Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Medicare Advantage Plans are an alternative to Original Medicare. Also known as Medicare Part C, these policies replace the coverage provided by Parts A (hospital insurance) and B (medical insurance). All Medicare Advantage policies must cover the same services as Parts A and B, although many offer extra benefits for more comprehensive coverage. For example, many plans include dental care, prescription drug coverage (Medicare Part D) and additional wellness services excluded from Original Medicare. Medicare-approved private health insurers sell Medicare Advantage policies. Seniors typically qualify for Medicare Advantage coverage if they’re eligible for Original Medicare, although most insurance companies don’t accept applicants with end-stage renal disease.
Health Maintenance Organization (HMO) and Preferred Provider Organization (PPO) policies are the most common types of Medicare Advantage coverage. HMO policies pay for care when the enrollee receives covered services from providers in the company’s network. PPO policies allow enrollees to receive care from out-of-network providers, although they may charge the difference if the cost of care exceeds the insurer’s approved amount. Seniors can also purchase specialized Medicare Advantage Plans tailored to people with complex needs. For example, some insurers sell plans designed for people living in nursing homes.
Medicare Advantage enrollment in Idaho increased significantly between 2022 and 2023. The number of Idaho residents enrolled in Medicare Advantage Plans rose by 11.6% during this period, compared to 9.75% across the U.S. Eligibility for Medicare Advantage policies also increased by 3.69%, slightly more than the national average of 2.66%. Of the Idaho residents eligible for Medicare Advantage, 7.63% more purchased a plan in 2022 than in 2023. This figure exceeds the U.S. average of 6.9%.
This guide assists Idaho residents considering Medicare Advantage Plans. It clarifies plan options, coverage, costs and provides easy insights into enrollment periods and finding suitable plans.
The Top 10 Medicare Advantage Plans in Idaho
In Idaho, the number of available Medicare Advantage Plans depends on what service area a beneficiary lives in. The table below lists the Top 10 Medicare Advantage Plans in Idaho in terms of enrollment. It includes the total enrollment numbers to illustrate how many Idaho residents enrolled in each plan. Cost information and star ratings provide further context. Many insurers offer several Medicare Advantage policies, so the table presents average monthly costs as a range.
All plan information in the table below is accurate as of July 2023. Medicare.gov provides the most up-to-date information about Medicare Advantage Plans in Idaho.
Name
Enrollment
Medicare Star Rating
Monthly Cost Range
Plan Types
UnitedHealthcare
59701
3.5
$0 – $99
PPO, HMO
Highmark Inc.
56042
3.5
$0 – $152
HMO
Humana
17665
3
$0 – $199
PPO, HMO
Molina Healthcare of Utah & Idaho
8742
3
$0 – $0
HMO
SelectHealth
7976
5
$0 – $88
HMO
Regence BlueShield Of Idaho
7107
3.5
$0 – $122
PPO
PacificSource Medicare
5760
3.5
$0 – $35
HMO
Saint Alphonsus Health Plan
1854
3.5
$0 – $29
HMO
Aetna Medicare
1238
3
$0 – $36
PPO
Blue Cross of Idaho
895
N/A
$0 – $0
PPO
How Medicare Advantage Plans Work in Idaho
The 16% of Idaho’s population aged 65 and older, along with younger adults with disabilities, can choose between various different Medicare Advantage plans. The four main types of Medicare Advantage Plans in Idaho are Health Maintenance Organization (HMO), Preferred Provider Organization (PPO), Private Fee-for-Service (PFFS) and Special Needs Plan (SNP). Each one varies in price and differs when it comes to the referral requirements and in-network versus out-of-network health centers. Plan providers often offer more than one plan type. Information comparing and contrasting the four main types of Medicare Advantage plans is below.
What Medicare Advantage Plans Cover in Idaho
In Idaho and nationwide, Medicare Advantage plans cover all the same health care services as Original Medicare, except for hospice care which remains covered under Medicare Part A. This includes services such as preventative screenings, X-rays, lab tests, hospital care and durable medical equipment.
Medicare Advantage plan providers can also offer additional benefits such as dental, vision, hearing aids and prescription drug coverage. Beneficiaries considering a Medicare Advantage plan should carefully review plan documents to compare and contrast coverage.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Idaho
All Idaho residents eligible for Medicare Parts A and B can enroll in Medicare Advantage. They must be age 65 or older, have a qualifying disability and be U.S. citizens or lawful immigrants. Beneficiaries must enroll in Original Medicare before applying for Medicare Advantage.
Some Medicare Advantage plans have additional eligibility requirements. For example, Medicare Special Needs Plans (SNP) are only available to individuals with specific diseases or chronic conditions.
Beneficiaries can only apply for Medicare Advantage during specific enrollment periods. Once the enrollment periods are over, there’s no way to sign up for a plan or change coverage unless a qualifying life event occurs, such as moving or losing coverage elsewhere. Medicare Advantage enrollment periods include:
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Idaho
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
Idaho’s Senior Health Insurance Benefits Advisors (SHIBA) provides free, unbiased information on Medicare benefits, plans and costs. Operated by the Idaho Department of Insurance, SHIBA program volunteers and partner organizations deliver group presentations and educational workshops throughout the state. SHIBA-certified Medicare counselors and outreach workers also conduct one-on-one Medicare counseling sessions in-person and by phone. SHIBA offices are located in Boise, Pocatello and Coeur d’Alene.
For more information about SHIBA services or to book an appointment with a SHIBA counselor, call the SHIBA Medicare helpline at (800) 247-4422.
Senior Medicare Patrol (SMP)
Idaho’s Senior Medicare Patrol program is a volunteer-based fraud prevention program that provides consumers with education and one-on-one counseling. SMP volunteers deliver free Medicare fraud prevention workshops and attend public events throughout the state to raise awareness about Medicare double-billing, over-billing, marketing scams and financial exploitation related to Medicare. Seniors who are concerned about their Medicare Advantage plan billing or service delivery can speak with an SMP volunteer, and cases that may involve criminal actions are escalated to the appropriate authorities.
Idaho Legal Aid Services is a non-profit law firm that helps low-income Idaho residents with civil legal matters throughout the state. The organization operates the Senior Legal Hotline, a free telephone service for seniors age 60 and older who need legal advice. The Senior Legal Hotline is staffed by lawyers and paralegals who can review civil law concerns and provide legal guidance. If a caller requires further assistance, they will be referred to a low-cost or pro bono law clinic in their community.
To speak with a Legal Aid attorney, call the Senior Legal Advice Line at (208) 746-7541.
Idaho Commission on Aging
The Idaho Commission on Aging is a state-run organization that works to ensure Idahoans have access to the resources needed to live independently and with dignity. The Commission maintains an up-to-date listing of resources for seniors throughout the state, advocates for seniors at the state and federal level, and helps connect seniors with community supports. Seniors can find plain-language guides on the ICOA website with information about safety issues, Medicare fraud and Adult Protective Services for vulnerable adults.
Seniors can visit the ICOA online or call (208) 334-3833.
Local Medicare Advantage Resources
City of Boise — Dick Eardley Senior Center
The Dick Eardly Senior Center is a multipurpose community center for adults age 62 and older that is owned and operated by the City of Boise. The center operates a variety of free and low-cost leisure and wellness programs during the week that is designed to help seniors stay active and engaged in their community. Seniors are also able to enjoy low-cost lunchtime meals through the senior nutrition program, and the center frequently hosts informational workshops that cover Medicaid Advantage plan options in the area. Seniors can also learn about local resources such as low-cost transportation, housing, home care and financial assistance.
Seniors can view the monthly newsletter and program calendar on the City of Boise’s website, or call the center at (206) 608-7580.
Area Agency on Aging of North Idaho
Located in Coeur d’Alene and serving Benewah, Bonner, Boundary, Kootenai and Shoshone counties, the Area Agency on Aging of North Idaho assists older adults in finding the information and support they need to maintain a satisfactory quality of life. In order to promote independent living, the agency provides home delivered meals, homemaker services, and respite services as well as connecting seniors to Adult Protective Services and Long Term Care Ombudsmen. They also partner with SHIBA to provide free Medicare Advantage workshops and counseling to seniors living in North Idaho.
More information is available on the Area Agency on Aging of North Idaho’s website or by calling (208) 667-3179 / (800) 786-5536 or emailing [email protected].
