Eligibility Guidelines and Application for Medicare Plans

There are a few different ways to get Medicare insurance. The most common way is through the federal government program, which is available to those who are 65 years of age or older, or those with certain disabilities. There are also private insurance companies that offer Medicare plans, although these can be more expensive.

Medicare is a health insurance program that is run by the federal government. It provides health coverage for those who are 65 years of age or older, or those with certain disabilities. There are four parts to Medicare: Part A, Part B, Part C, and Part D. Part A covers hospital expenses, Part B covers doctor visits and other outpatient care, Part C is an optional managed care plan, and Part D covers prescription drugs.

In Idaho, Medicaid and Medicare Advantage plans are available to eligible people. The two most popular types of these plans are the Preferred Provider Organization and the Health Maintenance Organization with Point of Service Option. These programs are not subsidized by the federal government and you must pay the premiums for them. In most cases, these plans offer much lower monthly premiums than Original Medicare. These programs are ideal for the elderly or disabled.

Learn about the various Medicaid programs in Idaho by downloading our guide to financial assistance for Medicare beneficiaries. You can also consult SHIBA, the state's Senior Health Insurance Benefits Advisors. The website is easy to navigate and contains useful information about eligibility requirements. If you are unsure about eligibility, you can contact SHIBA.

Medicare Advantage Plans

If you're covered by a Medicare Advantage Plan, you can apply for Medicare through the plan. You can also contact the plan directly to find out how to join. When you have a Medicare Advantage Plan, you're still in the Medicare program. You'll get your Medicare benefits through the plan, and the plan will work with Medicare to pay your claims.

The way you get your benefits may be different from Original Medicare. For example, you may have to see doctors who participate in the plan's network or get referrals from your primary care doctor before you can see a specialist.  You may also have extra benefits that Original Medicare doesn't cover—like routine vision or dental care, and prescription drug coverage.

Advantage plans are offered by insurance companies and it combines Part A, Part B, and sometimes Part C into one plan. They also offer added benefits, such as dental, vision, and gym memberships. During the Open Enrollment Period, which runs from January to March, Medicare beneficiaries can switch or drop their plans. However, there are some limitations. So, it is very important to understand all your options. It is best to get as much information as you can and then decide which is the best one for you.

The most important part of Medicare is its eligibility requirements. The government requires all citizens to qualify for Medicare before they can get a Medigap or Advantage policy. You must meet the requirements of your health insurance plan to qualify for Medicaid. If you are eligible, you will be approved for Medicaid, and if you don't qualify for it, you will have to pay for it yourself.

If you live in Idaho, you may be able to get Medicare through federal or private insurance companies. Some states also offer Medicare Advantage plans to some of their rural residents.

The state of Idaho has the lowest spending per enrollee for Medicare in the nation. In 2016, approximately 344,604 people in Idaho have enrolled in a Medicare plan Idaho. To see if you qualify for a plan, you should consult with a certified health insurance agent in your area. You can also use Chris Antrim Insurance Brokers to determine your eligibility for a private plan. 

Medicare Supplement Insurance Plans

The Centers for Medicare and Medicaid Services (CMS) is responsible for administering the Medicare supplement insurance program. CMS contracts with private insurance companies to provide supplemental coverage to Medicare beneficiaries. To be eligible for a Medicare supplement policy, you must be enrolled in both Medicare Part A and Part B. You must also reside in the state where the policy is being offered.

There are a variety of different types of Medicare supplement policies available, each with different premiums and benefits. The most popular type of policy, Medigap Plan F, covers 100% of the gaps in Original Medicare coverage. If you are interested in purchasing a Medicare supplement policy, you should contact your local insurance agent or company representative.

In Idaho, more than 358,000 people are enrolled in Medicare. More than 40% of the Idaho population has Medicare Advantage. Right now 34 of the state's 44 counties have at least one plan for the program. . By 2021, the state will have over fifty percent of its residents enrolled in a Medicare Advantage plan.

How to Apply for Medicare in Idaho

Navigating the process of applying for Medicare can be a crucial step in securing healthcare coverage for your retirement years. If you reside in the beautiful state of Idaho, this guide is here to walk you through the steps of applying for Medicare. From eligibility criteria to the application process, we'll cover everything you need to know to ensure a smooth and successful enrollment.

• Understanding Medicare Eligibility: Before applying, it's essential to determine your eligibility. Generally, individuals aged 65 and older qualify for Medicare. Younger individuals with certain disabilities or specific medical conditions may also be eligible.
• Gather Necessary Information: Collect important documents such as your Social Security card, proof of citizenship or legal residence, and information about your current healthcare coverage. This preparation will streamline the application process.
• Enroll in Social Security: Medicare is administered through the Social Security Administration. If you're not already receiving Social Security benefits, you'll need to enroll through their online portal, over the phone, or by visiting a local Social Security office.
• Review Medicare Plan Options: Idaho residents have various Medicare plan options, including Original Medicare (Part A and Part B), Medicare Advantage (Part C), and Medicare Supplement (Medigap) plans. Research and understand each plan to determine which suits your healthcare needs best.
• Apply for Original Medicare (Part A and Part B): You can apply for Original Medicare online through the official Social Security website, by calling Social Security, or by visiting your local Social Security office. Ensure you apply at least three months before you turn 65 to avoid any gaps in coverage.
• Consider Additional Coverage: While Original Medicare provides essential coverage, many individuals opt for additional coverage through Medicare Advantage or Medigap plans. Research these plans and apply for the one that complements your healthcare needs.
• Enroll in a Prescription Drug Plan (Part D): If you opt for Original Medicare, consider enrolling in a Medicare Prescription Drug Plan (Part D) to cover your prescription medication needs. These plans are available through private insurance companies.
• Explore Medicare Advantage Plans: If you prefer an all-in-one alternative to Original Medicare, Medicare Advantage plans offer additional benefits and may include coverage for vision, dental, and prescription drugs. Apply for these plans through private insurance companies offering them in Idaho.
• Review and Compare Medigap Plans: If you choose Original Medicare, you may want to supplement your coverage with a Medigap plan. Compare the available plans in Idaho, considering factors like coverage, costs, and provider networks.
• Seek Assistance if Needed: If you find the application process challenging or have questions about Medicare plans, consider seeking assistance from local resources, healthcare providers, or insurance agents specializing in Medicare.

Comparing Medicare Advantage and Medicare Supplement

As individuals approach the important decision of selecting the right Medicare coverage, understanding the differences between Medicare Advantage and Medicare Supplement plans is crucial. Both options offer unique benefits, and choosing the one that aligns with your healthcare needs requires careful consideration. In this article, we will provide an in-depth comparison of Medicare Advantage and Medicare Supplement plans to help you make an informed decision.

• Basic Overview: Medicare Advantage, also known as Medicare Part C, combines the benefits of Original Medicare (Part A and Part B) into a single plan offered by private insurance companies. On the other hand, Medicare Supplement plans, or Medigap, work alongside Original Medicare to cover gaps in coverage, such as deductibles and copayments.
• Coverage Differences:
• Medicare Advantage: These plans often provide additional benefits beyond Original Medicare, such as vision, dental, and prescription drug coverage. However, they may have networks of preferred providers, and coverage may vary by plan.
• Medicare Supplement: These plans focus on filling the gaps in Original Medicare coverage, offering standardized benefits across different plans. They don't typically include additional benefits like prescription drug coverage.
• Provider Networks:
• Medicare Advantage: Plans may have provider networks, and coverage may be limited to in-network providers. Some plans may require referrals to see specialists.
• Medicare Supplement: There are no provider networks, giving you the flexibility to see any healthcare provider that accepts Medicare.
• Out-of-Pocket Costs:
• Medicare Advantage: While premiums for Medicare Advantage plans can be lower, they often come with out-of-pocket costs such as copayments, deductibles, and coinsurance. Maximum out-of-pocket limits can protect against excessive expenses.
• Medicare Supplement: Plans typically have higher premiums, but they may offer more predictable out-of-pocket costs, depending on the plan type.
• Prescription Drug Coverage:
• Medicare Advantage: Many plans include prescription drug coverage (Medicare Part D), providing a convenient all-in-one solution for healthcare needs.
• Medicare Supplement: Prescription drug coverage is not included, so beneficiaries may need to purchase a separate Part D plan if they want this coverage.
• Flexibility and Travel:
• Medicare Advantage: Coverage may be limited when traveling outside the plan's service area. Some plans may offer coverage for emergencies during travel.
• Medicare Supplement: Since there are no provider networks, these plans offer more flexibility for individuals who travel frequently or reside in multiple locations.
• Enrollment Periods:
• Medicare Advantage: Enroll during Initial Enrollment Period (IEP), Annual Enrollment Period (AEP), or Special Enrollment Periods (SEP) based on qualifying circumstances.
• Medicare Supplement: The best time to enroll is during the Medigap Open Enrollment Period, which starts when you're 65 or older and enrolled in Medicare Part B.

In choosing between Medicare Advantage and Medicare Supplement plans, it's essential to consider factors such as your healthcare needs, budget, and preferred level of flexibility. Each option has its advantages, and the right choice depends on your individual circumstances. Take the time to compare plans, weigh the pros and cons, and, if needed, seek guidance from healthcare professionals or insurance experts to make an informed decision for your healthcare coverage.

Boise Life & Health Insurance Agency - Chris Antrim Medicare & Health Insurance Broker has been helping clients for over twenty years with their Insurance needs. Call the office today for a quote or a review of your current plan or policy. We offer health, life, auto, home, long-term care, disability, MAPD, and Medigap plans.