County-by-County review of Idaho Medicare Advantage plans*
Each Idaho County has their own specific list of Medicare Advantage plans available to residents.
Why? Because individual insurance companies decide which Counties they will offer which plans.
Some Idaho Counties have 5 plans available while others have over 30.
Changes in 2025 Idaho Medicare Advantage market.
Aetna left the Idaho market.
Select Health withdrew their plans from all counties except Bonneville and Franklin.
The St. Luke Health Partner plans were removed from the market in all counties.
Blue Cross of Idaho, St Alphonsus Health Plan(s), Pacific Source, Molina, Humana, Regence Blue Shield of Idaho, and United Health Care adjusted their 2025 plan portfolio.
We noticed some of the above companies adjusted certain ‘extras’ (dental, over the counter benefit, dropped some of the upper end facilities from their gym network, etc.).
Positive changes were made too!
New and unique plans were introduced in 2025.
Some of these help people with Diabetes mellitus; and/or Chronic heart failure; and/or Cardiovascular disorder (cardiac arrhythmias, coronary artery disease, peripheral vascular disease, chronic venous thromboembolic disorder).
We also noticed a few insurance companies tweaked their plan portfolio(s) with the goal of picking up market share. More on this after the January and February enrollment reports are released by CMS.
If you have not reviewed your Medicare Advantage plan options in 3 or more years, we suggest you request an audit.
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.
A note about HMO plans.
This type of Medicare Advantage plan has a defined network of doctors/hospitals/other providers. If plan members want their insurance company to pay for their non-emergent health care services, they need to use the providers in the plan’s network. There are some exceptions to this and are found in the plan’s Evidence of Coverage (EOC) document.
These plans typically have ‘prior authorizations’ on covered health care services. This means your physician must get approval from the insurance company before they can proceed implementing their health services for you. The insurance company can deny prior authorizations.
Providers in a plan’s network are listed in the plan’s ‘provider directory’. Changes can be made real time throughout the year. This resource is found on the insurance company’s website.
HMO-POS is a variation of the basic HMO plan.
POS stands for ‘point of service’. This means the plan may permit plan members to use ‘out of network’ providers. Reference the plan’s EOC for details.
What else do you need to know about HMO plans.
Each HMO plan may have a different combination of hospitals/physicians/other providers in their network. These are listed in a plan’s ‘provider directory’. This is available on the insurance company’s web site.
HMO plans may have lower out of pocket costs for plan members when compared to PPO plans.
We see some plans with unique non-Medicare covered extra services.
Both policy holders and insurance companies can change plans annually.
When policy holders read their ‘annual notice of change’, they will be made aware of how next year’s version of their current plan will change. This important document shows up in early October.
If the policy holder is ok with the changes for next year, they will be automatically re-enrolled in their same plan. If they wish to change to a different plan, it must be done by December 7th.
‘Special enrollment periods’ (SEP) are available to people meeting the conditions of the SEP. They are discussed here. We encourage you to be familiar with these situations and take advantage of them if you qualify.
The HMO market is quite competitive and changes annually.
The Idaho HMO market can be categorized into 3 different sub-markets.
In our opinion each can be defined by the population of Medicare enrollees in a specific County AND availability of medical resources to support plan members.
Counties in tiers 1 and 2 typically have more plans to consider and their plans may be richer in benefits.
Why we need to pay attention to what happens in our County.
Insurance companies can move new plans into certain counties and remove plans from other counties and do this annually. They can also change the details of next years version of current plans.
What can change? Some years very little/nothing to just about everything.
Changes can affect your pocketbook, your choices of providers, covered medications, plan services, and just about everything else.
Occasionally we see a new plan which takes advantage a disruption in the market. We believe 2025 is such a year and is evident in certain Counties.
The insurance companies offering these products are challenged to design plans which meet the market need, are competitive, cover their expenses, and make a profit.
Is an HMO plan a good fit for you?
If a person is fine getting their health care from the hospitals and physicians in the plan’s network, HMO plans can be a good fit.
If you are diagnosed with a serious health issue, would you prefer to be treated at one of the top hospitals that specialize in your health issue? If your answer is ‘yes’, a PPO plan or a medigap plan may be a better choice.
Details of PPO plans you should be aware of.
This type of plan has a network of providers available to plan members.
Members may also be able to use other providers which are not in the plan’s network.
Providers that do not ‘accept Medicare’ will not be in any plan’s network. If you choose to use their services, they will expect you to pay for services provided. This means your plan will not pay for services received. Medicare will not either.
Some providers do not accept appointments from people insured by a Medicare Advantage plan. These same providers may accept people insured with Medicare Part A and B but not enrolled in a Medicare Advantage plan.
Read chapter 4 of your plan’s ‘Evidence of Coverage’ (EOC) to learn what your ‘out-of-network’ cost share (and other rules that may be in place).
This PDF document can be downloaded from any insurance company’s website. It can be found in the section where ‘plan details’ are reviewed.
The language we often see in this document reads:
As a member of our plan, you can choose to receive care from out-of-network providers. However,
please note providers that do not contract with us are under no obligation to treat you, except in
emergency situations.
What else should I know about PPO plans?
PPO plans have an additional feature which cap’s your share of the left-over costs you when you use ‘out-of-network’ providers. This ‘cap’ is different from the ‘cap’ when you use ‘in-network-providers’.
This cap is also called the plans maximum out of pocket limit (MOOP).
Medicare defines both MOOP figures annually. They typically go up.
For 2025, the Medicare MOOP for in-network-providers is $9,350; the ‘out-of-network’ figure is $14,000. Insurance companies can set each of their plan’s MOOP to the Medicare maximum figure or something lower. This is a figure people should be looking at when selecting a plan.
When you use ‘out of network’ providers, your Maximum out of pocket limit (MOOP) will switch to the ‘out of network MOOP’ for your plan. This figure can be noticeably higher than the ‘in-network’ MOOP.
We favor plans with a low monthly premium, low MOOP, low out of pocket costs when plan services are used, a good network of hospitals/doctors, and ‘extras’.
Brokers licensed with all plans help you find these plan(s).
Are Medicare Advantage plans losing favor with Hospitals/physicians?
Take a moment and read the announcement from Mayo Clinic here. A similar announcement was made in September of 2023. Read the 2024 article on this same subject here.
Will I have fewer restrictions on which doctors/hospitals I can use if I stay with Original Medicare (do not enroll in a Medicare Advantage plan)?
Yes.
Click your county name from the list below. You will have a good introduction to your other choices.
Where do I go from here?
If you would like to learn more about your Medicare health care plan options, we can help you.
All brokers are required to follow Medicare’s rules before doing so. This means we must have a signature on the Medicare document called a ‘Scope of Appointment’. This is available here.
Please print, sign and send us the document. This can be sent via email attachment, texted with the signed document attached or faxed. Call us if you have questions on this.
We look forward to helping you.
Southwestern Idaho Medicare Advantage Plans
Ada County plans are reviewed here.
Adams County Plans are reviewed here.
Boise County plans are reviewed here.
Canyon County plans are reviewed here.
Elmore County plans are reviewed here.
Gem County plans are reviewed here.
Owyhee County plans are reviewed here.
Payette County plans are reviewed here.
Washington County plans are reviewed here.
Valley County plans are reviewed here.
Medicare Advantage Plans in Northern Idaho Counties
Benewah County plans are reviewed here.
Bonner County plans are reviewed here.
Boundary County plans are reviewed here.
Clearwater County plans are reviewed here.
Idaho County plans are reviewed here.
Kootenai County plans are reviewed here.
Latah County plans are reviewed here.
Lemhi County plans are reviewed here.
Lewis County plans are reviewed here.
Nez Perce County – plans are reviewed here.
Shoshone County – plans are reviewed here.
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Medicare Advantage Plans in Central Idaho Counties
Blaine County plans are reviewed here.
Butte County plans are reviewed here.
Camas County plans are reviewed here.
Custer County plans are reviewed here.
Medicare Advantage Plans in South Central Idaho Counties
Cassia County plans are reviewed here.
Gooding County plans reviewed here.
Jerome County plans are reviewed here.
Lincoln County plans are reviewed here.
Minidoka County plans are reviewed here.
Twin Falls County plans are reviewed here.
Medicare Advantage Plans in Eastern Idaho Counties
Bannock County plans are reviewed here.
Bear Lake County plans are reviewed here.
Bingham County plans are reviewed here.
Bonneville County plans are reviewed here.
Caribou County are reviewed here.
Clark County plans are reviewed here.
Franklin County plans are reviewed here.
Fremont County plans are reviewed here.
Jefferson County plans are reviewed here.
Madison County plans are reviewed here.
Oneida County are available here.
Power County plans are reviewed here.
Teton County plans are available here.
We are here to help you think through your choices of Idaho Medicare Advantage plans.
Thank you for reading the article.
Contact us. We will answer your questions, help you think through your plan choices and enroll in the plan you choose.
*Statistics on Medicare Advantage plans available in Idaho and other facts stated above came from this resource and this resource.