Medicare Advantage Plans in Utah

Medicare Advantage in Utah provides your Medicare Part A and Part B benefits through a private insurance company. Many Medicare Advantage policies also feature prescription drug benefits.

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.”

You may notice when you search for available Medicare Advantage plans in Utah that there are often three (sometimes) more letters after the plan’s name. A common one is an HMO 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. Another is PPO A 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. These letters denote different health plan types.

HMOs are a popular plan among Medicare Advantage enrollees in Utah. 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 PPO is another common Medicare Advantage type in Utah. A PPO is slightly 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 17 Medicare Advantage plans in Utah in 2023 that offered innovative benefits. Examples of these benefits include wellness planning, rewards, healthcare incentives and even additional hospice benefits.

On average, a Medicare Advantage enrollee in Utah paid a monthly premium A premium is a fee you pay to your insurance company for health plan coverage. This is usually a monthly cost. of $15.77 in 2023.

While most people pay around $20 for the Medicare Advantage premium, all Utah residents eligible for Medicare had access to at least one $0 premium Medicare Advantage plan in 2023. When considering the premium for 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 stop paying for services you don’t utilize.

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.

Yes, there are several Medicare Advantage plans in Utah that 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.

Of the available Medicare Advantage plans in Utah in 2023, 24 followed the Part D Senior Savings Model, a relatively new offering that provides reduced-cost insulin. If you select a Medicare Advantage plan that offers prescription drug coverage through the Senior Savings Model, you will pay no more than $35 a month for insulin.

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.