Assisted living facilities primarily help residents with non-medical needs. Although minor and infrequent medical services, such as first-aid for a wound, can sometimes be met on-site by nurses. These communities may sometimes also be called ALFs, residential care facilities, retirement homes, or long-term care facilities.
The financial options available to help pay for senior care is dependent on, among other things, the type of care that is required. If you are just beginning the research process on how to pay for long-term care, it is helpful to have an idea about the type of care you or your loved one currently requires, as well as to anticipate future needs. In addition, it is important to be familiar with the associated eldercare terminology.
Can using home care technology help your family save money caring for an aging loved one? The answer is most certainly “Yes”. Our goal is not to provide a comprehensive list, but rather to make sense of those that are available on the market today and can reduce the care hours required by elderly persons. As such, they can reduce a family’s out-of-pocket care costs or reduce the hours they spend providing care themselves.
Medicare Advantage (Part C), a privately offered alternative to Original Medicare (Parts A and B), has grown in popularity over the years. Despite the growing popularity of Medicare Advantage, some seniors face obstacles that prevent them from truly understanding how it works and who it benefits. Common mistakes about Medicare Advantage include misunderstanding its differences from Original Medicare, getting it confused with other forms of private Medicare insurance (like Medigap or Part D), or not understanding how to look up or evaluate plans.
Established in 1965, Medicare is a program designed to ensure seniors and younger adults with certain disabilities have access to health coverage. For years, Original Medicare was the only option available. Under Original Medicare, beneficiaries receive inpatient care through Medicare Part A and outpatient care through Part B. In 2003, beneficiaries were given an additional option: Medicare Advantage.
The purpose of Medicare Advantage was to give Medicare beneficiaries access to plans offered by private insurance companies, which would help save money by encouraging providers to compete with each other based on price and plan features. Every Medicare Advantage Plan covers almost all the same medically necessary services as Original Medicare, but many providers also offer extra benefits to encourage beneficiaries to sign up for the program. One of the most significant differences between Medicare Advantage and Original Medicare is that an individual enrolled in a Medicare Advantage Plan typically must use doctors and hospitals within that plan’s network. Otherwise, Medicare Advantage may not cover the service, or it may cover it at a lower percentage than it would for in-network care.
In Utah, 432,862 residents are eligible for Medicare, and 44% of them are enrolled in Medicare Advantage, as of 2021. Utah’s Medicare Advantage enrollment rate exceeds the national enrollment rate of 42%.
This guide explains the benefits available under Medicare Advantage, provides information about the top 10 plans available in Utah and offers tips for finding the right Medicare Advantage Plan based on specific medical and financial circumstances.
The Top 10 Medicare Advantage Plans in Utah
Utah’s Medicare Advantage Plans are sold by several insurance companies, and each company typically offers more than one type of plan. There’s more information about these plans in the table below, which lists the top 10 Medicare Advantage plans in the state. To account for the multiple plans offered by each provider, cost data is presented as a price range, instead of an average price. Enrollment numbers for individual plans were also combined to provide the total enrollment for each provider. Information about these plans is current as of April 2022. Seniors who need current cost and enrollment information should visit Medicare.gov.
Name
Total Enrollment
Star Rating
Min Cost
Max Cost
Plan Types
UnitedHealthcare
103,245
4
$0
$39
HMO, PPO
SelectHealth
32,825
5
$29
$67
HMO
Humana
17,732
4
$0
$39
HMO, PPO
Aetna Medicare
13,681
3.5
$37
$65
HMO, PPO
Regence BlueCross BlueShield of Utah
11,254
4.5
$31
$179
PPO
Molina Healthcare of Utah & Idaho
10,782
3.5
$0
$0
HMO
Cigna
5,391
3.5
$0
$0
HMO, PPO
Advantage U
1,218
0
$0
$0
PPO
Anthem Blue Cross and Blue Shield
516
0
$0
$0
PPO
Blue Cross Blue Shield of Michigan
83
0
$0
$0
PPO
How Medicare Advantage Plans Work in Utah
Unlike Original Medicare, which is the same for every enrollee, Medicare Advantage makes several types of plans available to Utah residents. These plans have different rules regarding where beneficiaries can receive care and whether an enrollee needs a referral to visit a specialist. Some plans even limit enrollment to Medicare beneficiaries with certain chronic health conditions. The graphic below lists the main types of plans and provides more information about the coverage available under each one.
What Medicare Advantage Plans Cover in Utah
Medicare Advantage Plans cover a wide range of medically necessary services. With the exception of hospice care which remains covered by Medicare Part A, each plan must cover the same services as Original Medicare, such as X-rays, doctor visits and lab tests. Most Medicare Advantage Plans also include prescription benefits, giving enrollees access to medications for high blood pressure, diabetes and other health conditions. One of the main benefits of enrolling in Medicare Advantage is that many plans cover dental care, hearing aids, contact lenses, eye exams and other services that aren’t covered by Original Medicare.
Coverage Available With Medicare Parts A & B?
Coverage Available With Medicare Advantage?
Preventive Screenings
Yes
Yes
Hospital Care
Yes
Yes
Durable Medical Equipment
Yes
Yes
Prescription Drugs
No
Yes**
Vision Care
No
Yes*
Dental Care
No
Yes*
Hearing Aids
No
Yes*
*Select plans offer this coverage
** Most plans offer this coverage
Eligibility for Medicare Advantage in Utah
To qualify for Medicare Advantage, a Utah resident must live in a plan’s service area, have Medicare Part A and Part B coverage and meet the general Medicare eligibility requirements. Medicare is available to residents who are at least 65 years old or have a disability that makes them eligible for Medicare at a younger age. The program is also limited to U.S. citizens and immigrants who have obtained lawful permanent resident status.
When it comes to Medicare enrollment, timing is everything. Both Original Medicare and Medicare Advantage have limited enrollment periods, which are described in the list below. Enrolling as soon as possible can help Medicare-eligible seniors start taking advantage of a wide variety of benefits.
Initial Coverage Election Period: This is the initial 7-month period, coinciding with one’s 65th birthday, during which everyone is eligible to enroll in a Medicare Advantage plan.
Annual Election Period (AEP): Also referred to as the Open Enrollment Period, this is the time of year when anyone over 65 can enroll in Medicare Advantage for the first time or change to a new plan.
Medicare Advantage Open Enrollment Period: During this period, those who are already enrolled in Medicare Advantage can switch to a different plan or switch back to Original Medicare.
Start Date
End Date
Initial Coverage Election Period
3 Months Before One’s 65th Birth Month
3 Months After One’s 65th Birth Month
Annual Election Period (AEP)
October 15th
December 7th
Medicare Advantage Open Enrollment Period
January 1st
March 31st
Additionally, Medicare Advantage plan participants can change their plan outside of these enrollment periods under certain qualifying circumstances, such as moving to a new state.
How to Find & Choose a Medicare Advantage Plan in Utah
Navigating the many intricacies of Medicare Advantage plan types, insurers, and the specific plan options available by region can be a difficult and time-consuming task. Below are several resources we’ve created to help you through the process.
First is a downloadable PDF that you can use as a guide to help you compare plans as you research. Finally, we have listed a number of organizations that you can contact with experts that will help you determine whether Medicare Advantage is right for you and what plans you should consider.
The State Health Insurance Information Program (SHIIP) is a nationwide program operating in many states, including Utah. It provides free and impartial one-on-one counseling and assistance to adults 60 or older who are eligible for Medicare, both via telephone and in face-to-face sessions, to help people find the right Medicare and Medicare Advantage plans. It also puts on public Medicare education programs and courses for people of all ages.
Take Care Utah is an initiative of the Utah Health Policy Project (UHPP), specifically designed to guide people to accurate information about enrollment and coverage in health care plans, with navigating with the health care marketplace and understanding of their options, including plans offered through Medicare and Medicare Advantage. Take Care Utah guides individuals to counseling and information resources, and provides free assistance with applications and enrollment.
More information about Take Care Utah can be obtained from the Utah Health Policy Project by calling 801-433-2299. Services can also be accessed through Take Care Utah’s website.
Utah Aging & Disability Resource Center & COVER to COVER
Utah’s ADRC and C2C initiatives are a collaboration between the Centers for Medicare and Medicaid Services, the Veterans Health Administration and the U.S. Administration on Community Living. Together, they’re designed to allow seamless access to long-term services and supports for older adults and people with disabilities, creating a “one-stop shop” for anything these individuals may need. The COVER to COVER program is sponsored by the Office of Rural Health and Geriatrics and Extended Care and designed to support access to benefits and programs for rural veterans within their communities, in collaboration with Area Agencies on Aging and other community partners.
Contact Info
The C2C program can be contacted by email at [email protected]. Further information about the program and a directory of C2C office locations in Utah and their contact details can be found on the ADRC website.
Utah Department of Health’s Office of Health Care Statistics
The Utah Department of Health provides a number of services through its Office of Health Care Statistics that can be helpful with Medicare enrollment and navigation, such as public access to data comparing Utah health plans and hospital costs, answers to common questions about health care in the state and guidelines to using and interpreting the data on their site. Many of the reports compiled from this data are freely accessible by the public and can be an invaluable resource in evaluating Medicare and Medicare Advantage options.
The mission of the Utah Insurance Department is to make sure that insurance products offered in the state are affordable, reliable and accessible to all on fair terms. It serves and protects consumers residing in the state of Utah through insurance law and regulation, following up on insurance complaints, licensing and certification of cross-border insurers and other initiatives. It also provides general information and counseling about health insurance, including Medicare Advantage plans.
The department can be reached toll-free within Utah by calling 1-800-439-3805, or on its main line at 801-538-3800. A directory of further contacts, along with directions to department offices, can be found on its website.
An initiative of the United Way of Utah, 2-1-1 Utah is a comprehensive information portal to find a wide range of services in the state, including health insurance counseling. The service can be accessed by phone or via a smartphone app. The 2-1-1 Utah resource is directly tied to Take Care Utah, which is similarly dedicated to helping people navigate health insurance options.
Seniors can contact 2-1-1 Utah through the program’s website or via the downloadable app available there. General inquiries can also be made by calling 801-736-8929.
A group of community health centers that takes a holistic approach to health and wellness, the Bear Lake Community Health Center has Utah locations in Garden City, Providence, North Logan and Brigham City, as well as several sites out of state. In addition to providing access to quality primary and urgent medical care regardless of ability to pay, the center provides information services that help seniors with navigating health care coverage options, including Medicare and Medicaid, and finding economically efficient choices.
BLCHC’s administration offices can be reached by phone at 435-755-6061, or by mail at 517 West 100 North, Suite 210, Providence, Utah 84332. A directory of their clinic locations and contact information can be found on their website.
Based in the College of Social Work in Salt Lake City’s University of Utah, the Goodwill Neighbors Helping Neighbors program is over two decades old. Its focus is on providing services for seniors and collaborating with community partners in helping older adults adjust to the challenges of aging. NHN mobilizes students to support seniors in learning about preventative health measures, rehabilitative and support services and how to navigate issues with medical insurance coverage. The program provides information and referral support, individual and family counseling and help with applications for a range of public services. These services come with no financial eligibility requirements and are prioritized for those most in need of help.
