Changes are coming for individuals who are eligible for BOTH Medicare and Medicaid in Idaho. Let’s briefly review those changes, what to expect, and what you can do if you are affected by these changes.
What is the difference between Medicaid and Medicare?
First, what is Medicare? It is a federally run health insurance program, typically used by eligible individuals who are 65 and older or individuals under 65 who have been disabled for at least 2 years. The program is administered by the Center for Medicare Services through the Social Security Administration. You can find more information at ssa.gov
What is Medicaid? It is a state run health insurance program for those with low incomes including adults, children, pregnant women, the elderly, and people with disabilities. The program is administered by the Idaho Department of Health and Welfare. You can find out more information at their website.
Can I be enrolled in both Medicaid and Medicare at the same time?
Individuals can be eligible for both Medicaid and Medicare at the same time. These individuals are called dual-eligible and may enroll in dual-eligible programs. These programs can coordinate both Medicare and Medicaid benefits into one plan. In Idaho, there are two authorized insurance companies at a time chosen to administer dual-eligible plans. In June 2025, United Health Care will replace Blue Cross of Idaho as one of those authorized plan providers. The second providers is Molina Healthcare. Individuals who are on a Blue Cross coordinated plan will need to change plans prior to the end of May 2025. Enrollment and disenrollment in the MMCP is allowed one time per month.
This document published in March 2025 by the Idaho Dept. of Health and Welfare (DWH) outlines the options available to dual-eligible individuals. Generally, individuals can choose either of these two options:
- 1. Idaho Medicaid Plus (IMPlus)
- 2. Medicare Medicaid Coordinated Plan (MMCP)
How do you decide which program and which plan to choose?
We suggest that you ask the following questions of each of your options:
1. Are my providers in the plan network?
2. Are my medications on the Medicare Part D formulary?
3. What are supplemental benefits will I receive if I choose an MMCP?
Dual-eligible MMCP programs may offer benefits such as an over-the-counter allotment to buy items at no cost and grocery allotments to spend monthly on groceries as Medicare benefits. Treasure Valley Heath Insurance can help you compare options to determine which dual-eligible plan works best for you. You can also reach the Idaho Dept. of Health and Welfare for questions at 833-814-8568.