Idaho Medigap Plans and Carrier Difference
500′ Overview of Idaho Medigap plans.
Idaho Medigap plans help residents pay the left-over costs when they use services covered by Original Medicare.
Residents must be enrolled in Medicare Part A and B to be eligible to enroll in a Medigap plan.
Medigap plans have enrollment rules that are different from Medicare Advantage AND Medicare prescription drug plans. This is important and discussed below.
There are 12 different plans offered by over 20 insurance companies. We consider the 2 hi-deductible versions plans (Plan F and G) separate plans from their ‘parent’ plans. More on this below.
Each plan picks up a different combination of the remaining costs that Medicare Part A and B do not cover. Medigap Plan G picks up ALL the left-over costs, except the Medicare Part B annual deductible. Medigap plan F picks up all the left-over costs, but has a higher premium than Plan G.
What this means to you is you can budget with confidence for Medicare covered health care costs.
Is choice of physicians and hospitals important to you?
Most doctors and hospitals in the US ‘accept Medicare insurance’. You can find them here.
All of them are available to you when you have a Medigap plan. You just need to make the appointnent.
This includes all/most all of the top 250 hospitals in the US.
Did you know the top 250 hospitals in the USA have better surgical results? Many of them accept Medicare insurance. You can learn more about these facilities by reading the annually updated report found here. These resources may not be available to you if you enroll in a Medicare Advantage (MA) plan.
We favor using this resource to find top hospitals as the CMS hospital star rating may not be a reliable resource as it does not adequately consider surgical outcomes. Read more here.
Medigap Plans — the details.
We encourage you to download and open an important Medicare authored document titled ‘Choosing a Medigap Policy’.
This is available here. Page 11 is a table which helps you understand the differences between each plan.
If you are unsure of the differences between Idaho Medigap plans and Idaho Medicare Advantage plans, please review this information.
Individuals under the age of 65 and enrolled in Medicare, please review this information.
Enrollment rules for Idaho Medigap plans.
Enrollment in Medicare Part A and Part B is a requirement before you can join a Medigap plan.
People have a choice to enroll in either a Medigap Plan OR a Medicare Advantage plan. You cannot have both plans at the same time. You can switch between these 2 plan types; however, you need to follow their enrollment timelines and rules.
If you choose a Medigap policy, you should also consider enrolling in a Medicare prescription drug plan (Part D plan). More on this later.
Medigap plans have enrollment rules which are different from Medicare Advantage and Prescription drug plans.
You should be aware of these.
These are reviewed in pages 14 – 16 of the document you just downloaded.
How much does Medicare pay and what is my share?
Learn the specifics of your share of the left-over costs from Part A and Part B covered services here.
These are the amounts you will be billed for each time you use Part A and B services if you do not have a Medigap plan.
If you have an MA plan, the insurance company offering the plan sets their own cost sharing figures. These can change annually.
What are the differences between the 12 Medigap Plans?
Idaho Medigap plans are identified by a unique alphabetic character (A through N).
The differences between the 12 plans are presented in the table found on page 11 of document referenced above.
Look at the coverage differences between a Medigap Plan A and Plan B. Then compare Plan B to a Plan G. Be sure and read the foot notes at the bottom of the page. They provide a succinct description of the 2 hi-deductible plans (Plan G and Plan F).
Call us if you would like assistance interpreting this table.
Notice the coverages for plans C, D, F, G and N. They pay all/most all the left-over costs for Part A and B services.
If you choose one of these plans, it is possible to budget effectively for your Medicare covered health care. Note Plan C and F have specific eligibility requirements.
What are the differences between the insurance companies offering Idaho Medigap plans?
Key differences include fees for monthly premiums, their experience, commitment to the marketplace, and financial stability.
The Idaho Department of Insurance (IDOI) regulates companies offering Medigap policies in Idaho. These companies follow federal and State laws designed to protect the Medicare beneficiary (you).
Each Medigap policy (like Plan G) must offer the same basic benefits, no matter which insurance company sells it. This simplifies company selection as you are comparing ‘apples to apples’. Some companies may add additional benefits to their plans which are not covered by Medicare Part A and B.
Customer service is typically not an issue to Medigap policy holders. Why? Medicare identifies the rules for which services are covered by Medicare and which are not. Insurance companies simply follow Medicare’s rules when paying their policy holders share of leftover costs.
Understanding how Part A and B work is key.
Understanding Medicare Part A and B and what services are covered/not covered is important. These rules are documented in the PDF document titled ‘Medicare and You. This is the same document you downloaded a few moments ago (available here).
Using physicians/other providers that ‘accept Medicare insurance’ is important. Also confirm the services they provide to you are covered by Medicare. If you use providers that DO NOT accept Medicare insurance, you may end up paying retail. The same applies if you receive services that ARE NOT covered by Medicare.
How do you make sure you are not exposed to these issues? Ask the provider before they perform any services for you. If the service is not covered by Medicare, ask them to use a service that is. Your other choice is to find another provider to work with or be prepared to pay for the service you receive yourself.
Why you would want a Medigap Policy
You have the flexibility of choosing any doctor(s)/hospital(s) in the US and other providers that accept Medicare insurance.
Over 90% of the physicians in the US do as do most of the hospitals. This means many of the top clinics in the US are available to you.
There are 12 different Medigap plans. This means you have choices.
We count the 2 hi-deductible plans (Plan G and Plan f) in this figure.
Each of these plans cover a different combination of the left-over costs that Part A and Part B do not completely pay. Some of these plans pay all/most all your left-over costs. This means you can budget confidently for your Medicare covered health care costs.
Existing Medigap policy holders can change companies annually.
Why would you do this? Because new companies can enter the Idaho market with lower premiums AND existing companies can get annual premium increases. Premium increases can range from 0% to double digits. During 2021 some Idaho Medigap policy holders received 10% + rate increases. Protecting yourself from these issues can be done by changing companies and get the same plan.
We encourage people to manage their home, auto and health insurance costs annually. It takes maybe 15-minutes to complete an online application (when you work with a broker) to complete a Medigap application. Shop smart.
Prior authorizations for most health care services covered by Medicare are not present.
This means you do not have an insurance company standing between you and your doctor to decide the next step in your health care.
How to limit on your annual out of pocket costs.
Be aware when a person stays with Original Medicare, there is no cap on their share of leftover costs.
These ‘left over costs’ are your share of the fees for Medicare Part A and Part B covered services.
When a person starts using more Medicare covered services these 20% copays and other deductibles can add up to significant figures. For example, 20% of an $13,000 shot administered in a doctor’s office or a hospital can put a dent in the savings account…especially if the shot is not a one-time event. If you have a Medicare Advantage plan, this could be the path to hitting the plan’s annual ‘Maximum Out of Pocket Limit’.
An easy way to eliminate the ‘no out-of-pocket limit’ issue with Original Medicare’ is to select one of the 12 Medigap Plans.
Medigap plans (C, D, F, G, or N) can leave you with no or little out of pocket costs when you use Medicare services.
There are ‘hi-deductible’ versions of Plan F and G. These plans have lower premiums and are a good alternative to Medicare Advantage (MA) plans.
The Hi-deductible amount (limit) is like MA plans ‘out of pocket limit’. This ‘deductible’ is $2870 in 2025. This is a Medicare controlled figure and goes up a bit annually.
What happens if you move?
Medigap plans are good anywhere in the USA. This means you can use any doctor/hospital/other providers in the USA that accept Medicare insurance. The plan travels with you.
A Closer Look at the 12 different Idaho Medigap Plans
This section reviews the Idaho and National marketplace for each of the 12 different Medigap plans.
Reference this article published by AHIP (learn about them here).
The individual Medigap Plans
As you review the information below, having the table on page 11 of the ‘Choosing a Medigap Policy’ we be useful.
Medigap Plan G
The laws affecting enrollment in Plan C and F changed in 2015. This change prohibits people new to Medicare on January 1, 2020/later from enrolling Medigap Plan C and F. People already enrolled in thee plans can keep them. If a person is eligible for Medicare prior to this date they can still enroll in these plans.
Since this law was announced, more insurance companies started offering Plan G.
Why? Because Plan G would become the new ‘gold standard’ for health insurance for people on Medicare.
Compare Plan F to Plan G
Compare Plan G to Plan F using the same chart mentioned above. The plans are the same except Plan G does not cover the Part B annual deductible.
This year’s deductible is available here.
Plan G has lower annual out-of-pocket costs than plan F.
How do you determine this?
Annualize the monthly premium for Plan G and Plan F. Then add the annual Part B deductible to your annualized Part G premium. This result is still lower than your annualized Plan F premium.
This is the contributing reason for accelerated growth in the number of Plan G policies issued across the US.
We feel if an individual wants comprehensive health insurance, Plan G is the preferred choice.
The Hi-deductible versions of Plan F and Plan G
Medigap Plan G Hi-deducible is new to the market on January 1, 2020. It came about because Medigap Plan F Hi-deductible was closed to people new to Medicare on January 1, 2020. Plan F Hi-deductible is still available to people eligible/on Medicare prior to January 1, 2020.
We feel the word ‘deductible’ is misleading when describing these 2 plans. This ‘deductible’ operates in the same manner as MA plans ‘out of pocket limit’. These plans DO NOT work the same way pre-65 hi-deductible health insurance plans do.
Be aware Medicare Part A and B still pay their share of the costs when you use these services. The Medigap Hi-deductible plan member pays their share of the left-over costs for the calendar year.
These out-of-pocket costs are capped at the ‘deductible’ amount. This deductible amount is a CMS controlled figure and it can go up annually.
By the way, CMS bumped up the maximum out-of-pocket limit for MA plans in 2021, 2023, 2024, and 2025.
What does this mean? The MA plan member could be exposed to a higher share of their plan’s health care cost.
Medigap Plan C and Plan F
Most of individuals enrolled in a Medigap plan prior to 2015 chose either Plan C or Plan F.
Since the law change was announced in 2015, enrollment in Plan G took off.
Plan C and F are still available to people either eligible for Medicare or enrolled in Medicare prior to January 1, 2020.
At this writing fewer than 30% of the insurance companies offer Plan C in Idaho.
Medigap Plans A and B
These plans have been losing interest by Medicare beneficiaries for several years.
Why? Thes plans do not cover services people may need later in life. This means the plan holder is responsible for the copays Medicare leaves when these services are used.
Underwriting comes into plan if a person presently holds either plan wants to switch to a Plan G. Depending on the answer to these questions, the company may not accept the application.
Medigap Plan D
We like Medigap Plan D but favor Plan G.
Why? Plan G covers ‘excess charges’ while Plan D does not. It is possible we could use the services of a physician that is eligible to add ‘excess charges’ to their bill. Having this coverage makes sense.
At this writing, less than 20% of the insurance companies offering Medigap plans in Idaho offer Plan D. All, but one, companies offer Plan G.
At present, there is little difference in premiums for Plan D and G
Medigap Plan K, L, and M
Less than 2% of the Medigap policies in force in the US are with one of these 3 plans.
We feel Medigap Plan G Hi-deductible offers better value than any of these 3 plans.
Medigap Plan N
We like Medigap Plan N.
It has similar coverages to Plan G (but with copays on some services) and the monthly premium is typically lower.
Be aware as we start increasing the frequency of doctor and ER visits, the copays can add up.
Keeping track of such details as we get older can be a challenge for some. Plan G may be a better alternative for people with these concerns.
What are ‘Excess Charges’?
Did you notice some Medigap Plans cover ‘excess charges’ (page 11 of Choosing a Medigap Policy.
Providers that do not normally accept ‘assignment’ (learn more here) can choose to treat you on a selective basis. Doing so means they are paid the ‘Medicare-approved amount’ for the service they provide and can add an ‘excess charge’. This is a tool that permits providers to earn more for their services when treating Medicare-insured patients.
We feel this feature is important and is a key reason we like these Idaho Medigap plans.
Providers that do not ‘accept assignment’ may ask you to sign a document acknowledging your awareness of their fees. Be cautious about moving forward. What you will be paying could be noticeably more than if you used a provider that accepted Medicare insurance.
Medigap plan F and Medigap Plan G cover ‘excess charges’.
How much do Idaho Medigap Plans cost?
Current monthly premiums for all companies offering Idaho Medigap Plans are available here.
Note there are different rate charts for people that use tobacco, those that do not and pre age 65 enrollees on Medicare.
Insurance companies offering Medigap plans in Idaho are regulated by the Idaho Department of Insurance (IDOI). Part of the IDOI’s responsibility is to assure that any ‘annual rate increase’ to a plan’s premium is justified.
IDOI updates these premium charts several times throughout the year.
How often should we expect increases to occur with our Medigap plan?
Each company has their own annual premium increase. This is typically based on the ‘claims’ experience of a company had (relative to the premium revenue). During 2024 and the 1st quarter of 2025, we are seeing 8%/higher often.
We encourage you to budget for annual premium increases in the 8% – 14% range for the next few years. Why? Because the cost of health care is and has gone up.
When can I expect my first premium increase?
Most insurance companies will not change their rate for 12-months from your plan’s effective date.
What else you should know
Agents and Brokers
Many insurance companies use independent brokers to help enroll people in their Medigap policies. A few restrict sales of their plans to in-house employees (agents).
Brokers choose which products (Medicare Advantage vs Medigap) they will specialize in.
Some brokers represent both types of plans. Brokers can be licensed with many or just a few companies.
Several of these companies do not advertise on TV, cold call people or mail pamphlets.
Our Recommendations
We recommend Idaho residents work with brokers that specialize in Medicare and represent both Medigap and all the Medicare Advantage plans.
Doing so means you get a compare/contrast of the different plans available to you and you choose which companies/plans you want.
Working with an agent employed by a specific company typically means you only hear about the plan(s) they represent. You are not getting the complete picture of your options.
Know National and your State’s laws affecting insurance companies offering Medigap plans.
Insurance companies offering Idaho Medigap plans have both State and Federal regulations they must follow. We feel it is important for State residents to learn how their State may have supplemented these regulations.
Idaho Code for Medigap Insurers
You can read the Idaho code which regulate insurance companies offering Medigap plans here. Look at docket 18-01-54.
Minnesota, Massachusetts, and Wisconsin are waiver States. This means they:
- A) Provide different kinds of Medigap policies NOT labeled with letters/
- B) Have comparable benefits to standardized plans/
- C) Offer a different system that includes basic (“core”) and optional (“rider”) benefits.
How the 50 States vary on their rules
If you have an interest in this topic, the Kaiser Family Foundation produced a report you should read. It summarizes the variance of rules across the 50 States.
Also included in the report is a broad list of medical conditions that different insurance companies can screen for in their underwriting process.
PERSI
If you have funds in a PERSI account, you can use them to pay your Medigap plan premium. PERSI will help you understand how their process works and provide a list of companies they work with.
When your PERSI funds run out, the rest of the insurance companies offering Medigap plans in Idaho are open to you.
We suggest you change to the company offering the same plan but with a lower monthly premium.
Call us if you want help understanding plan differences and enrolling in the plan you choose.
Prescription Drug coverage
When encourage you consider adding a prescription drug plan (PDP).
Why? To get favorable pricing on your medication refills and avoid a ‘late enrollment penalty’. A late enrollment penalty is added to your plan premium if you choose to enroll in a plan later in life. The penalty increases for every month enrollment is deferred.
If you are currently not taking any prescription medications, be aware you can enroll in one of these plans with a monthly premium less than $10.
Note that your annual out of pocket cost for the same set of medications can vary by 300%+/- between plans. Annual out of pocket costs means annual premium + annual refill cost.
We can help you find the plan that covers your medications at the lowest annual cost.
Closing Comments
Are Medigap plans right for everyone? No. Medicare Advantage plans are not either. People are unique in their needs, retirement budget, and preferences for health care.
If you plan to work with a broker and are considering an Idaho Medigap or a Medicare Advantage plan, contact us.
Read the information found here to learn which Medicare Advantage and prescription plans we are licensed with.
We are licensed with all Medigap plans available to Idaho residents. If you prefer a drug plan not available to brokers, we will direct you to the resource where you can do this yourself.
We are here to help. Call us when you are ready.
This page was updated
Disclaimer: This website is a private website and is not associated, endorsed or authorized by the Social Security Administration, the Centers for Medicare and Medicaid Services, or the Department of Health and Human Services nor do we claim to be. These agencies have not endorsed content on this website. This site is for the benefit of Idaho residents seeking help and wanting to enroll in a Medigap, Medicare Advantage Plan, or a Prescription Drug Plan. If you want to learn how you can enroll in Original Medicare or you would like to find more information about the US Government Medicare program, contact us or visit www.Medicare.gov.