Medicare in Utah
Key Takeaways
- 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). in Utah is available to anyone age 65 or older. It features hospital and medical coverage with options to add drug and supplemental coverage.
- MedicaidMedicaid is a state-based health insurance program for individuals that qualify. Unlike Medicare, Medicaid does not have age restrictions for members. in Utah offers similar coverages, but eligibility is based on need regardless of age. You can be eligible for both Medicaid and Medicare.
- 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). in Utah (Part C) substitutes for Original Medicare (Part A and B) and usually bundles additional services like dental, hearing, vision and prescription drug coverage.
In the world of healthcare, it’s crucial to stay in step with changes that can impact your plan’s performance. When it comes to Medicare in Utah, GoHealth can help.
How Do I Apply for Medicare in Utah?
If you are receiving Social Security benefits before you turn 65, you may be automatically enrolled in Original Medicare. If not, you have to apply. Your first chance to sign up is during your Initial Enrollment Period, a seven-month window that includes the month you turn 65 and the three months before and the three months after your birthday.
Your choices for applying for Medicare in Utah are:
- Enrolling online with the Social Security Administration
- Enrolling over the phone at 1-800-772-1213 (TTY: 1-800-325-0778)
- Visiting a local Social Security office
Still have questions? GoHealth has the answers you need.
What Are the Requirements for Receiving Medicare?
If you are a U.S. citizen or permanent resident age 65 or older, you qualify for Medicare in Utah. It’s as simple as that.
You’re also eligible regardless of your age if:
- You have end-stage renal disease or Lou Gehrig’s disease (also known as amyotrophic lateral sclerosis, or ALS).
- You have received 24 monthly payments of Social Security Disability Insurance or Railroad Board benefits.
You can enroll in Part A (hospital insurance), Part B (medical insurance), or both. Once enrolled in Part A and B (known collectively as Original Medicare), you have the option of switching to Medicare Advantage in Utah (also known as Part C) to substitute for Parts A and B while offering other benefits like dental and vision coverage.
If you decide to stay enrolled in Parts A and B, you have the option to add Part D to cover a portion of your prescription drug expenses. You may also choose to add Medigap, which is supplemental coverage that helps fill in gaps like copays and coinsurance.
A couple of Medigap plans also offer the protection of an out-of-pocket maximum, something that Original Medicare alone doesn’t provide. Medicare Advantage is required to feature an out-of-pocket maximum while bundling Parts A and B and — in most cases — drug coverage.
What Is the Income Limit to Receive Medicare?
If you have worked at least 10 years, you don’t pay a monthly premium for Part A. If you haven’t worked 10 years but your spouse has and is at least 62 years old, then that also qualifies you.
With Part B, some higher-income earners may have to pay more than the standard premium. In 2025, for example, the standard monthly premium for Part B is $185. That rate increases if your individual income, based on your 2023 tax return, is more than $103,000. The Centers for Medicare & Medicaid Services (CMS) estimates that only seven percent of Medicare beneficiaries are impacted.
Still have questions? GoHealth has the answers you need.
Do I Qualify for Medicaid in Utah?
Each state has its plan for administering Medicaid, a federal/state program founded alongside Medicare that helps those facing a financial need or a disability regardless of age. The Utah Department of Health lists several categories of Medicaid on its website, stating that the limits for the various programs range between 55% and 13.3% of the Federal Poverty Level.
What Are the Types of Medicare Advantage Plans?
While Original Medicare is only one plan, Medicare Advantage in Utah comes in all shapes and sizes.
The cost savings inherent in Medicare Advantage plans are possible in part because beneficiaries get favorable rates when they visit providers within a regional network. Those networks are set up within four different types of Medicare Advantage plans.
- Health Maintenance Organization (HMO) plans use provider networks. HMOs typically require that the policy holder designate a primary care physician that provides referrals if you need to see another doctor.
- Preferred Provider Organization (PPO) plans give you the freedom to see any doctor in your network without a referral.
- Private Fee-for-Service (PFFS) plans pay your providers each time you receive a service.
- Special Needs Plans (SNPs) are for patients with specific diseases or financial situations.
Which Company Has the Best Medicare Advantage Plan?
The Centers for Medicare & Medicaid Services has a Medicare Star Rating system that assigns a rating of one to five stars (five being the highest-rated) to individual Medicare Advantage plans.
If you’re already on a Medicare Advantage plan and it’s not five-star plan, you are offered the opportunity to switch to a five-star plan each year.
While the rating system can shed light on Medicare Advantage plans’ performance, it’s not as easy as just picking the highest-rated plan. A dedicated GoHealth licensed insurance agent can review your situation and figure out what Medicare Advantage plan is the right fit for your specific situation.
Can I bundle multiple benefits into one plan?
Thousands of older adults enroll in Medicare every day across the United States. The latest CMS data shows that 384,282 people are enrolled in Medicare Part A and B in Utah. The total number of beneficiaries enrolled in Medicare Advantage increased from 156,376 to 173,361 year over year. Medicare Advantage participation in Utah went from 42.30% to 45.11% year over year. If you’d like to dive deeper into how Medicare in Utah breaks down across the state, we provide a glance at who is using Medicare and how.
384,282 Beneficiaries with Part A & Part B
173,361 Medicare Advantage Beneficiaries
45.11% Medicare Advantage Participation Rate
53.74% Female
46.26% Male
90.03% Non-Hispanic White
0.58% African American
4.51% Hispanic
4.88% Other/Unknown
9.64% Eligible for Medicaid
0.94 Average HCC Score
$9,436.63 Actual Per Capita Costs
12.59% Hospital Readmission Rate
25.10% % of Beneficiaries with an Emergency Department Visit
156,376 Medicare Advantage Beneficiaries, Previous Year
Increased Medicare Advantage, Year over year
42.30% Medicare Advantage Participation Rate, Previous Year
Table reflects the latest Beneficiary Demographics Data: Medicare Geographic Variation – by National, State & County
Average HCC Score: The Hierarchical Condition Category score gauges a population’s overall health. The score is based on a value of 1.0. Populations with an HCC score of less than 1.0 are considered relatively healthy. The score can be used to estimate health costs.
Medicare Assistance (SHIP)
https://daas.utah.gov/services/#ship
What should I know about SHIP?
The State Health Insurance Assistance Program in Utah provides residents with free, unbiased Medicare advice.
State of Utah Insurance Transparency
What should I know about State of Utah Insurance Transparency?
Government-sponsored website provides an educational tool for residents researching a healthcare decision.
Utah Department of Health Medicaid
Phone lines open M-F, 8 a.m. to 5 p.m. (except Thursdays 8 a.m. to 11 a.m.)
https://medicaid.utah.gov/who-eligible/
What should I know about Utah Department of Health Medicaid?
The state’s Medicaid program oversees several financial assistance programs for Utah residents.
Utah Department of Veteran and Military Affairs
https://veterans.utah.gov/benefits-services/
What should I know about Veteran and Military Affairs?
The state organization helps veterans and their families with their health-related benefits.
Nationwide Resources
Speak with a GoHealth insurance agent that is licensed in Utah about your Medicare questions.
Mon – Fri, 8 a.m. – 6 p.m. CT
Centers for Medicare and Medicaid Services
You can reach the Social Security Administration by phone for general questions. Not all questions can be answered over the phone.
Also, SSA.gov provides online resources for the following: Review information, apply for benefits, or manage your account online
1-800-722-1213
TTY 1-800-325-0778
Speak to SSA Representative, Monday – Friday, 8 AM – 7 PM ET
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
- Apply for Benefits. SSA.gov.
- Social Security Office Locator. SSA.gov.
- Medicare costs at a glance. CMS.gov.
- Who Is Eligible? Utah.gov.
- Poverty Guidelines. HHS.gov.
- Special Needs Plans (SNP). Medicare.gov.
- 5-star special enrollment period. Medicare.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.