Medicare in Utah
Learn how Medicare in Utah can contribute to a healthy lifestyle
Reviewed by: Brett Braithwaite, Licensed Insurance Agent. Written by: Bryan Strickland.
Original Medicare in Utah is available to anyone age 65 or older. It features hospital and medical coverage with the option of adding drug and supplemental coverage.
Medicaid in Utah offers similar coverages, but eligibility is based on need regardless of age. You can be eligible for both Medicaid and Medicare.
Medicare Advantage in Utah (Part C) replaces Original Medicare (Part A and B) but offers the same Part A and B benefits and coverages as Original Medicare. Along with Part A and B benefits, Medicare Part C often bundles additional services like dental, hearing, vision and prescription drug coverage.
Since the 1880s, The Tabernacle Choir based in Utah has delighted the world with majestic music made to sound effortless.
Of course, making something seem easy doesn’t mean that it is.
It’s much the same in the world of healthcare, where 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 orchestrate things for you.
If you are receiving Social Security benefits before your 65th birthday, 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 of your 65th birthday and the three months before and the three months after your 65th birthday.
Your choices for applying for Medicare in Utah are:
What are the Requirements for Receiving Medicare?
If you are a U.S. citizen 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.
What exactly is Medicare in Utah?
Medicare is a federal program launched in 1965 to provide affordable healthcare for older Americans nearing retirement.
You can enroll in Part A (also known as “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 replace the benefits of 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 the gaps in terms of things 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 in Utah 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?
Your income isn’t a factor in your ability to sign up for Medicare in Utah. It’s a different story with Medicaid (more on that in a minute).
When it comes to Part A of Original Medicare, having earned income over your lifetime is, in fact, a positive. 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 a spouse that is at least 62 years old has, then that also qualifies you.
With Part B, some higher-income earners may have to pay more than the standard premium. In 2021, for example, the standard monthly premium for Part B was $148.50. That rate increases if your individual income, based on your 2020 tax return, is more than $88.000. The Centers for Medicare & Medicaid Services estimates that only seven percent of Medicare beneficiaries are impacted. 
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 20 categories of Medicaid on its website,  stating that the limits for the various programs range between 55% and 133% of the Federal Poverty Level. 
What are 4 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.
Table reflects the latest Beneficiary Demographics data: 2018, All Beneficiaries by State, Centers of Medicare & Medicaid Services (CMS)
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)
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.)
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
What should I know about Veteran and Military Affairs?
The state organization helps veterans and their families with their health-related benefits.
Speak with an insurance agent that is licensed in Utah about your Medicare questions.1-855-792-0088 TTY: 711
Monday - Friday, 8 AM - 9 PM CT
Medicare & Medicaid
If you have general questions about Medicare in UT, or need help with current Medicare benefits.1-800-MEDICARE (1-800-633-4227)
Social Security Administration
You can reach the SSA 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
Speak to SSA Representative, Monday - Friday, 8 AM - 7 PM ET