Medicare Advantage Plans in Utah
Key Takeaways
- All Utah residents had access to a Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plan in 2024.
- Medicare Advantage plans are offered by private insurance carriers to substitute for Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). as well as provide additional coverage.
- Most Medicare Advantage plans offer Part DMedicare Part D is prescription drug coverage for people enrolled in Medicare. Part D is optional and is offered by private insurance companies. prescription drug coverage.
Utah Medicare Advantage Plan Coverage
Medicare Advantage provides your Medicare Part A and Part B benefits through a private insurance company. Most plans also feature prescription drug benefits and .
Parts A and B are collectively called Original Medicare. Part A is commonly referred to as “hospital insurance.” Medicare Part B is commonly referred to as “medical insurance.”
HMOs A Health Maintenance Organization (HMO) is a type of plan that uses a network of doctors, hospitals, and other providers to treat an insurance company’s customers.
, which stands for Health Maintenance Organization arethe most common type of Medicare Advantage plan. These plans require you to establish an in-network primary care provider. This provider can make referrals for you when you need specialty services. Typically, if you do not use an in-network provider, your HMO will not cover their services.
A PPOA Preferred Provider Organization (PPO) is a health insurance plan that doesn’t require you to get a referral from a primary care physician to see other doctors. Most PPOs allow you to see any doctors or providers in their network.
, or Preferred Provider Organization, is different from an HMO in that you may not need a referral for a specialist and you may receive at least a percentage of reimbursement if you see an out-of-network provider. Typically though, your greatest savings in any Medicare Advantage plan will come from utilizing in-network providers.
Medicare Advantage plans can offer more benefits than Original Medicare. According to the Centers for Medicare & Medicaid Services, there were 13 Medicare Advantage plans in Utah that offered innovative benefits like reduced cost sharing and nutrition assistance in 2024.
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UT Medicare Advantage Plan Costs
On average, a Medicare Advantage enrollee in Utah paid a monthly premiumA premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost.
of $13.05 in 2024.
Nearly all Utah residents eligible for Medicare have access to at least one $0 premium Medicare Advantage plan. When considering any plan, it’s important to examine not only the monthly premium, but also the deductible, copayments and coinsurance. Unlike Original Medicare, Medicare Advantage plans provide the protection of an out-of-pocket maximum. The lower your out-of-pocket maximum, the more you could save if you do meet the yearly maximum.
Evaluating your current coverage and assessing what plans are available on an annual basis could potentially save you money, expand your coverage, and help you avoid paying for services you don’t use.
Medicare Advantage Plan Eligibility & Enrollment in Utah
You are eligible for Medicare when you turn age 65. If you have paid Medicare taxes over at least 10 years of work, you are eligible for premium-free Medicare Part A. If you have Medicare Part B, you usually will pay a monthly premium even if you switch to Medicare Advantage.
Some people do qualify for Medicare before age 65. These circumstances include having a qualifying disability, or having end-stage renal disease or Amyotrophic Lateral Sclerosis (also known as Lou Gehrig’s disease).
Even after you are in a Medicare Advantage plan, you have the opportunity to switch your plan at specific times throughout the year. One of the most common times is the Medicare Open Enrollment Period, also known as the Annual Enrollment Period. From October 15 to December 7 on an annual basis, you can enroll in a new plan if you wish. If you do enroll in a new plan, your benefits will start on January 1 of the following year.
There also is a Medicare Advantage Open Enrollment period from January 1 through March 31 each year. At this time, you can change to a different Medicare Advantage plan or go back to Original Medicare. You cannot, however, switch from Original Medicare to Medicare Advantage.
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Are There Utah Medicare Advantage Plans With Prescription Drug Coverage?
Most Medicare Advantage plans offer prescription drug coverage. You can connect with a GoHealth licensed insurance agent to learn about plans that offer prescription drug coverage as part of a Medicare Advantage plan — some of which have a $0 premium.
Keep in mind that Medicare Advantage plans cover a regional area, so all plans aren’t available to all people in Utah. This means if you move outside the city or major geographic area you live in, you may qualify for a Special Enrollment Period to search for a new plan.
When you choose a Medicare Advantage plan with prescription drug benefits, it’s important to carefully read the plan’s formulary. This is a listing of the prescription drugs the plan covers. Medicare requires that all Medicare Advantage prescription drug plans cover at least two medications in each major category of care. If you have specific medications you are taking related to your health, make sure your new plan covers them. Otherwise, you may have higher medication costs or switch to different medications (with your doctor’s approval) as a cost-saving measure.
Medicare Learning Guides
Healthcare is personal. So is choosing insurance. If you are new to Medicare, a beneficiary researching options, or a caregiver, we have tailored Medicare Guides for you.
Before 65 Guide
Understanding health insurance before age 65, especially when considering early retirement
Medicare Plans Guide
Costs, coverage and enrollment details for each Medicare plan
Medicare Beneficiary Guide
For those currently enrolled in Medicare
Low Income and Medicare Guide
For individuals with a qualifying income status
A Caregiver's Guide
For individuals with a qualifying income status
Sources
- FACT SHEET. CMS.gov.
This website is operated by GoHealth, LLC., a licensed health insurance company. The website and its contents are for informational and educational purposes; helping people understand Medicare in a simple way. The purpose of this website is the solicitation of insurance. Contact will be made by a licensed insurance agent/producer or insurance company. Medicare Supplement insurance plans are not connected with or endorsed by the U.S. government or the federal Medicare program. Our mission is to help every American get better health insurance and save money.
Any information we provide is limited to those plans we do offer in your area. Please contact Medicare.gov or 1-800-MEDICARE to get information on all of your options.