Medicare in Idaho runs on the same federal rules as every state, but Idaho adds a Medigap birthday rule and free SHIBA counseling through the Department of Insurance., The birthday rule gives you a 63-day window each year to switch supplement plans with no health screening, and Idaho runs its Medicare Savings Programs through the Department of Health and Welfare using the standard federal income and resource limits.

In This Guide

About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Idaho SHIBA at 1-800-247-4422.

What Do Parts A and B Cost in Idaho?

Original Medicare is run directly by the federal government and comes in two parts. The mechanics and costs are identical in Idaho and every other state.

Part A (Hospital Insurance)

Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.

Cost Amount
Monthly premium $0 for most people (40+ quarters of work history)
Hospital deductible $1,736 per benefit period
Hospital coinsurance, days 61-90 $434 per day
Lifetime reserve days $868 per day
SNF coinsurance, days 21-100 $217 per day

The hospital deductible rose $60 from 2025. A benefit period starts the day you are admitted and ends 60 days after you leave. Get readmitted after that, and the deductible applies again.

Part B (Medical Insurance)

Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It does not cover routine dental, vision, or hearing.

  • Monthly premium: $202.90 (higher if your 2024 income was above $109,000 single or $218,000 married, under the income-related adjustment)
  • Annual deductible: $283
  • After the deductible: you pay 20% of the Medicare-approved amount for most services

Part B is technically optional, but nearly everyone signs up. Delay past your enrollment window without other creditable coverage and you will owe a late penalty of 10% for every 12 months you could have had it, for as long as you keep Part B.

Medicare Advantage in Idaho (Part C)

Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, except hospice, which Original Medicare keeps covering. Most bundle in Part D drug coverage along with extras like dental, vision, and hearing.

Idaho residents in the Boise metro generally see the widest choice of plans. As you move into rural Idaho and the eastern Snake River Plain, the number of available plans drops, and some rural areas have very limited options. Plan options, networks, and prices change every year and differ by county, so compare what is actually available at your address before you decide.

How These Plans Work

Use the Medicare Plan Finder at medicare.gov to compare plans by ZIP code. Enter your doctors and prescriptions and it shows which plans cover them and your estimated cost. If you want help reading the results, an Idaho SHIBA counselor will go through them with you for free.

How Does Medicare Part D Work in Idaho?

Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or built into a Medicare Advantage plan.

The Inflation Reduction Act eliminated the old coverage gap, the donut hole, so that higher-cost middle stage is gone. Part D now moves through three phases:

  1. Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
  2. Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
  3. Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.

That $2,100 cap is the number that matters most in Part D. It was $2,000 in 2025 and rises with drug-spending growth. Standalone Part D plan premiums are set by each carrier and vary widely; the projected 2026 average is roughly $40 to $50 a month. Every plan also has to offer the Medicare Prescription Payment Plan, which lets you spread your out-of-pocket drug costs into capped monthly payments across the year instead of paying in full at the pharmacy. People who qualify for Extra Help often pay much less, sometimes nothing.

Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.

Should You Buy Medigap in Idaho?

Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage.

Idaho offers the federally standardized plans, labeled A through N, including high-deductible Plan F and Plan G. Plans C and F are closed to anyone who became Medicare-eligible on or after January 1, 2020. Plan G is the popular choice for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.,

Your first opening is the federal Medigap Open Enrollment Period, the six months that begin when you are 65 and enrolled in Part B. During that window an insurer must sell you any plan at the standard rate regardless of your health. Outside it, Idaho insurers may use medical underwriting for some purchases.

Idaho's Medigap Birthday Rule

Idaho is one of a handful of states with a Medigap birthday rule. Each year, a current Medigap policyholder gets a 63-day window beginning on their birthday to switch to a similar-or-lesser plan from their own or any Idaho company, guaranteed issue, with no underwriting. Under the same 2022 changes, new Idaho Medicare Supplement premiums are no longer based on the applicant's age. Idaho does not have a state-law guarantee of Medigap access for beneficiaries under 65 who reach Medicare through disability; if you are under 65 and on Medicare, contact an Idaho SHIBA counselor about your options.

Medigap or Medicare Advantage?

You cannot hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who takes Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that freedom for a network and a lower upfront cost. For a side-by-side look at the trade-off, see our guide to Original Medicare vs. Medicare Advantage.

Help Paying for Medicare in Idaho

If you are on a fixed income, two programs can cut your Medicare costs sharply.

Medicare Savings Programs

Idaho runs its Medicare Savings Programs through Idaho Department of Health and Welfare (DHW), Idaho's Medicaid agency. Idaho uses the standard federal income tiers and resource limits. These programs pay some or all of your Medicare premiums and cost-sharing based on income.

Program Income range Individual Couple What it pays
QMB (Qualified Medicare Beneficiary) At or below 100% FPL Up to about $1,350 Up to about $1,824 Part A and B premiums, deductibles, coinsurance
SLMB (Specified Low-Income Medicare Beneficiary) 100-120% FPL Up to about $1,616 Up to about $2,184 Part B premium
QI (Qualifying Individual) 120-135% FPL Up to about $1,816 Up to about $2,455 Part B premium

QMB is the most generous, covering your Part B premium plus your deductibles and coinsurance, and federal law bars providers from billing a QMB enrollee for that cost-sharing. For all three programs the 2026 resource limit is $9,950 for one person and $14,910 for a couple. The income figures are tied to the Federal Poverty Level and update each April. Enrolling in any of these programs automatically qualifies you for Extra Help.

How to Apply for Idaho's Medicare Savings Programs

You apply through the Idaho Department of Health and Welfare, and free help is one phone call away if you would rather not do it alone.

1
Step 1

Gather your paperwork

Have your Medicare card and recent proof of income and resources ready, such as a Social Security award letter, pension or wage statements, and current bank balances.

2
Step 2

Apply through Idaho DHW

File your Medicare Savings Program application with the Idaho Department of Health and Welfare, Idaho's Medicaid agency, online at healthandwelfare.idaho.gov.

3
Step 3

Or let a counselor do it with you

Call Idaho SHIBA at 1-800-247-4422 and a counselor will help you complete the application and weigh your income against the current limits, at no cost.

4
Step 4

Confirm this year's limits first

Because the income thresholds update every year with the Federal Poverty Level, verify the current figures before you file so you know whether you qualify.

Extra Help for Part D

Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources. Since 2024 the partial-subsidy tier is gone, so everyone who qualifies now gets the full subsidy.

  • Income limit (2026): up to about $1,995 a month for an individual, $2,705 for a couple
  • Resource limits: $16,590 for an individual, $33,100 for a married couple
  • If you qualify for QMB, SLMB, or QI, you are enrolled in Extra Help automatically

Apply through Social Security at ssa.gov or call 1-800-772-1213.

Medicare Enrollment Periods

Miss a deadline and you can face coverage gaps or permanent penalties. These dates are federal and the same in Idaho as everywhere else.

Period Dates What you can do
Initial Enrollment 7 months around your 65th birthday Sign up for Parts A, B, and D; pick MA or Medigap
Annual Open Enrollment Oct 15 - Dec 7 Switch MA plans, move between MA and Original Medicare, change Part D
MA Open Enrollment Jan 1 - Mar 31 Switch MA plans or drop MA for Original Medicare (if already in MA)
General Enrollment Jan 1 - Mar 31 Sign up for Part B if you missed your initial window
Medigap Open Enrollment 6 months from age 65 + Part B Buy any Medigap plan at the standard rate, no health screening

Changes you make during Annual Open Enrollment take effect the following January 1. If you are already getting Social Security before 65, you are enrolled in Parts A and B automatically; if not, you sign up yourself through Social Security. If you work past 65 with employer coverage, you can delay Part B without penalty and have an 8-month Special Enrollment Period after that coverage ends.

Free Medicare Help: Idaho SHIBA

You do not have to figure this out alone, and you do not have to pay a broker. Idaho runs SHIBA (Senior Health Insurance Benefits Advisors), the state's version of the federal State Health Insurance Assistance Program (SHIP). It is housed inside the Idaho Department of Insurance. Counselors are trained, give free and unbiased help, and do not sell insurance.

An Idaho SHIBA counselor can help you:

  • Understand your Medicare options and what each part covers
  • Compare Medicare Advantage, Part D, and Medigap plans side by side
  • Apply for Medicare Savings Programs and Extra Help
  • Sort out claims, denials, and appeals

Call the national SHIP routing line at 1-800-247-4422 to reach Idaho SHIBA contacts, or visit doi.idaho.gov/shiba to find local help.

Frequently Asked Questions

What does Medicare cost in Idaho in 2026?

Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D adds a plan premium (with a deductible up to $615 and out-of-pocket capped at $2,100 for the year), and many Medicare Advantage plans charge no extra premium., Your total depends on the plan you pick and the care you use.

Does Idaho have a birthday rule for Medigap?

Yes. Since 2022, Idaho has a Medigap birthday rule: each year a current Medicare Supplement policyholder gets a 63-day window, beginning on their birthday, to switch to a similar-or-lesser plan from their own or any Idaho company on a guaranteed-issue basis, with no medical underwriting. New Idaho Medicare Supplement premiums are also no longer based on the applicant's age. See our Idaho Medigap birthday rule guide for how to use it.

What are Idaho's Medicare Savings Programs?

Idaho administers QMB, SLMB, and QI through Idaho DHW Medicaid, using the standard federal income and resource limits. QMB (up to about $1,350/month individual) covers premiums and all cost-sharing; SLMB and QI cover the Part B premium only. The 2026 resource limit is $9,950 individual and $14,910 couple. You apply at healthandwelfare.idaho.gov.

Who runs Medicare counseling in Idaho?

The Idaho Department of Insurance runs SHIBA (Senior Health Insurance Benefits Advisors), Idaho's free Medicare counseling program. Counselors are trained and do not sell insurance. Reach Idaho SHIBA by calling 1-800-247-4422 or by visiting doi.idaho.gov/shiba.

Are Medicare Advantage plans available across Idaho?

Plan availability varies significantly by location. The Boise metro area offers the widest selection. Rural parts of Idaho, including much of the eastern Snake River Plain, have fewer options. Use the Medicare Plan Finder at medicare.gov to see what is available at your specific address.

Learn More

MedicareMedicare Plans by State: What Varies and What Doesn'tOriginal Medicare is the same in all 50 states. Medicare Advantage, Part D, and Medigap rules are not. See what changes by state, then open your state guide. MedicareMedicare: The National GuideWhat is Medicare? A plain guide to Parts A, B, C, and D, who qualifies, 2026 costs, when to enroll, and what it doesn't cover, with help-paying options. MedicareOriginal Medicare vs. Medicare AdvantageCompare original Medicare vs Medicare Advantage on cost, networks, the $9,250 cap, and switching back. A neutral 2026 side-by-side to help you choose. MedicareHow Medigap WorksMedigap (Medicare Supplement) explained: how the standardized A-N plans work, Plan G vs Plan N, closed C and F plans, and the 6-month guaranteed-issue window. MedicareMedicare Part D Drug CoverageMedicare Part D in 2026: a $2,100 out-of-pocket cap, no donut hole, three benefit phases, the $615 deductible, premiums, the late penalty, and Extra Help. MedicareMedicare Savings ProgramsMedicare Savings Programs help low-income enrollees pay Part B premiums and, with QMB, all cost-sharing. See the four MSPs, 2026 limits, and how to apply. MedicareMedicare Enrollment PeriodsWhen to sign up for Medicare without a lifelong penalty: the 7-month Initial Enrollment Period, working past 65, the GEP, and what each late penalty costs.

Find personalized help with Medicare in Idaho at brevy.com.

The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.

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