighty.

Issue aged plans are no longer available in Idaho effective 3/1/2022.  If you have an ‘issue aged’ plan, you can keep it. 

If you want to change plans to get different coverage or a lower premium, your new plan’s monthly premium is based on ‘community rating’.

How would a person change plans?

We suggest they work with an Idaho based broker that specializes in the Idaho Medigap marketplace.

Call us.  We have been helping Idaho residents do this since 2012.   

 

Are Idaho Medigap plans now a commodity like product?

With the 2022 Idaho law change, we think Idaho Medigap plans are approaching ‘commodity’ status. 

To us, this means the main difference between your choices is the company behind the plan.  We look at their AM Best rating, their experience in the Medigap business, and the number of active policies they have in force.   

These products have the same basic features and the companies offering them compete on price. 

Some of these companies tout their ‘customer satisfaction’ rating. 

Something to keep in mind is the national customer satisfaction rating of Medigap plans…then see if a specific company’s messaging is comparable to the national overall rating.  An article titled “A whopping 94% of the people with a Medicare supplement policies say they are satisfied with their health insurance policies” documents this point.  

With the Idaho law permitting existing Medigap policy holders to switch insurance companies annually (during their ‘birthday window’), and do this without going through underwriting, we feel it just makes sense to make the switch when the premium difference is meaningful to you and you follow the other guidelines mentioned above when choosing a company to do business with.  

 

When you work with us

We have specialized in Idaho Medicare insurance since 2012 and monitor the Idaho Medigap market weekly.  When premiums change, new companies enter our market, or when existing companies leave, we update our records.  

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 get it done.  

Idaho residents, call us when you want help.

This page was last modified on Apr 15, 2026 @ 1:16 PM

 

You have 10 Medicare Advantage plans to consider.  

These plans are broken down into several categories. 

Some of these have specific qualification rules for enrollment; these are not available to all County residents.

When you review your Nez Perce 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, 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 Nez Perce 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 Nez Perce 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.

 

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

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

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 Nez Perce County.

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

Notice that none of the hospitals listed have a 4 or 5 ‘star rating’ by Medicare. 

The nearest 4 star hospital 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 change the search radius around zip code 83501 to find more hospitals.  Be sure and look to see if the new hospitals are still in Nez pierce County and in the provider directory of any Nez Perce 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 Nez Perce 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. 

 

This page was last modified on Feb 20, 2026 @ 6:57 PM

2026 Minidoka County Medicare Advantage plans.

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

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

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

 

 

Several 2025 Minidoka County Medicare Advantage plans caught our attention.

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) are now available.

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

Interested in learning more?  Print the ‘Scope of Appointment’ document (available here), sign/date it, then take a picture of the signed document and text it to us (1-208-867-0296).  Upon receipt we will call you and share the details.   

 

What else you need to know! 

For 2025, Minidoka County has 21 Medicare Advantage plans for residents to consider.  

Here is the high level break down:

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

                  3 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 who qualify for Medicaid special needs plans (C-SNP or D-SNP).

 

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

When you choose this plan, all doctors/hospitals that accept Medicare insurance in the USA are available to you and prior authorizations are minimal.  This simply means you are not limited by network rules found in Medicare Advantage plans. 

This also means you do not have an insurance company standing between you and your physician to get to the ‘next step’ in your health care. 

You are not charged a ‘premium’ for services received when you use services out of your immediate area (like many PPO plans).

Learn more about Idaho Medigap plans here. 

 Call if you have questions.

 

What are the some of the differences between Minidoka County Medicare Advantage plans?

One item is the plan’s Maximum out of pocket limit (MOOP). 

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.    

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

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

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

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

What are the actual MOOP figures for Minidoka County Medicare Advantage plans?

Medicare’s maximum MOOP for this year’s HMO plan is $9,300. 

The MOOP maximum for PPO plans cannot exceed $14,300.   

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

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

The range of MOOP for your County’s HMO Medicare Advantage plans is $4,500 to $6,400.

The range for PPO plans is $5,900 to $14,000. 

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. 

After you pay for these services, you subtract them 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 Medicare Advantage plan sets the cost sharing for each Part A and B covered service too.  

This simply means that you pay your share of the costs for services provided by your physician, use specific hospital services like MRI or CAT imaging, cancer treatments, services provided in the surgical suite, etc..   The insurance company behind each plan sets their own cost sharing for that plan.  You find these figures in each plan’s ‘Evidence of Coverage’ (EOC).    

The EOC also identifies which services must be approved by the insurance company before they can be performed.  Be aware approval requests can be denied by the insurance company.    

Prior Authorizations.   

Services covered by any Medicare Advantage plan may have a ‘prior authorization’ tag on a service.   These are found in the plan’s EOC. 

The insurance company can approve or deny the prior authorization request.  Learn more about what is going when these requests are reviewed and approved or denied by reading this article, this article,  and this article.  CMS is in the process of implementing changes to help get this back on track. 

When you stay with Original Medicare (Part A and B….not have a Medicare Advantage plan) these are the Medicare covered services which have prior authorizations. 

Doctors/hospitals/other providers available in Minidoka Medicare Advantage plans.

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 of the physicians/providers that ‘accept Medicare’ insurance are not in your plan’s network.  

If, during your plan research, you wish 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, you have tools available to figure this out.  It may be useful knowing which plans have the higher percentage of cardiologists, oncologists, etc. are in their network.  We can show you how to get the answer to this question.  

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 are competing for other financial needs of the hospital.   

Proton Therapy is an example of newer technology for treating cancer.  It is being used as an alternative to radiation treatments.  

Read this article if you are unfamiliar with this. 

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

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

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

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

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

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

 

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

The 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, and you have a Medigap plan.

Does Medicare rate hospitals for us?

Yes.

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. 

 

 Will you have more flexibility and less hassle by choosing a Medicare Supplement plan?

Probably. 

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.

This means you do not have an insurance company standing between you and your physician to get the ‘next step’ in your health care done. 

Check out what services have prior authorizations when you are enrolled in Part A and B AND not in a Medicare Advantage plan.  Compare this list to the ‘Evidence of Coverage’ (chapter 4) document of any Medicare Advantage plan you are considering.  Just look for the words ‘prior authorization’.

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

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

We recommend you consider a Medigap Plan G. 

Are there lower premium Medigap plans what have some copays?

Yes.

The 2 different Medigap plans mentioned above 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.  

 

Minidoka 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 $100 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.

 

Why the interest by insurance companies in the Veterans Medicare niche?

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

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

This market niche has become quite competitive between the insurance companies.

At the current moment, the major insurance companies offering these plans are in Bingham County. There may be more new entrants next (or following) years.

In our opinion, these companies want to increase their market share by offering more attractive features than their competitors.

These plans have different features and costs to the Veteran.

These can include the doctors/hospitals in the plan’s network, the cost for health care services provided to the plan member, and the details of any ‘extra’ services not covered by Medicare.

Why is the Part B ‘buyback’ important?

Many MA plans in Idaho also include the Part B buyback.  This means the insurance company MAY offer to pay part of the Veterans Part B monthly premium.  In other Idaho Counties, this figure varies from $0 and up.

Some Veterans that get their health care from the VA simply enroll in one of these plans to get help paying for their Part B monthly premium and to take advantage of the $0/low cost for the other features included in the plan.  Others want access to urgent and emergency care outside of the VA.  Others simply want a broader choice of doctors and hospitals.

Another key point is these companies may improve their offerings annually.  They do this to attract Veterans already enrolled in another insurance company’s plan as well as Veterans new Medicare.

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

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

 

Minidoka 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.  

 

Medicare Advantage plans for the rest of the Medicare beneficiaries living in Minidoka County.

Check out the hospitals in each plan’s network and where they are located.

Minidoka Memorial Hospital in Rupert and St. Lukes hospital in Twin Falls are key medical resource for Minidoka County for Medicare beneficiaries.

Hospital selection can be a very important decision when you get your health care.

We recommend you research their differences and be sure any plan you choose has those resources you prefer in their plan’s network.

Minidoka  County has several hospitals/clinics in reasonable driving distance from Rupert (50-miles).   Check these out by clicking here.

When this screen pops up, be sure and enter your zip code (83343) and adjust the radius to 50-miles.

Notice there are 5 hospitals within this radius. 

Check out the hospital ratings.  We prefer facilities with either a 4 or 5 star ratng.  

Why don’t hospitals have a rating?

Hospital(s) without a rating may not have reported their results or did not meet the minimum number of procedures to be measured and rated for the current period.

When selecting a health plan, be sure the hospitals and doctors you want to take care of you, no matter the health issue, is available to you.

The CMS hospital rating system is a guideline to consider using.

You can also use another tool that identifies the top 100 hospitals in the US.

This information rates hospitals by type of surgery within hospital too.  Learn more here.  You can consider these resources if you have a plan which opens these facilities to you.

Are plan premiums important?

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

Monthly premiums for Medicare Advantage plans in Minidoka County plan range from $0 to over $130.

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.

Additional information on Minidoka County plans in just a moment.

 

What insurance companies offer Medicare Advantage plans in Minidoka County?

 

Blue Cross of Idaho

Humana

United Healthcare

Other tidbits to be aware of

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 is sounds like a great and often needed ‘extra’.   

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

For example, some plans restrict coverage to preventative care (a few cleanings annually, x-rays you can get have their own schedule, etc.).  The plan may cover certain periodontal services.  If covered, the plan may limit the number of times specific service(s) can be used during the year. Some plans include class II and III services.  If they do, there may be restrictions on specific services covered and may explicitly exclude certain dental billing codes.  Please read your plan’s ‘Evidence of Coverage’ for specific details.

Do you need to use the plans network of dentists? 

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

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

Hearing Aids.  

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

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

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

 

Would a Medicare coach be helpful?

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. 

 

 

 

This page was last modified on Oct 4, 2025 @ 4:20 PM

 

 

2026 Cassia County Medicare Advantage plans.

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

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

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

 

 2025 Cassia County has 22 Medicare Advantage plans for residents to consider. 

Here is the high level break down:

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

                  3 of these are PPO;

                  2 is an HMO plan.        

        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 who 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 Cassia 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?

The plan’s monthly premium.  They range from. $0 to over $140. 

We do not recommend plans with a monthly premium above $70?  Why?  The above mentioned Medigap plans may offer you better value.

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.

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

Think about where you would like to be treated if you have a serious health issue too.

What hospital(s) do you want to use if you are diagnosed with a serious health issue?

Would you prefer to have access to one of the major hospitals (and physicians) in the Pacific Northwest (or the entire US)?   How do you find them and narrow down the list that excel at treating your specific issue?

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 plans.  What is actually 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?

Brokers specializing in Medicare plans are available to you help you navigate your way through this maze.

We have been helping Idaho residents with their Medicare plan choices since 2012.  This includes residents in Cassia County.

If you would like to use our ‘cost-free’ help, complete the ‘scope of appointment’ document mentioned above, send it to us.  We will call you for your 1st appointment.

How do brokers get paid for their services? 

By the insurance company.  Medicare regulates how much a broker gets paid; all/most all insurance companies offering Medicare Advantage plans in Idaho are pay the brokers the same.  To us, that means we focus on the people’s needs we are working with and present plans which meet those needs.

 

If you want to learn more, additional details are below.

What are the actual MOOP figures of Cassia County Medicare plans?

Medicare’s maximum MOOP for this year’s 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 $4,500 to $6,400. 

The range for PPO plans is $5,900 to $14,000. 

 

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 Medicare Advantage 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’.  You can find this document on your insurance company’s website or by calling the customer service phone number on your member card.

Prior Authorization is an example.

A ‘prior authorization’ may be required on specific plan covered services.  What does this mean?  Your insurance company is requesting information from the prescribing physician about the service they wish to perform.  The insurance company can approve or deny the service request from your physician.  If the service request is denied, your prescribing physician has to go to ‘plan B’ and start the process over.  In the meantime, the patient/plan member is waiting.

The article found here information on what has been going on in this industry.  

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 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 of the physicians/providers that ‘accept Medicare’ insurance are not in your plan’s network.  

If, during your plan research, you wish 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, you have tools available to figure this out.  It may be useful knowing which plans have the higher percentage of cardiologists, oncologists, etc. are in their network.  We can show you how to get the answer to this question.  

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 are competing for other financial needs of the hospital.   

Proton Therapy is an example of newer technology for treating cancer.  It is being used as an alternative to radiation treatments.  

Read this article if you are unfamiliar with this. 

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

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

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

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

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

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

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

The 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, and you have a Medigap plan.  Learn about examples of these here and here, 

Does Medicare rate hospitals for us?

Yes.

Hospitals are assigned a ‘star rating’ by Medicare.  We recommend Idaho residents focus on 4 and 5-star rated hospitals AND skilled nursing facilities.  This article points out further information on this topic.   

There are other 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. 

 

Cassia County Medicare Advantage plans for Veterans.

We like the choices Veterans living in Cassia County have to get VA health care.  Idaho Falls and Twin Falls have clinics available.  Both Salt Lake City and Boise have hospitals too. 

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 $100 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.  

Is an HMO or a PPO plan right for you?

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

Be aware when you get plan services are from ‘out of network’ providers, the plan members share of the cost for services can be noticeably higher when compared to using ‘in network doctors/hospitals/etc.  Getting ‘out of network’ services may greatly increase the Veterans probability of hitting their plans cap on your share of costs for the year.  Check out this figure if you are interested in a PPO plan.  Call us if you want help thinking this through.

An HMO plan may fit a veteran that wants coverage outside the VA for regular health care OR just want access urgent and emergent care when it is needed. 

Some Veterans choose a $0 premium plan so they can get the low/no-cost ‘extra’ benefits which can come with these plans.  We noticed some plan(s) with a high Part B giveback also come with high-cost sharing when plan health care service is used. 

If a Veteran plans to get health care from an HMO plan, we need to pay attention to the plan’s network.  Participating hospitals and doctors can vary by plan and this can change annually. 

Why the interest by insurance companies in the Veterans niche?

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

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

This market niche has become quite competitive between the insurance companies.

Some of these companies want to increase their market share by offering more attractive features than their competitors.   Look at the ‘extra’ services not covered by Medicare for each plan you are considering.  Do you see any differences? 

These companies may improve their offerings annually.  They do this to attract Veterans already enrolled in another insurance company’s plan as well as Veterans new Medicare. 

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

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

 

Cassia 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.  

 

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 plans for the rest of the Medicare beneficiaries living in Cassia County

Monthly premiums of Medicare Advantage plans range from $0 to over $135.   

The differences between these plans include the available hospital(s), physicians, skilled nursing facilities, physical therapists, durable medical equipment providers, etc. Your share of the cost for services received AND the ‘out of pocket maximum limit’ also vary between plans. 

Some plans let you use ‘out of network’ providers at a higher cost sharing and ‘out of pocket maximum limit’. 

Be aware out of network providers are not required to accept your plan, unless you have an ’emergency’. 

Also note Mayo Clinic no longer accepts Medicare beneficiaries enrolled in a Medicare Advantage plan, unless their facilities are part of the plan(s) network (reference the plan’s provider directory).   Reference this note for details.  

 

What insurance companies offer Medicare Advantage plans in Cassia County?

American Health Advantage of Idaho

Blue Cross of Idaho

Humana

Molina

United Healthcare

Other tidbits to be aware of

Hospitals in your immediate area.

There are 2 hospitals within 25 miles of downtown Burley.

To see these, you will need to enter your zip code and adjust the radius around the search area.  Please start with 25 miles, review there results and then bump it up to 50 or 100 miles.  Click here to see where the hospitals are located. 

Hospitals are rated by The Center for Medicaid and Medicare Services (CMS).  We recommend people use facilities rated 4 or 5 stars.  If you see a hospital without a star rating, this can mean that the hospital did not submit information to be rated or they did not do enough procedures to be rated.  

Having resources with these ratings can be important to you when you get regular care, emergency and scheduled surgical procedures. 

All of these hospitals listed may not be in every plan.

 

Read the fine print that describes ‘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 is sounds like a great and often needed ‘extra’.   

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

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 Membership.

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

Hearing Aids.  

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

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

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

 

Would a Medicare coach be helpful?

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. 

 

 

This page was updated on Oct 4, 2025 @ 4:17 PM

 

Resources to find hospitals nearby

This resource identifies the 8 hospitals within 50 miles of downtown Preston.  Notice there is one facility with either a 4 or a 5 Medicare assigned Star rating.  Notice 4 of the hospitals are located in Utah.  These may not be included in the provider directory of the Medicare Advantage plans available to you.  You need to check each plan’s ‘provider directory’ to confirm this.  These documents are available on the insurance company’s website.

Depending on your health issue, you may want to use the resources in one of the top 250 hospitals in the US.  More on this below.

This page was last modified on Feb 22, 2026 @ 1:58 PM.

 

 

2026 Clark County Medicare Advantage plans.

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

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

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

What you need to know about 2025 Medicare plans available to Clark County Idaho residents. 

 

For 2025, Clark County has 16 Medicare Advantage and 12 Medigap 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.

                  3 of these are PPO;

                  1 is a HMO plan.        

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

                  5 are HMO plans;

                  3 are PPO plans. 

           The remaining plans are reserved for individuals which 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 Clark County Medicare Advantage plans.

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

Also, there are fewer ‘prior authorizations’ for them to deal with.

Learn more about Idaho Medigap plans here. 

 

What are the some of the differences between Medicare Advantage plans?

One item is the plan’s Maximum out of pocket limit (MOOP).  

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.    

Be mindful the insurance company offering a Clark County Medicare Advantage plan pays its share of the cost for services you use.  You pay the rest.  Your share of these costs can vary noticeably between plans.

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

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

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

What are the actual MOOP figures?

Medicare’s maximum MOOP for this 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 $5,500 to $6,000. 

The range for PPO plans is $6,700 to $14,000. 

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

Why?  The two Medigap plans mentioned above have lower premiums, a much lower cap on your share of the out of pocket costs, a network of all doctors/hospitals in the US which ‘accept Medicare’ and has far fewer restrictions.

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

If you understand the math for MOOP, skip to the next paragraph. 

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 from your physician.  If the service is denied, your prescribing physician has to go to ‘plan B’ and start the process over.  If you have a medigap plan, there are far fewer services with ‘prior authorizations’.   

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 of the physicians/providers that ‘accept Medicare’ insurance are not in your plan’s network.

If, during your plan research, you wish 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, you have tools available to figure this out.  It may be useful knowing which plans have the higher percentage of cardiologists, oncologists, etc. are in their network.  We can show you how to get the answer to this question.

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.  It is being used as an alternative to radiation treatments.

If you are unfamiliar with this technology, read this article.

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

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

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

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

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

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

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

Would you consider using the services of the top hospitals in the Seattle, Salt Lake City, or the Mayo Clinics?

The top 250 hospitals in the US may have the latest technologies to treat different health issue(s)…and the physicians that know how to use them.  These resources are available to you if they accept Medicare insurance (Part A and B).  Some do not accept Medicare Advantage plans (Part C).  Others prefer you have a Medigap plan.

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

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

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

Medications covered by each plan.

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

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

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

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

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

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

Below is a cut/paste from (Section 30.2.5) the current 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. 

 

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.

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

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

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

We recommend you consider a Medigap Plan G. 

Are there lower premium Medigap plans what have some copay’s?

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.   

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

 

There are three different audiences for Clark County Medicare Advantage plans.

Clark 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 $100 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.

 

Why the interest by insurance companies in the Veterans Medicare niche?

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

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

This market niche has become quite competitive between the insurance companies.

At the current moment, the major insurance companies offering these plans are in Clark County. There may be more new entrants next (or following) years.

In our opinion, these companies want to increase their market share by offering more attractive features than their competitors.

These plans have different features and costs to the Veteran.

These can include the doctors/hospitals in the plan’s network, the cost for health care services provided to the plan member, and the details of any ‘extra’ services not covered by Medicare.

Why is the Part B ‘buyback’ important?

Many MA plans in Idaho also include the Part B buyback.  This means the insurance company MAY offer to pay part of the Veterans Part B monthly premium.  In other Idaho Counties, this figure varies from $0 and up.

Some Veterans that get their health care from the VA simply enroll in one of these plans to get help paying for their Part B monthly premium and to take advantage of the $0/low cost for the other features included in the plan.  Others want access to urgent and emergency care outside of the VA.  Others simply want a broader choice of doctors and hospitals.

Another key point is these companies may improve their offerings annually.  They do this to attract Veterans already enrolled in another insurance company’s plan as well as Veterans new Medicare.

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

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

 

Clark County residents enrolled in Medicare and Medicaid.

 

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.  

 

Medicare Advantage plans for the rest of the Medicare beneficiaries living in Clark County.

Monthly premiums of Medicare Advantage plans range from $0 to over $130.   

The differences between these plans include the available hospital(s), physicians, skilled nursing facilities, physical therapists, durable medical equipment providers, etc. Your share of the cost for services received AND the ‘out of pocket maximum limit’ also vary between plans. 

Some plans let you use ‘out of network’ providers at a higher cost sharing and ‘out of pocket maximum limit’. 

Be aware out of network providers are not required to accept your plan, unless you have an ’emergency’. 

Also note Mayo Clinic no longer accepts Medicare beneficiaries enrolled in a Medicare Advantage plan, unless their facilities are part of the plan(s) network (reference the plan’s provider directory).   Reference this note for details.  

Some of the plans offer access to more hospitals beyond Clark County borders. 

 

What insurance companies offer Medicare Advantage plans in Clark County?

 

Blue Cross of Idaho

Humana

Molina

As Clark County’s population of Medicare beneficiaries increases other insurance companies may enter this market. 

Other tidbits to be aware of.

Hospitals in your immediate area.

There are 0 hospitals within 25 miles of downtown Dubois.

To visually see the locations of hospitals around Clark County, click here.  Adjust the radius search area to 100 miles.  This will give you a broader view. 

When done reviewing this, be sure and hit your browsers ‘back button’ to return to this page. 

Hospitals are rated by The Center for Medicaid and Medicare Services (CMS).  We recommend people use facilities rated 4 or 5 stars.  If you see a hospital without a star rating, this can mean that the hospital did not submit information to be rated or they did not do enough procedures to be rated.  

Having resources with these ratings can be important to you when you get regular care, emergency and scheduled surgical procedures. 

All of these hospitals listed may not be in every plan.

 

Read the fine print that describes ‘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 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. 

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.  If you have any question about whether a service is covered, call your plan’s customer service.  

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.

We have noticed some plans cut this benefit back for 2025. 

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 Membership.

Several insurance companies restructured their gym plans for 2025. 

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, or one of the new vendors in our area.  Be sure you read the plan’s rules for this service…and which facilities in your area are available to you.

Hearing Aids.  

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

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

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

 

Would a Medicare coach be helpful?

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 ads include this service for you?

Call us if you would like help. Our hours are 8am to 8pm Monday through Saturday. 

 

 

This page was last modified on Oct 4, 2025 @ 4:27 PM

 

2026 Camas County Medicare Advantage plans.

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

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

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

 

Several 2025 Camas County Medicare Advantage plans caught our attention.

The first is an HMO-POS plan with key 5-star hospitals in Oregon, Washington, Utah and Idaho in their network!  This means you pay in-network rates when you use these resources.  This same plan opens up access to other hospitals/physicians in the US that ‘accept Medicare’ too.  

Next 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 Camas County Medicare plans on our recommend list.  Which medications, health issues, and hospital preference(s) a person has/does not have are determining factors on which are appropriate.

Don’t forget, if you are enrolled in a Medicare Advantage plan now and the 2025 version of your 2024 plan left you wanting, you can switch to a different plan between January 1 and March 31.

 

What else you need to know!

For 2025, Camas County has 15 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.        

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

                  5 are HMO plans;

                  4 are PPO plans. 

           The remaining plans are reserved for individuals which qualify for Chronic Special Needs plans (C-SNP).  This plan is available to residents qualifying for this type of care.

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.

What does this mean?  Your  insurance company can approve or deny the service request from your physician.  If the service is denied, your prescribing physician has to go to ‘plan B’ and start the process over.  This article documents points out what has been going on in the US on this subject. 

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

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

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

Doctors/hospitals/other providers.

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

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

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

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

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

Proton Therapy is an example of newer technology 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.  Learn more about this subject 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 use a ‘board certified physician‘.

What are the differences between Camas County 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.

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

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

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

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

What are the actual MOOP figures?

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

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

The range of MOOP for your County’s HMO Medicare Advantage plans is $4,500 to $6,300.  The range for PPO plans is $5,900 to $14,000.

We prefer plans that meet a person’s needs AND have 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.

 

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 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.

 

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 in the US?

We recommend you consider a Medigap Plan G.  

 

Camas County Medicare Advantage plans for Veterans

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

Camas County residents have VA Clinics in Twin Falls (and several locations around the State) and hospitals in Boise, Salt Lake City and several other parts of the US.

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 $100 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.  

Is an HMO or a PPO plan right for you?

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

Be aware when plan services are provided by ‘out of network’ providers, the plan members share of the cost for services can be noticeably higher when compared to using ‘in network doctors/hospitals/etc.  Getting ‘out of network’ services may greatly increase the Veterans probability of hitting their ‘out of network’ maximum out of pocket limit.  Check out this figure if you are interested in a PPO plan.  Call us if you want help thinking this through.

An HMO plan may fit a veteran that wants coverage outside the VA for regular health care OR just want access urgent and emergent care when it is needed. 

Some Veterans choose a $0 premium plan so they can get the low/no-cost ‘extra’ benefits which can come with these plans.  We noticed some plan(s) with a high Part B giveback also come with high-cost sharing when plan health care service is used. Call us if you want help thinking this through.

If a Veteran plans to get health care from an HMO plan, we need to pay attention to the plan’s network.  Participating hospitals and doctors can vary by plan and this can change annually. 

Why the interest by insurance companies in the Veterans niche?

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

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

This market niche has become quite competitive between the insurance companies.

We expect more insurance companies will enter the Camas County MA marketplace in the future. 

Keep in mind, some of these companies want to increase their market share by offering more attractive features than their competitors.   

When this occurs, we need to pay attention to plan differences.

These can include the doctors/hospitals in the plan’s network, the cost for health care services provided to the plan member, and the details of any ‘extra’ services not covered by Medicare. 

Many MA plans in Idaho also include the Part B buyback.  This means the insurance company MAY offer to pay part of the Veterans Part B monthly premium.  In other Idaho Counties, this figure varies from $0 and up. 

Some Veterans that get their health care from the VA simply enroll in one of these plans to get help paying for their Part B monthly premium and to take advantage of the $0/low cost for the other features included in the plan.  Others want access to urgent and emergency care outside of the VA.  Others simply want a broader choice of doctors and hospitals. 

Another key point is these companies may improve their offerings annually.  They do this to attract Veterans already enrolled in another insurance company’s plan as well as Veterans new Medicare. 

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

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

 

 

Camas 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. 

Please remember you have 60-days from your cancellation date to find replacement insurance for both your health and prescription medications.  If you miss this window, you may have to wait until the next ‘annual enrollment period’. 

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 plans for the rest of the Medicare beneficiaries living in Camas County

Check out the hospitals in each plan’s network and where they are located.

 

There are no hospitals in Camas County.  

Check out the other facilities within 50 miles of zip code 83327 by clicking here.  

Notice there are 4 hospitals within this radius. 

Take a look at the Medicare Star rating for each hospital.  We recommend Idaho residents consider hospitals rated 4 or 5. 

Learn more about CMS hospital rating here. 

Hospital(s) without a rating may have not reported their results or did not meet the minimum number of procedures to be measured and rated for the current period.  

When selecting a health plan, be sure the hospitals and doctors you want to take care of you no matter the health issue is available to you.  

The CMS hospital rating system is a guideline to consider using. 

You can also use another tool that identifies the top 100 hospitals in the US.  This information rates hospitals by type of surgery within hospital too.  Learn more here. 

You can consider these resources if you have a plan which opens up these facilities to you.  Depending on the plan you choose, some/all of these facilities may or may not be available to you.

 

What insurance companies offer Medicare Advantage plans in Camas County?

Humana

Pacific Source

United Healthcare

Other tidbits to be aware of

Additional details about the plans available in Camas County.

Monthly premiums of Medicare Advantage plans range from $0 to $68.   

The differences between these plans include the available hospital(s), physicians, skilled nursing facilities, physical therapists, durable medical equipment providers, etc. Your share of the cost for services received AND the ‘out of pocket maximum limit’ also vary between plans. 

Some plans let you use ‘out of network’ providers at a higher cost sharing and ‘out of pocket maximum limit’. 

Be aware out of network providers are not required to accept your plan, unless you have an ’emergency’. 

Also note Mayo Clinic no longer accepts Medicare beneficiaries enrolled in a Medicare Advantage plan, unless their facilities are part of the plan(s) network (reference the plan’s provider directory).   Reference this note for details.  

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 is sounds like a great and often needed ‘extra’ benefit.   

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

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 co

Do you need to use the plans network of dentists? 

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

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

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. 

Gym Memberships.

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

Hearing Aids.  

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

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

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

 

Would a Medicare coach be helpful?

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. 

                                            .  

 

This page was last modified on Oct 4, 2025 @ 4:15 PM

2026 Lincoln County Medicare Advantage plans.

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

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

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

Several 2025 Lincoln County Medicare Advantage plans caught our attention.

The first is an HMO-POS plan with key 5-star hospitals in Oregon, Washington, Utah and Idaho in their network!  This means you pay in-network rates when you use these resources.  This same plan opens up access to other hospitals/physicians in the US that ‘accept Medicare’ too.  This can be useful for ‘snowbirds’. 

The next two are plans for residents 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 Lincoln County Medicare HMO and PPO plans on our recommend list.  Which medications, hospital preferences, and health issues a person has/does not have are determining factors on which are appropriate. 

Interested in learning more?  Print the ‘Scope of Appointment’ document (available here), sign/date it, then take a picture of the signed document and text it to us (1-208-867-0296).  Upon receipt we will call you and share the details.   

Don’t forget, if you are enrolled in a Medicare Advantage plan now, you can switch to a different plan between January 1 and March 31. 

 

What else you need to know! 

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

Here is the high level break down:

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

                  4 of these are PPO;

                  1 are HMO plans.        

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

                  4 of these are PPO;

                  5 are HMO plans.                  

           The remaining plans are reserved for individuals who 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.

Two of the twelve plans deserve your attention.

When you choose this 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 to the ‘next step’ in your health care.   

Also important, this plan does not charged a ‘premium’ for services received from hospitals/physicians/other providers received outside of your immediate area (like many PPO plans).

Learn more about Idaho Medigap plans here. 

 Call if you have questions.

What are the some of the differences between Medicare Advantage plans?

One item is the plan’s Maximum out of pocket limit (MOOP). 

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 year’s HMO plan is $9,350; for a PPO plan it is $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 $4,500 to $6,000. 

The range for PPO plans is $5,900 to $14,000. 

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. 

After you pay for these services, you subtract them 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 Medicare Advantage plan sets the cost sharing for each Part A and B covered service too.  

This simply means that you pay your share of the costs for services provided by your physician, use specific hospital services like MRI or CAT imaging, cancer treatments, services provided in the surgical suite, etc..   The insurance company behind each plan sets their own cost sharing for that plan.  You find these figures in each plan’s ‘Evidence of Coverage’ (EOC).    

The EOC also identifies which services must be approved by the insurance company before they can be performed.  Be aware approval requests can be denied by the insurance company.    

Prior Authorizations.   

Services covered by any Medicare Advantage plan may have a ‘prior authorization’ tag on a service.   These are found in the plan’s EOC. 

The insurance company can approve or deny the prior authorization request.  Learn more about what is going when these requests are reviewed and approved or denied by reading this article, this article,  and this article.  CMS is in the process of implementing changes to help get this back on track. 

When you stay with Original Medicare (Part A and B….not have a Medicare Advantage plan) these are the Medicare covered services which have prior authorizations. 

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 of the physicians/providers that ‘accept Medicare’ insurance are not in your plan’s network.  

If, during your plan research, you wish 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, you have tools available to figure this out.  It may be useful knowing which plans have the higher percentage of cardiologists, oncologists, etc. are in their network.  We can show you how to get the answer to this question.  

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 are competing for other financial needs of the hospital.   

Proton Therapy is an example of newer technology for treating cancer.  It is being used as an alternative to radiation treatments.  

Read this article if you are unfamiliar with this. 

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

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

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

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

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

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

 

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

The 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, and you have a Medigap plan.

Does Medicare rate hospitals for us?

Yes.

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. 

 

 Will you have more flexibility and less hassle by choosing a Medicare Supplement plan?

Yes. 

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.

This means you do not have an insurance company standing between you and your physician to get the ‘next step’ in your health care done. 

Check out what services have prior authorizations when you are enrolled in Part A and B AND not in a Medicare Advantage plan.  Compare this list to the ‘Evidence of Coverage’ (chapter 4) document of any Medicare Advantage plan you are considering.  Just look for the words ‘prior authorization’.

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

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

We recommend you consider a Medigap Plan G. 

 

Lincoln County Medicare Advantage plans for Veterans, people enrolled in Medicaid and Medicare, and several plans for the rest of us.

Lincoln 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 $100 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.  

 

Why the interest by insurance companies in the Veterans Medicare niche?

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

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

This market niche has become quite competitive between the insurance companies.

We expect more insurance companies will enter the Lincoln County MA marketplace in the future. 

Keep in mind, some of these companies want to increase their market share by offering more attractive features than their competitors.   

When this occurs, we need to pay attention to plan differences.

These can include the doctors/hospitals in the plan’s network, the cost for health care services provided to the plan member, and the details of any ‘extra’ services not covered by Medicare. 

Many MA plans in Idaho also include the Part B buyback.  This means the insurance company MAY offer to pay part of the Veterans Part B monthly premium.  In other Idaho Counties, this figure varies from $0 and up. 

Some Veterans that get their health care from the VA simply enroll in one of these plans to get help paying for their Part B monthly premium and to take advantage of the $0/low cost for the other features included in the plan.  Others want access to urgent and emergency care outside of the VA.  Others simply want a broader choice of doctors and hospitals. 

Another key point is these companies may improve their offerings annually.  They do this to attract Veterans already enrolled in another insurance company’s plan as well as Veterans new Medicare. 

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

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

 

Lincoln 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.  

 

Medicare Advantage plans for the rest of the Medicare beneficiaries living in Lincoln County.

Monthly premiums of Medicare Advantage plans in Lincoln County range from $0 to $118.

The differences between these plans include the available hospital(s), physicians, skilled nursing facilities, physical therapists, durable medical equipment providers, etc. Your share of the cost for services received AND the ‘out of pocket maximum limit’ also vary between plans. 

Some plans let you use ‘out of network’ providers at a higher cost sharing and ‘out of pocket maximum limit’. 

Be aware out of network providers are not required to accept your plan, unless you have an ’emergency’. 

Also note Mayo Clinic no longer accepts Medicare beneficiaries enrolled in a Medicare Advantage plan, unless their facilities are part of the plan(s) network (reference the plan’s provider directory).   Reference this note for details.  

 

 

What insurance companies offer Medicare Advantage plans in Lincoln County?

Blue Cross of Idaho

Humana

Pacific Source

United Healthcare

Other tidbits to be aware of.

Additional details about the plans available in Lincoln County.

Hospitals in your immediate area.

There are 2 hospitals within 25 miles of downtown Shoshone.

To see these, you will need to enter your zip code and adjust the radius around the search area.  Please start with 25 miles, review there results and then bump it up to 50 or 100 miles.  Click here to see this information.

When done reviewing this, be sure and hit your browsers ‘back button’ to return to this page. 

Hospitals are rated by The Center for Medicaid and Medicare Services (CMS).  We recommend people use facilities rated 4 or 5 stars.  If you see a hospital without a star rating, this can mean that the hospital did not submit information to be rated or they did not do enough procedures to be rated.  

Having resources with these ratings can be important to you when you get regular care, emergency and scheduled surgical procedures. 

All of these hospitals listed may not be in every plan.

 

Read the fine print that describes ‘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 is sounds like a great and often needed ‘extra’.   

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

For example, some plans restrict coverage to preventative care (a few cleanings annually, x-rays you can get have their own schedule, etc.).  The plan may cover certain periodontal services.  If covered, the plan may limit the number of times specific service(s) can be used during the year. Some plans include class II and III services.  If they do, there may be restrictions on specific services covered and may explicitly exclude certain dental billing codes.  Please read your plan’s ‘Evidence of Coverage’ for specific details.

Do you need to use the plans network of dentists? 

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

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

Hearing Aids.  

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

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

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

 

Would a Medicare coach be helpful?

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. 

 

 

 

Content last updated Oct 4, 2025 @ 4:20 PM

 

 

We help Power County Medicare beneficiaries living in American Falls, Rockland, Arbon, Neeley, Pauline, and Roy with their Medicare insurance choices.  People living on sugar beet, wheat, and potato farms in Power County are included too.

We live in Idaho and residents have benefited from our services since 2012.  Remaining licensed with all plans available to you remains our priority.

When you are ready, call us on 1-208-867-0296 between 8 am and 8pm Monday through Saturday.

As a Power County Medicare beneficiary, you have a total of 16 Medicare Advantage (Part C) and 12 Medigap plans available to consider.

Your choices of Power County Medicare Advantage plans.

Your 16 plans are broken down into the categories below.

Power County residents enrolled Medicare and Idaho Medicaid have specific plans, based on your Medicaid status, which can help you.

People diagnosed with Diabetes mellitus, chronic heart failure, or cardiovascular disorders have their own unique plans whose networks of providers specialize in these health issues.  If you have a current diagnosis of one of these issues, we can help find the right plan and with the right insurance company.

Veterans who get their prescriptions from the VA and want additional options on where they get their emergency and regular health care have specific plans for consideration.  Some of these plans help you pay for your monthly Part B premium too. There are several plans and based on your interests and needs, one of these should match up with your budget and specific interests.

Individuals who prefer to get their health care from medical resources in a 50-mile radius around America Falls.  There are a variety of hospitals and physicians near you.

Residents that prefer to have access to the top rated hospitals in Northern Utah, Southwest Idaho and the rest of the US (Mayo Clinics, etc.) are also available with certain health plans.

 

Deductibles for health care services are appearing in more plans!

This is another out of pocket cost Power County Medicare beneficiaries will be exposed to if they pick the wrong plan.

Weighing out of pocket costs when plan covered services are used, the plan’s monthly premium, permission required to see a specialist, prior authorizations, dealing with appeals, and the cut back in the ‘non-Medicare covered services’ suggests people should be paying attention to their Medigap plan choices.  At a minimum, a Plan G Hi-deductible.  Depending on your use of medical services, you may get better value and flexibility going forward.  We can help you understand this option and specific plan choices.

Plan premiums vary from $0 to over $150/month.

When these premiums get above $60/month, we encourage you to review the lower premium Medigap plans too (Plan G Hi-deductible, for example).

If you are a moderate to frequent user of medical services, Medigap plans may offer you more flexibility on where and how you get your care and end up saving you money.

Hospitals within 50 miles of American Falls include:

Power County Hospital District, American Falls, Id.

Portneuf Medical Center, Pocatello, id.

Grove Creek Medical Center, Blackfoot, Id.

Bingham Memorial Hospital, Blackfoot, Id.

State Hospital South, Blackfoot, Id.

Minidoka Memorial Hospital, Rupert, Id.

Cassia Regional Hospital, Burley, Id.

Individual insurance companies pick the hospitals they wish to include in the networks included with their plan(s).

Consider including 4 and 5 star rated facilities to your list of resources.

These are available in Bonneville County, Twin Falls County, Ada County, and the resources in the Salt Lake City area.  Some plans provide access to these facilities AND the top 50 hospitals in the US.

Your Medigap plan choices.

These plans open access to all physicians, hospitals, and other providers in the US which accept Medicare insurance.  Most do.

You do not need permission from your primary care physician to get an appointment…you just call them and get the task done.   When they ask what insurance you have, you tell them, “Original Medicare with a Medigap plan”.  We suggest you begin by finding the hospital’s website and follow their instructions for making an appointment.   Call us if you want help with this.

The guide to understanding Idaho Medigap plans is available here.

If you already have a Medigap plan, check this web page to see if there are meaningful lower premiums available for your current plan.  The coverage is the same no matter who you buy the plan from.  You can switch companies, get the same plan, and lower your monthly premium.  Idaho’s ‘Birthday Window’ lets you do this annually.

You might be surprised to see how much you can save and get the same coverage from a different company.

We watch this market weekly and prefer these plans for individuals that do not want an insurance company standing between them and their choice of where they get their care.

Call us with your questions.

How to find the top hospitals in the US by type of surgery.

Companies which rank hospitals include Health Grades, Leapfrog, and The Centers for Medicare and Medicaid Services (CMS).  These are more, however these three are a good start.

We like Health Grades as they collect pre-op information as well as post-op data on all surgeries in the 4500+ hospitals in the US.  They also rank hospitals by type of surgery too.

 

Would a Medicare coach be helpful?

A coach can answer your question, 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 Medicare Advantage plan TV ad’s include this service for you?

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

 

This page was last updated Apr 12, 2026 @ 6:29 PM

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 Medicare Advantage plan TV ad’s include this service for you?

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

 

 

Content last updated Mar 1, 2026 @ 12:56 PM