Medicare in Idaho
- Find out whether you might be eligible for Medicare in Idaho and what plans are available in this guide, which also includes some helpful links.
What Idaho Medicare Plans Are Available?
Medicare is a federal health coverage program that helps eligible enrollees pay for medical expenses. Most people in the United States over the age of 65 are eligible for this coverage, but the choices you have can seem complex and be confusing. Find out more about Medicare plans available to Idaho residents below so you can make an educated decision about your benefits.
Medicare Part A
Medicare Part A is the part of Original Medicare that covers the cost of approved inpatient treatments. That can include stays in hospitals for covered surgeries or treatments for illnesses as well as some stays in skilled nursing facilities and other treatments. Most people who are eligible for Medicare Part A don't pay a monthly premium for this coverage because it was paid via taxes for the Medicare program over the years.
Medicare Part B
Medicare Part B is the other part of Original Medicare. It covers the costs associated with outpatient treatments and necessary medical supplies. That can include seeing your doctor for a wellness check, going to urgent care for a sore throat or seeing a specialist to manage a chronic disease such as diabetes.
Part B does come with a monthly premium for most people. How much you pay depends on your income, and the premium is typically deducted from your Social Security benefits. Part B coverage also comes with a small annual deductible and a 20% copay, so you will need to shell out for some of your medical expenses with this plan.
Medicare Advantage Plans
Medicare Advantage plans are also known as Medicare Part C. This is an option you can choose instead of, not in addition to, Medicare Parts A and B. Medicare Advantage Plans are legally required to provide all the benefits you would receive under A and B, but the plan is administered by private companies instead of public government agencies.
Part C plans sometimes come with extra benefits, including vision or prescription drug benefits. These plans also come with monthly premiums, deductibles and copays. When you're trying to decide whether you should sign up for Part C or Original Medicare, consider all the benefits under each option and how much you may need to pay out of pocket. That can help you figure out which might be the right choice for you.
Medicare Part D
Part D is a prescription drug benefit. It helps cover the cost of prescription drugs, reducing what can be one of the highest ongoing expenses some older adults have to contend with. You do need to already have Medicare to add on this benefit. Some Part C plans have built-in prescription drug benefits, so you may not need Part D if that's the case.
Medicare Supplement Plans
Supplement plans help cover the cost of the expenses leftover after Medicare pays. That can include deductibles and copay amounts. For older adults with chronic diseases or who may need ongoing treatment and supplies, a supplement plan can drastically reduce the cost of health care. These plans are sometimes referred to as Medigap plans.
In Idaho in 2020, roughly 344,000 people were covered by Medicare. Of that number, roughly 221,000 were covered by Original Medicare. The other 123,000 or so chose Medicare Advantage plans.
Who Is Eligible for Idaho Medicare?
Most people who are age 65 or older are eligible for Medicare in Idaho. Medicare is also available for individuals with certain disabilities.
For adults entering retirement age, automatic enrollment in Medicare Part A is common. If you're eligible for automatic enrollment, you'll receive your Medicare card and other information before your 65th birthday. Coverage typically starts on the first of the month during which you turn 65.
There's an Initial Enrollment Period, or IEP, around your 65th birthday during which you can enroll in Medicare plans. This runs from 4 months before your 65th birthday to 3 months after.
But that's not the only time you can enroll in Medicare or change your benefits elections. If you haven't enrolled or you want to change from Original Medicare, you can do so during open enrollment. That occurs from October 15 to December 7 every year.
If you opted for Medicare Advantage Plan and want to change your elections by switching to Original Medicare or another Part C plan, you can do it during the Medicare Advantage enrollment period. That occurs from January 1 through March 31 each year.
There's also a special enrollment period for individuals who decide not to enroll in Medicare because they have insurance through their employer or their spouse's employer. If you lose that coverage, you enter a short-term special enrollment period during which you can sign up for Medicare.
How Do I Enroll in Medicare in Idaho?
If you're not automatically enrolled in Medicare, you have several options for applying. You can call the Social Security Administration to apply via the phone or visit a local office. Alternatively, you can complete the online application. According to the Social Security Administration, it only takes around 10 minutes.
Contact Information for Idaho Medicare, Medicaid and Insurance Help
- If you're worried about covering medical expenses, consider looking into whether you can apply for Idaho Medicaid. Medicaid can act as an insurance that's secondary to Medicare, covering some of the copay and other costs for you.
- Contact the Senior Health Insurance Benefits Advisors (SHIBA) to get information about applying for Medicare or other insurance benefits. You can call SHIBA at 800-247-4422 or visit the SHIBA website.
- Visit the Idaho Department of Insurance website to discover more about insurance in the state.
Find out about the IdahoRx Card, which can help you get discounts and savings on prescription drugs.