Shoshone County Medicare Advantage plans
Several 2025 Shoshone County Medicare Advantage plans caught our attention.
2 of these plans are 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 8 other Shoshone County Medicare HMO and PPO plans on our recommendation list. Which medications, hospital preferences, and health issues a person has/does not have are determining factors on which are appropriate.
What else you need to know!
For 2025, Shoshone County has 17 Medicare Advantage plans for residents to consider.
Here is the high level break down:
3 plans do NOT include prescription drug coverage; Veterans may find these plans attractive.
1 of these is a PPO;
2 are HMO plans.
8 plans include prescription drug coverage and services covered by Medicare Part A and B.
7 are HMO plans;
1 is a PPO plan.
The remaining plans are reserved for individuals who qualify for Medicaid special needs plans (C-SNP or D-SNP).
There is another type of Medicare plan you should be aware of.
These are Medigap plans.
When you choose this Medigap plan, all doctors/hospitals that accept Medicare insurance in the USA are available to you. This means you do not have the network restrictions/rules found in Shoshone 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.
Medicare published a document that provides the rest of the details you need to know about Medigap plans. You can download this PDF document by clicking here.
Two of these plans limit your annual out of pocket costs for Part A and B covered services to less than $2,900.
This figure is controlled by Medicare and typically goes up a bit annually. If your cost share for Medicare Part A and B used services for the calendar year hits this figure, your Medigap plan pays the rest of your left-over health care costs.
Keep this figure in mind when you read the discussion below on ‘out of pocket limits’ in Medicare Advantage plans.
What are the differences between these Shoshone County Medicare Advantage plans?
Monthly premiums range from $0 to over $140.
The MOOP (Maximum out of pocket limit) is a key figure you should be aware of. Put plans on your short list that have a lower MOOP. This decision may save you money if you use Medicare covered health care services during the plan year.
Pay attention to your share of the costs for the services you know you will use. There are documented in the plan’s ‘Evidence of Coverage’ (EOC) document. You can download this from the insurance company’s website. Each plan has this document available.
Then look at the cost sharing for the services that would be needed if you were diagnosed with a serious health issue.
Look at the hospitals in the plans network. If you are diagnosed with a serious health issue, would you want to be treated at one of these facilities? Would you prefer to have access to one of the major hospitals (and physicians) in the Pacific Northwest (or the entire US)?
What is your cost share for filling/refilling the prescription medications you take? There is typically a 300% +/- annual difference in medication costs between plans for the same set of medications.
What are the extra (non-Medicare covered services) included in the plan. What is covered? Are the providers you currently use for these services in the plans network? What are the limits your plan will pay for these services?
The insurance company offering each Shoshone County Idaho Medicare Advantage plans sets the cost sharing for each Part A and B service.
This simply means what you pay to see your physician, use hospital services, pay for your MRI/CAT imaging, cancer treatments, skilled nursing care, etc. are often different between plans. When you compare plans annually, you look at these figures and choose the plan that best fits your pocketbook and needs. These figures can change annually.
Cost sharing for services used, the plan’s MOOP, monthly premium, and the financial savings you get when you use the plan’s non-Medicare covered services are some of the differentiators between plans.
Specific plan coverages may have limitations.
Rules may be imposed on specific coverages. You find these rules in your plan’s ‘Evidence of Coverage’.
Prior Authorization is an example.
Your insurance company can approve or deny the service request from your physician. An example is surgery to fix something. If the service is denied, your prescribing physician must go to ‘plan B’ and start the process over.
The article found here presents the issues of over utilization of this feature. Some progress is being made to correct the shortcomings of the initial implementation.
The number of days ‘skilled nursing care’ has their daily co-pays in place is something you need to pay attention to. Why? Because if you need this service and have the ‘wrong’ plan, it can be the quickest way for you to hit your plan’s MOOP.
Dental coverage is another example where reading the plan’s EOC is important.
An example we noticed, when reviewing 2025 EOC(s), reads: ‘Submitted claims are subject to a review process which may include a clinical review and dental history to approve coverage’. This is an example of why people interested in dental coverage included in a Medicare Advantage plan need to read the fine print before choosing a plan.
The dollar value the insurance company offers you for dental coverage can vary widely between plans.
Doctors/hospitals/other providers.
Availability of physicians, hospitals, physical therapists, skilled nursing facilities, durable medical equipment providers and all other provider types vary by plan. Read this article to learn more.
The insurance companies offering Medicare Advantage plans put together their networks of these people/facilities for their plan members. Medicare requires insurance meet a minimum adequacy requirement when they put their networks together. This means there is a good probability not all physicians/providers in your geographic area that ‘accept Medicare’ insurance are not in your plan’s network.
You have the tools available to find out how many of a certain type of specialists are in the plan’s network vs how many that ‘accept Medicare’ are in the same area . If you have existing health issues, would it be important for you to know how many specialists which treat this for you are in the plan you select? We can show you the tools to do this.
The above can change during the calendar year. This announcement is an example of why networks can change during the year. Another example is found here and here.
Be aware hospitals may/may not be using current technologies/techniques to treat patients. Why? Because of the cost for new technologies is competing for other financial needs of the hospital.
Proton Therapy is an 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 and are included in the top 250 hospital list. Learn more about Medicare Star ratings here.
There are physician rating services too. One is available here. We focus on physicians with a 4 or 5 star rating and have at least 10 ratings.
We also recommend you consider a ‘board certified physician‘.
Medications covered by each plan.
According to this source, there is a 20+/- % variance between the number of prescription medications covered by the plans available to you. Note none of these plans include 100% of the medications covered by Medicare.
This same resource documents the number of medications each plan has in each of the 5 (or 6) drug tiers AND the fill/refill cost by these same drug tiers. These figures can vary noticeably between plans.
Given the wide variance between plans on the above, it is easy to understand why there can be a 300% +/- variance in your projected annual out of pocket cost between your plan choices for the medications you take.
This is a key reason you should not enroll in any Medicare Advantage plan until you understand your cost for your prescription medications. If you are working with a broker/agent that just tells you your medications are covered, we suggest you work with someone else that will share the whole picture.
Are medications that treat serious health issues (cancer, etc.) covered by my plan?
The Centers for Medicare and Medicaid Services (CMS) has requirements insurance company(s) offering Medicare plan(s) must meet when they put together their list of covered medications.
Below is a cut/paste from (Section 30.2.5) the current Medicare Prescription Drug Benefit Manual.
“Part D sponsor formularies must include all or substantially all drugs in the immunosuppressant(for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic classes. CMS instituted this policy because it was necessary to ensure that Medicare beneficiaries reliant upon these drugs would not be substantially discouraged from enrolling in certain Part D plans, as well as to mitigate the risks and complications associated with an interruption of therapy for these vulnerable populations.“
Medicare Supplement plans.
These plans give you the choice of any doctor/hospital/other providers (in the US) that offer services to people enrolled in Medicare (both Part A and B). Over 90% of physicians in the US accept Medicare insurance (Part A and B) and most of the hospitals do…and prefer people with this insurance when compared to Medicare Advantage plans.
When you have a Medicare Supplement plan, typically the hospital as well as physicians you work with have far fewer ‘prior authorizations’ and denial of claims issues to deal with. You and your physician are making the decision on the ‘next step’ in your health care. You do not have an insurance company standing between you and your physician to get the ‘next step’ in your health care done.
Read the articles supporting the above comments here, here, and here.
Do you want a plan that pays for most all of the left-over cost for Part A and B cost sharing in the US?
We recommend you consider a Medigap Plan G. We consider this plan ‘the gold standard’ for health insurance for people on Medicare.
There are 3 different audiences for Shoshone County Medicare Advantage plans.
There are Medicare Advantage plans for Veterans, people enrolled in Medicaid and Medicare, and several plans for the rest of us.
Let’s take a closer look at each.
Medicare Advantage plans for Veterans
Veterans enrolled in Medicare Part A and B can enroll in a Medicare Advantage or a Medigap plan.
Why would a Veteran consider a Medicare Advantage plan?
Because:
- You will have flexibility to get your health care services from the VA and the network of providers in your Medicare Advantage plan. Available services include urgent, emergency, and regular health care. You can still get services from the VA.
- Take advantage of the Part B buyback offered by some of these plans. This means the insurance company MAY offer to pay part of the Veterans Part B monthly premium. At this writing, this ‘give back’ varies from $0 to $75 a month for plans available in Idaho. These figures are determined by the insurance company offering the plan and can change annually.
- Get the $0/low cost ‘extra’ features not covered by Medicare. Some plans have attractive features that may benefit the Veteran.
- Many of these plans have a $0 monthly premium.
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.
Other 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.
Companies offering these plans may improve them 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.
Shoshone 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.
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Additional information about the Hospitals found in Medicare Advantage plan(s) available in Shoshone County.
Check out the other facilities within 25 miles of zip code 83837 (Kellogg) by clicking here.
There is 1 hospital within this radius, and, at this time, it is not rated by CMS.
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.
Learn more about CMS hospital ratings here.
When the radius is bumped to 50 miles around zip 83837, there are 4 hospitals listed. 3 of which are not rated by CMS.
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.
What insurance companies offer Medicare Advantage plans in Shoshone County?
Blue Cross of Idaho
Molina
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 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 ads include this service for you?
Call us if you are interested. Our hours are 8am to 8pm Monday through Saturday.
We started this business in 2012 explicitly to help Idaho residents work their way through this maze.
There is no fee when you use our services.
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