If you’re eligible for Original Medicare , you have the option of switching to a Medicare Advantage plan in Idaho offered by a private insurance company under rules set by the federal Medicare program.
Original Medicare Parts A and B feature hospital and medical insurance. Medicare Advantage plans must provide the same coverage as Parts A and B and usually offer additional coverage like dental and vision benefits.
You still have to pay any Original Medicare premiums if enrolled in Medicare Advantage, but some Medicare Advantage plans have a $0 premium and some help pay the Part B premium.
Enrolling in Parts A and B allows you to switch to Medicare Advantage in Idaho, but the timeframe for signing up is limited to certain enrollment periods.
If you are eligible for Medicare in Idaho, then you are eligible for Medicare Advantage in Idaho.
And the large majority of eligible Idaho residents have access to at least one Medicare Advantage plan.
In 2023, 95% of people eligible for Medicare in Idaho had access to Medicare Advantage.
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For some people looking to maximize the benefits of their health insurance, Medicare Advantage is the answer.
But you may need the answer to this first: What exactly is Medicare Advantage?
Medicare Advantage plans are health insurance policies offered by private insurance companies that follow standards set by the federal Medicare program. While the federal program features Original Medicare Parts A and B — commonly referred to as hospital insurance and medical insurance — Medicare Advantage plans replace Original Medicare while offering the same coverage as Parts A and B. Most Medicare Advantage plans also offer forms of coverage not available if you’re on Original Medicare — services like dental, vision and hearing coverage, transportation to medical appointments and an allowance that helps pay for over-the-counter needs.
How can some Medicare Advantage plans offer more for less? Here are some things to keep in mind:
- While Original Medicare is accepted nationwide, Medicare Advantage plans Idaho work within a regional network of providers. It’s important to make sure your preferred doctors (or at least doctors you’re comfortable with) are covered by the Medicare Advantage plan you’re considering. A GoHealth licensed insurance agent can help you determine if a particular plan accepts your doctors.
- While Original Medicare features standard premiums and costs, each Medicare Advantage plan in Idaho features its own set of costs. Keep reading for details.
- Both Original Medicare and Medicare Advantage have designated enrollment periods. More on this below.
The cost of Medicare Advantage plans in Idaho has decreased in recent years, with the average monthly premium checking in at $20.45 in 2023. In 2020, the average was $42.62.
If you switch from Parts A and B of Original Medicare, you are still responsible for any premiums you owe in addition to any Medicare Advantage premium. While most people don’t have to pay a Part A premium, Part B has a standard premium of $164.90 in 2023. However, some Medicare Advantage plans actually help pay your Part B premium, and 94% of people eligible for Medicare in Idaho in 2023 had access to a Medicare Advantage plan with a $0 premium.
You also should keep other costs in mind when it comes to Medicare Advantage plans in Idaho.
In addition to premiums, common costs to consider with Medicare include deductibles, copays and coinsurance. Unlike Original Medicare, these costs vary depending on which Medicare Advantage plan you choose.
One thing that doesn’t vary: the presence of an out-of-pocket maximum. While Original Medicare doesn’t have an out-of-pocket maximum that puts a cap on how much money you can pay out of your own pocket in a given coverage period, every Medicare Advantage plan offers the protection of an out-of-pocket maximum (the actual dollar amount varies by plan).
If you are on Original Medicare, you can add an out-of-pocket maximum to your coverage by adding one of several Medigap supplemental insurance plans that offers that feature. GoHealth licensed insurance agents also can assist you with Medigap in Idaho.
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Having Medicare eligibility means you also have Medicare Advantage eligibility.
So, who is eligible in Idaho?
- Any U.S. citizen age 65 and older.
- Anyone, regardless of age, who has received 24 monthly Social Security Disability Insurance payments.
- Anyone, regardless of age, who has end-stage renal disease or Amyotrophic Lateral Sclerosis (ALS, also known as Lou Gehrig’s disease).
To be eligible for Medicare Advantage, you must be enrolled in both Parts A and B of Original Medicare.
So, when can you enroll in both Parts A and B?
- Initial Enrollment Period: If you’re set to become eligible at age 65, the seven-month period on either side of and including your birthday month is your first chance to enroll. Signing up for both Parts A and B of Original Medicare allows you to switch to Medicare Advantage during this same window.
- General Enrollment Period: If you missed your Initial Enrollment Period, you can enroll in Parts A and B during this period, which runs from January 1 to March 31 each year. If you do so, you’re granted a Special Enrollment Period for switching to Medicare Advantage.
- Open Enrollment Period: If you’re already enrolled in Parts A and B and want to switch to Medicare Advantage, the period from October 15 to December 7 allows you to do so. It’s also called the Annual Enrollment Period.
- Special Enrollment Period: Sometimes you are granted an enrollment period based on your specific circumstances to enroll in Medicare. This can include moving or losing other coverage.
Most Medicare Advantage plans in Idaho include Part D drug coverage.
Like Medicare Advantage plans, Part D plans are offered by private insurance companies under rules established by the federal Medicare program. While you can get a standalone Part D plan if you’re on Original Medicare, Medicare Advantage in Idaho often bundles Part D coverage with your plan.
If you’re already on a Medicare Advantage plan that doesn’t have drug coverage, you can switch to a plan that does include Part D coverage from January 1 to March 31 each year. During the Open Enrollment Period from October 15 to December 7, you can add Part D if you’re enrolled in Original Medicare or as a part of enrolling in Medicare Advantage, or by switching to a new Medicare Advantage plan in Idaho.
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