Medicare Advantage

Does an HMO or PPO fit your Boise situation?

For 2027, Boise is looking at 27 Medicare Advantage plans: 4 new, 9 gone since 2026, and 15 still here but changed on premium, deductible, plan type or name, 5 of them under a new name. Below, how the lineup shifted in Ada County and what to compare, with no plan ranked or recommended.

Medicare AdvantageBoise, ID

Picking a Medicare Advantage plan in Boise starts with a question that trips up a lot of people: what kind of plan is it? HMO, PPO, PFFS and Special Needs Plans work differently, and the label on the plan card shapes how you see doctors, whether you need referrals, and who is eligible in the first place. Before you compare premiums or extras, it helps to know how the plan types themselves are built.

Boise sits in Ada County, and that is the geography that matters here. Medicare Advantage plans are approved and sold at the county level, so the lineup available to a Boise resident is the Ada County lineup. According to the CMS Medicare Advantage Landscape Source File for plan year 2027, Ada County has 22 Medicare Advantage plans from 7 carriers, and every one of them includes drug coverage.

Who sells Medicare Advantage in Boise

Seven carriers offer Medicare Advantage plans in Ada County for 2027. Listed alphabetically, they are American Health Advantage of Utah, Blue Cross of Idaho, Humana, Molina Healthcare of Utah & Idaho, PacificSource Medicare, St. Luke's Health Plan and UnitedHealthcare. Saint Alphonsus Health Plan is not offering plans in the county for 2027. The full plan-by-plan list is in the table below.

The number of plans each carrier offers varies. American Health Advantage of Utah offers 1 plan. Blue Cross of Idaho offers 4. Humana offers 11. Molina Healthcare of Utah & Idaho offers 2. PacificSource Medicare offers 2. Saint Alphonsus Health Plan offers 4. UnitedHealthcare offers 8. More plans is not the same as better — it just means more options to compare inside that carrier's lineup.

What HMO, HMO-POS and PPO actually mean

An HMO (Health Maintenance Organization) plan uses a set network of doctors and hospitals. You usually pick a primary care doctor, and you generally need a referral to see a specialist. Out-of-network care is typically not covered except in emergencies. In Ada County, 11 of the 32 plans are HMOs.

An HMO-POS (Point of Service) plan is an HMO with a limited door to go outside the network for certain services, usually at a higher cost. The Ada County HMO-POS count for 2027 is in the table below.

A PPO (Preferred Provider Organization) plan also has a network, but you can generally see out-of-network providers who accept the plan — you'll usually pay more when you do, and you don't need a referral for specialists. See the table below for the PPO count in the county's 2027 lineup.

You may also hear about PFFS (Private Fee-for-Service) plans. These let you use any Medicare-approved provider who agrees to the plan's payment terms. There are no PFFS plans listed in Ada County for 2027, but it's worth knowing the term exists because it shows up in Medicare's national materials.

Special Needs Plans: who they're for

Special Needs Plans (SNPs) are Medicare Advantage plans limited to people who meet specific criteria. There are three types:

• D-SNP (Dual-Eligible): for people who have both Medicare and Medicaid.
• C-SNP (Chronic Condition): for people with certain qualifying chronic conditions, such as diabetes or heart conditions.
• I-SNP (Institutional): for people who live in, or need the level of care provided by, a nursing facility or similar setting.

You can't just choose an SNP — you have to qualify. Ada County includes SNPs among its 22 plans for 2027. The roster below shows which carriers offer SNPs and what type each is (C-SNP, D-SNP or I-SNP). If you think you might qualify for one, your local State Health Insurance Assistance Program (SHIP) can walk through it with you.

Drug coverage is built in

All 22 Medicare Advantage plans available in Ada County for 2027 include prescription drug coverage. CMS data shows no stand-alone Part D plans listed in the area for 2027, so most people using Medicare Advantage in Boise will get their drug coverage through their Advantage plan.

A few Part D rules to keep in mind for 2027:

• The Part D out-of-pocket cap is $2,100 for the year. Once you hit it, you pay $0 for covered drugs the rest of the year.
• The maximum Part D deductible is $615.
• The old coverage gap ("donut hole") is gone as of 2025 — Part D now has three phases, not four.
• The Medicare Prescription Payment Plan lets you spread your drug costs over the year in monthly payments instead of paying big amounts at the pharmacy counter. It's optional and doesn't change what you owe overall.

How to use this to compare

Start with the plan type. If keeping a specific doctor matters most, check whether that provider is in-network for the plans you're considering, and how the plan handles out-of-network care. If you have Medicaid, a qualifying chronic condition, or live in a facility, look at whether an SNP fits your situation. Then look at drug coverage against the medications you actually take.

One last note on Star Ratings: CMS publishes quality ratings for Medicare Advantage contracts, and you can see them on Medicare's Plan Finder. In this area, no contracts are currently rated 4 stars or higher, so ratings alone won't do the sorting for you — the plan-type and network questions matter more here.