Medicare in Utah

Medicare is a federal health care program providing coverage to people aged 65 and over, as well as younger individuals who are living with certain disabilities. The program includes several components covering different aspects of medical care. Out of Utah’s 3.3 million residents, just over 410,000 are enrolled in some form of Medicare. The majority (just over 250,000) of enrollees have chosen the Original Medicare program in 2020.

Original Medicare comprises Medicare Parts A and B. Part A focuses on hospital stays, nursing homes, hospice care and some aspects of home health care. Part B covers medical supplies, outpatient services and preventative care. In addition to this, seniors can optionally add Part D coverage, which is a program that helps with the cost of prescription drugs.

Medicare Advantage is a privately run program offering the same coverage as Original Medicare Parts A and B. This program is also known as Medicare Part C. Insurance providers have to meet certain minimum standards of coverage with their Medicare Advantage plans but can also provide additional services, such as vision and dental care, hearing aids or prescription drug coverage. Medicare Supplemental plans, or Medigap, are offered by private companies to Original Medicare users to help reduce the out-of-pocket expenses faced by customers.

This guide covers the different Medicare programs available to Utah residents. It offers information about how seniors can customize their Medicare coverage and provides a list of useful resources to help seniors make informed health insurance decisions.

Options for Medicare Coverage in Utah

Original Medicare provides a good level of basic coverage and is suitable for many older adults. However, some seniors may prefer a more tailored policy. Utah residents have several options when it comes to customizing their Medicare coverage. In addition to the coverage options provided by the federal government, Medicare beneficiaries can purchase tailored policies from private insurance companies.

Original Medicare (Parts A & B)

Original Medicare is administered by the Centers for Medicare & Medicaid Services (CMS) and is open to seniors aged 65 and over, along with those under 65 years old, but with certain disabilities or end-stage kidney disease. It includes two parts. Part A covers inpatient hospital care, nursing home and skilled nursing care, hospice and home health care. Part B, or medical coverage, pays for medically necessary goods and services such as durable medical equipment, mental health services and emergency medical transportation. 

Unlike most private Medicare plans, Original Medicare’s provider network isn’t limited to the beneficiary’s geographic region, making it easier to obtain services while traveling within the country. In most cases, Medicare doesn’t pay for health services the individual receives outside the United States. 

Under this program, seniors pay for services as they receive them. They must pay an annual deductible, which is $1,556 for Part A and $233 for Part B in 2022. After they’ve paid this amount, Medicare covers all eligible services at 80%. Beneficiaries pay the remaining 20% out of pocket.

Who Should Consider Original Medicare

Original Medicare may be a good option for those who:

• Travel frequently within the United States
• Don’t need extra benefits such as home-delivered meals and coverage for over-the-counter medication
• Want to choose their own prescription drug coverage

Medicare Advantage (Part C)

Medicare Advantage is a program that combines Medicare Parts A and B into one plan, called Medicare Part C. Unlike Original Medicare, Medicare Part C is administered by private insurance companies. These companies offer beneficiaries the same coverage as Original Medicare except hospice care which Part A covers. Most Advantage plans include drug coverage (Part D) and many plans provide additional services such as vision and dental care. There are approximately 160,000 people enrolled in Medicare Advantage in Utah, as of 2020.

Seniors who choose Medicare Advantage can select from four different plan types. These are Health Maintenance Organizations (HMO), Preferred Provider Organizations (PPO), Private Fee-for-Service plans (PFFS) and Special Needs Plans (SNP). Each of these coverage options has different rules regarding out-of-pocket expenses, referrals and networks.

Who Should Consider Medicare Advantage

Medicare Advantage may suit seniors who:

• Are generally in good health and may qualify for lower premiums
• Want the simplicity of one provider for all coverage
• Are looking for additional benefits such as vision and dental care
• Are happy with the network options in their area

The Top 10 Medicare Advantage Plans in Utah

Many insurance companies in Utah have Medicare Advantage plans. The following table lists 10 of the most popular providers in the state, ranked by enrollment and updated in April 2022. Most providers have more than one plan option, so the costs listed here are a range, and the enrollment figures for each provider take into account all of the plans it offers. See more information about Medicare Part C plans on the Medicare Advantage Plans in Utah page.

Medicare Prescription Drug Coverage (Part D)

Original Medicare doesn’t pay for most prescription drugs through Part A or B coverage. Instead, seniors purchase separate prescription drug policies, also called Part D coverage. Medicare contracts with private health insurance companies to provide this coverage. There are multiple plans to choose from with varying monthly premiums, which beneficiaries pay in addition to their Original Medicare premiums. While seniors don’t have to purchase prescription drug coverage when they’re first eligible for Medicare, not obtaining this coverage at this time may result in late enrollment penalties they pay for as long as they have Medicare if they enroll later.

Each prescription drug plan has its own formulary, or list of covered drugs. Formularies are typically split up into tiers. The tier a medication is in determines how much the insurance company pays and how much the beneficiary pays for it. Lower-level tiers are usually made up of generic and low-cost brand name drugs, while higher tiers are composed of more expensive brand name and specialty drugs. In most cases, the lower the tier, the lower the policyholder’s cost-sharing responsibility.

Who Should Consider Medicare Prescription Drug Coverage

Seniors who may benefit from prescription drug coverage include those who:

• Currently take prescription medication or expect to in the future
• Want to avoid late enrollment penalties
• Want to reduce out-of-pocket prescription drug expenses

Medicare Supplement Insurance (Medigap)

While Original Medicare provides coverage for many medical costs, seniors may still have significant out-of-pocket expenses. These may include copays, coinsurance and deductibles. Seniors may be able to reduce their cost-sharing obligations by purchasing a Medigap plan. These plans can only be used with Original Medicare. It’s illegal for private insurance companies to sell Medigap plans to those with Medicare Advantage plans.

For more information on Medigap plans, seniors can refer to the Best Medicare Supplement Companies of 2022 page.

Who Should Consider Medicare Supplement Insurance

Good candidates for Medigap may be those who:

• Have ongoing health issues and expenses
• Travel overseas often
• Want to access an expanded network of health care providers
• Expect to need health services not covered by Original Medicare

Medicare Resources in Utah

Understanding eligibility, enrollment periods and coverage options for Medicare in Utah can be a challenge for some seniors. The following organizations offer help and support for seniors and their loved ones as they try to select the best Medicare plans for their needs. They help beneficiaries understand the plan options, enroll in prescription drug coverage or select Medicare or Medigap coverage that suits their circumstances.