How are the HMO's for Medicare in IF? (Boise, Idaho Falls: health insurance, home)

[mdc01]

I'm considering bringing my parents up with me to Idaho Falls when I move. They're currently on a Humana PPO which is proving rather costly and they'd like to go back onto an HMO instead. For anyone who is on Medicare, what insurance carrier is popular for those on Medicare? Will it be relatively easy for them to find a primary care physician? Thank you for any advice you may have!

[banjomike]

I'm very happy with Pacific Source. It's a long-time health insurer that only recently began offering insurance to the public; for most of it's existence it has concentrated on businesses only. The company also limited itself to Oregon for almost 90 years before expanding into Idaho, Washington, and a few other regional states.

My brother turned me onto the company; he was insured by Humana until his agent convinced him Pacific Source was a better buy. I'm pretty healthy, so I don't have regular ongoing prescription costs, and I seldom go to a doctor. Pacific Source has been very good to pay for my rare prescriptions (I just paid $10 out of pocket for some antibiotics that cost $130 this week), and I had no problems at all when I underwent an emergency appendectomy last year. My total out of pocket expenses for the operation, hospital, follow-ups, and medication was less than $300 in total.

Pacific Source is a member of the Idaho ACA exchange. I don't know how popular they are here, as the company is fairly new to Idaho, and my needs may be different from your parent's, but the company is worth checking out. One thing about them is they are really into preventive medicine and encourage regular check-ups and physicals. I plan to get a complete physical very soon, and they will pay almost all of the cost.

My monthly bill is very affordable- under $100 for me singly. My brother's is even a bit less as he has been with them longer.

[juneaubound]

Originally Posted by banjomike

My monthly bill is very affordable- under $100 for me singly. My brother's is even a bit less as he has been with them longer.

Mike, which plan did you get and what do your deductables and co-pays look like?

[Mtn. States Resident]

Originally Posted by mdc01

I'm considering bringing my parents up with me to Idaho Falls when I move. They're currently on a Humana PPO which is proving rather costly and they'd like to go back onto an HMO instead. For anyone who is on Medicare, what insurance carrier is popular for those on Medicare? Will it be relatively easy for them to find a primary care physician? Thank you for any advice you may have!

For the OP, I have no idea where home is for your parents currently or what diseases they may have. Have they talked to their MD about living at Idaho Falls altitude (high altitude for some depending where they live now)? I wouldn't assume anything about Medicare. I'd triple check it.

Does ID offer an HMO? IDK. I'd recommend you contact Medicare and confirm a few things first. This isn't open enrollment period, does that matter which companies they can use? When would they be able to change plans, if they can't currently? What plans are offered in eastern ID (watch out for Select Health in the Treasure Valley (Boise metro).

PCP''s an excellent question for the insurance companies.

Please post what you learn as others will benefit from your info.

BTW, I also encourage you to use the Search feature on the Idaho Falls. sub-forum. Some of your questions have been answered in the last 4-6 months. That's why your post of what you learn will be helpful to others when they search first.

Looking forward to what you learn and share

MSR

[banjomike]

Originally Posted by juneaubound

Mike, which plan did you get and what do your deductables and co-pays look like?

There are top limits on medication, but since I have no on-going prescriptions, I haven't paid any attention to the top limit. I honestly don't get sick often enough to have many deductibles, but so far, I have had all my flu shots and preventive stuff completely covered.
My co-pay so far has been very low, except for dental expenses. I didn't get dental in my policy, and that saved me a lot of money. (But not recently! Just had some major dental done!). Even though I have to cover my new big dental bill, I was able to get the associated meds covered very well.

I can't remember the plan's details, but essentially, it was pretty basic. If my health changes, I'll probably have to get some stuff changed.

As MSR mentioned, anything that has to do with MedicAid is most likely more problematic right now than what my coverage is. Idaho continues to refuse MedicAid's expansion, and we just passed up $3.3 Billion in medical assistance. There's a lot of our tax money going to health coverage right now- too much, when we are leaving that kind of money on the table.

But until our legislators face reality, getting MedicAid to help pay for our health is going to be increasingly more restrictive and reluctantly accepted. i don't expect a change until we are in deep financial crisis.

[mdc01]

They're healthy for the most part, no diseases, the altitude won't be an issue. You're correct, it's not open enrollment period, but I believe a move is considered a special circumstance, at least that is what I discovered on the healthcare website for myself, non-medicare. I did do a search for health insurance, medicare, primary care keywords on the forum but didn't turn up anything current that I recall, which is why I made this post.

I like the idea of preventative medicine though, I think a lot of this country's healthcare woes would be solved if people started taking care of themselves instead of doing whatever they want day in and day out and then hoping some doctor will be able to fix them when something goes wrong... Anyhow, will update with anything substantial that I learn on the subject.

[Mtn. States Resident]

Originally Posted by mdc01

They'rar healthy for the most part, no diseases, the altitude won't be an issue. You're correct, it's not open enrollment period, but I believe a move is considered a special circumstance, at least that is what I discovered on the healthcare website for myself, non-medicare. I did do a search for health insurance, medicare, primary care keywords on the forum but didn't turn up anything current that I recall, which is why I made this post.

I like the idea of preventative medicine though, I think a lot of this country's healthcare woes would be solved if people started taking care of themselves instead of doing whatever they want day in and day out and then hoping some doctor will be able to fix them when something goes wrong... Anyhow, will update with anything substantial that I learn on the subject.

mdc01,

I think you're correct about moving qualifying as an opportunity to change. Having lived elsewhere and worked with Medicare, I'm still not certain if ID offers an HMO. That's one to research further, unless someone is certain.

BTW, it's good to hear you couldn't find earlier posts. There was a person who asked many of the same questions but was very offensive with many remarks just months ago. It sounds like that thread got removed!

The one thing I'd still encourage you to do is find out via Medicare which companies offer plans in ID. Absolutely keep both you and your parents covered as you move. Don't change carriers until you are moved. Too much can happen moving.

Call Medicare, unless you can find an online site you trust about who offers Medicare in ID. Even though I think I know two companies, I won't say as there are different parts of Medicare and I'm not certain about "D" vs. other parts.

Your parents should do ok finding a PCP especially if you use the same doctor. But different plans offer different providers. The sooner you can learn the plans the more you can learn.

Let us know what you find.

MSR

[Mtn. States Resident]

Originally Posted by banjomike

There are top limits on medication, but since I have no on-going prescriptions, I haven't paid any attention to the top limit. I honestly don't get sick often enough to have many deductibles, but so far, I have had all my flu shots and preventive stuff completely covered.
My co-pay so far has been very low, except for dental expenses. I didn't get dental in my policy, and that saved me a lot of money. (But not recently! Just had some major dental done!). Even though I have to cover my new big dental bill, I was able to get the associated meds covered very well.

I can't remember the plan's details, but essentially, it was pretty basic. If my health changes, I'll probably have to get some stuff changed.

As MSR mentioned, anything that has to do with MedicAid is most likely more problematic right now than what my coverage is. Idaho continues to refuse MedicAid's expansion, and we just passed up $3.3 Billion in medical assistance. There's a lot of our tax money going to health coverage right now- too much, when we are leaving that kind of money on the table.

But until our legislators face reality, getting MedicAid to help pay for our health is going to be increasingly more restrictive and reluctantly accepted. i don't expect a change until we are in deep financial crisis.

Mike,

You probably got interupted during your post. You started with Medicare and ended up on Medicaid. Trust me, I've done worse when interrupted.

They are different programs, designed for different populations. Idaho's legislature doesn't vote or have anything to do with Medicare. Neither does the Gov. Medicare most usually is for seniors, disabled, renal and a few other populations.

Medicaid, which ID didn't expand, is for children, pregnant women and a few others. Medicaid is means tested. Medicare is not given the limitations of who is eligible.

Hope that helps to clarify.

MSR