Speak to a Licensed Insurance Agent 1-855-792-0088 TTY 711
Mon - Sun, 7am - 10pm
Menu

Medicare in Idaho

Learn about Medicare in Idaho: Costs, coverage and enrollment

Reviewed by: Cassandra Parker, Licensed Insurance Agent. Written by: Rachel Nall, MSN, CRNA, APRN.

Key Takeaways

  • More than 344,000 residents are enrolled in Medicare in Idaho.

  • Both Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). and Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans are available in Idaho.

  • An estimated 75 Medicare Advantage plans are available in Idaho in 2021, an increase from 68 Medicare Advantage plans in Idaho for 2020.

 

Although Idaho is known for its plentiful potatoes, there’s another attribute the state is known for: its gems. Idaho produces a whopping 72 gemstone types, including amethysts, rubies, diamonds, and star garnets. It’s no wonder then that Idaho is known as “the Gem State.”

However, Idaho’s true gems are its people — known as Idahoans. With more than 1.68 million people, Idaho had 344,604 enrollees (nearly 20 percent of its population) who were Medicare beneficiaries in 2020. Keep reading to find out more about Medicare in Idaho.

Does Idaho Have Medicare?

More than 340,000 people are enrolled in Medicare in Idaho. Of these individuals, an estimated 221,657 participate in Original Medicare, while another 122,947 are members of Medicare Advantage plans in Idaho.

When you qualify for Medicare in Idaho, you can choose to participate in Original Medicare or Medicare Advantage. Original Medicare lets you see any doctor or go to any facility that accepts Medicare. Original Medicare is divided into “Parts.” Each part is responsible for paying for different medical needs. For example, Medicare Part A in Idaho pays for mostly hospital coverage and long-term skilled nursing stays. Medicare Part B in Idaho pays for doctor’s visits, some immunizations, and durable medical equipment.

Another option for Medicare in Idaho is Medicare Advantage plans. Also known as Medicare Part C, these plans are when a person chooses a private insurance company to provide their Medicare coverage. Medicare Advantage provides additional benefits (such as dental or eye care coverage), and most offer prescription drug coverage.

Medicare Advantage plans in Idaho are usually region-specific. The plans will contract with doctors, hospitals, and other healthcare organizations to provide services. As a result, you will usually choose from a list of providers if you select a Medicare Advantage plan in Idaho.

What is Medicare ID?

Medicare ID is a government-funded insurance program that is usually for individuals ages 65 and older and those who qualify based on disability or certain medical conditions. The Medicare and Medicaid programs were started in 1965 to provide medical coverage to those ages 65 and older.

Over the years, Medicare has expanded in its scope, specifically to increase the availability of services to those who are disabled, have been diagnosed with end stage renal disease, or have amyotrophic lateral sclerosis (ALS).

Medicaid is also a program that helps make healthcare more affordable. However, Medicaid in Idaho may vary from other states because each state administers Medicaid funds and programs.

Where is Medicare number on card?

When you enroll in Medicare, you will receive a red, white, and blue Medicare enrollment card. This card allows healthcare providers to identify that you’re enrolled in Medicare and bill Medicare on your behalf. You will have your own Medicare number, which is like an account number.

Your Medicare number is located on your Medicare card immediately below your name. This number is actually a mixture of numbers and letters. Ideally, this protects you from identity theft because other identifying information, such as your Social Security number, is not on the card. However, your Medicare number is still personal information. You should not share the number with persons other than healthcare providers. If someone is trying to obtain this information from you, contact Medicare at 1-800-MEDICARE (1-800-633-4227).

Do You Get Free Medicare When You Turn 65?

Medicare is not completely free insurance coverage. If you paid Medicare taxes for 40 quarters of work (about 10 years), you will receive Medicare Part A premium-free. Medicare Part B or medical coverage requires you to pay a monthly premium, which Medicare sets each year.

Even if you choose a Medicare Advantage plan in Idaho, you will continue to pay a monthly Part B premium, plus a premium (if any) to your Medicare Advantage plan. Some plans offer premium-free coverage.

In addition to Medicare premiums, you will have co-payments and deductibles to pay with Medicare. However, Medicare negotiates with healthcare providers to keep these costs as low and consistent as possible.

Does Idaho have free health insurance?

While Medicare does offer reduced-cost insurance, you will still have costs under Medicare. In addition to Medicare, Idaho does offer financial assistance for healthcare through its Medicaid program. Medicaid doesn’t have the same age requirements as Medicare. Instead, most people qualify for Medicare based on their income. Idaho has income requirements to offer varying levels of financial support.

What Medicare Plans are Required at 65?

Medicare is a benefit available to you when you turn age 65, but you don’t have to enroll if you have other insurance coverage, such as through an employer. You can defer your Medicare plan when you turn age 65 if you have other insurance. Medicare also requires you to have some form of prescription drug coverage. This is known as Medicare Part D, and it is available through private insurance companies in Idaho.

If you don’t enroll in Medicare when you turn age 65 (or notify Medicare you are delaying your coverage), you could face penalties. These are usually determined by how long you went without Medicare coverage. Penalties apply for delayed enrollment in Part B and Part D. Once you have a penalty, you must pay it for a lifetime — that’s why it is best to enroll in Medicare at the correct time.

Are There Medicare Advantage Plans in Idaho?

An estimated 75 Medicare Advantage plans are available in Idaho, with 94 percent of Idaho residents having access to a Medicare Advantage plan. [1] Medicare Advantage plans are region-specific in Idaho. A GoHealth licensed insurance agent can help you search for Medicare Advantage plans in your area. As a general rule, the larger the population of the city in Idaho you live in, the more Medicare Advantage plans an insurance company likely offers.

Some insurance companies offer multiple plan types. These plans may have different attributes, such as $0 monthly premiums. An estimated 93 percent of people in Idaho have access to a $0 monthly premium Medicare Advantage plan. Other plans may charge a premium, but offer innovative services, such as wellness and health planning, cost-sharing, and incentive programs. An estimated 12 such wellness-related plans are available through Medicare Advantage in Idaho.

Who has the best Medicare Advantage plan?

The best Medicare Advantage plan in Idaho is the one that meets your distinct health needs. You must consider factors like monthly premium cost, out-of-pocket limits, network, prescription drug plan, and available services when selecting a Medicare Advantage plan.

The Centers for Medicare and Medicaid Services (CMS) also have a star rating system. The highest rating is five stars, which 21 Medicare Advantage plans achieved in the United States in 2021. However, there were no Medicare Advantage plans in Idaho that received a 5-star rating. [2] The average Medicare Advantage plan in Idaho has between a 3.5 and 4-star rating.

You can also ask friends and family about their Medicare plan, and if they would recommend it. Another way to evaluate the best Medicare Advantage plan in Idaho is to ask your preferred doctor or doctors what insurance types they accept. Doing so will help you choose a plan that allows you to continue seeing doctors you trust.

What is the Downside to Medicare Advantage plans?

he main downside to a Medicare Advantage plan in Idaho is that most plans limit the providers you can see. Original Medicare allows you to see any provider who accepts Medicare across the country. While Medicare Advantage plans do have an out-of-pocket limit (unlike Original Medicare), you could find you pay more for care until you meet your out-of-pocket deductible.

However, Medicare Advantage does have several benefits compared to Original Medicare. This includes that many have $0 monthly premiums and offer prescription drug or Part D coverage as part of their coverage. Many Medicare Advantage plans in Idaho offer additional services that Original Medicare does not cover, such as dental, vision, or hearing insurance coverage.

Medicare in Idaho by the Numbers

Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 306,754 people are enrolled in Medicare in Idaho. The total number of beneficiaries enrolled in Medicare Advantage in Idaho is 109,174. The previous year, 100,780 enrolled in Medicare Advantage. Medicare Advantage participation in Idaho went from 34.21% to 35.59% year over year. If you’d like to dive deeper into how Medicare in Idaho breaks down across the state, we provide a glance at who is using Medicare, and how.

Outline of Idaho
306,754
Beneficiaries with Part A & Part B
109,174
Medicare Advantage Beneficiaries
35.59%
Medicare Advantage Participation Rate
52.08%
% Female
47.92%
% Male
0.86
Average HCC Score
$8,463.64
Actual Per Capita Costs
17.97%
% Eligible for Medicaid
29.93%
% of Beneficiaries with an Emergency Department Visit
13.49%
Hospital Readmission Rate
92.03%
% Non-Hispanic White
0.29%
% African American
3.84%
% Hispanic
3.84%
% Other/Unknown

Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)

Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.

Idaho Medicare Resources & Contacts

Beneficiaries spend an average of $8,463.64 each year on Medicare in Idaho. To be certain you are not leaving anything on the table, let us help. A GoHealth licensed insurance agent can assess your coverage or explain which Idaho-based resources, like these, may be able to help:

Idaho Department of Insurance

1-800-721-3272

https://www.doi.idaho.gov

What should I know about the DOI?

If you have questions about the health insurance you’ve bought, contact the Department of Insurance.

Idaho Medicaid Program

1-877-456-1233

https://www.healthandwelfare.idaho.gov

What should I know about Idaho Medicaid?

If you have questions about health coverage eligibility or having a hard time affording coverage, contact Idaho’s Medicaid Program.

Senior Health Benefits Advisors (SHIBA)

1-800-247-4422

https://doi.idaho.gov/shiba/

What Should I Know about SHIBA?

If you are on Medicare or have a disability or end stage renal disease, contact SHIBA.

Idaho Department of Veterans’ Affairs

208-780-1300

https://www.veterans.idaho.gov

What should I know about IDVA?

If you are a veteran and have a question or concern about veterans’ health care benefits, contact IDVA.

Nationwide Resources

Speak with an insurance agent that is licensed in Idaho about your Medicare questions.

1-855-792-0088 TTY: 711

Monday - Friday, 8 AM - 9 PM CT

Medicare & Medicaid

If you have general questions about Medicare in ID, or need help with current Medicare benefits.

1-800-MEDICARE (1-800-633-4227)

Social Security Administration

You can reach the SSA by phone for general questions. Not all questions can be answered over the phone.

Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online

Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET

Medicare Learning Guides

Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.

Previous Next

New to Medicare Guide

Helpful information to get you started with enrolling in Medicare.

Medicare Beneficiary Guide

For those currently enrolled in Medicare.

Medicare Plans Guide

Costs, coverage and enrollment details for each Medicare plan.

Low Income & Medicare Guide

For individuals with a qualifying income status.

A Caregiver’s Guide

For those helping a loved one with Medicare.