Medicare Advantage Plans In Utah

Fact Checked
Published: 5/31/2021

When you hear the word Medicare, you probably think of Original Medicare coverage, which includes Part A (hospitalization) and Part B (preventive and outpatient care). Although Original Medicare covers millions of people, it has some coverage gaps that can leave you paying thousands of dollars out of pocket every year. Fortunately, there's an alternative. Medicare Part C, also known as Medicare Advantage, combines Original Medicare services with extra benefits, giving you the best of both worlds.





  • In 2019, there were 30 Medicare Advantage Plans available in Utah.
  • 36% of the total Medicare population in Utah is enrolled in Medicare Advantage Plans as of 2018.
  • In 2018, Original Medicare spent an average of $9,103 per beneficiary in Utah, which is 10% lower than the national average.
  • Available Medicare Advantage Plans range from one to 23 across Utah’s 29 counties.

Private insurance companies sell Medicare Advantage Plans, so the benefits available to you depend on which company you choose. The number of plans available also depends on your geographic location, as some insurers offer coverage in more counties than others. When you’re ready to choose a Medicare Advantage Plan, you’ll need to select one based on your medical needs and budget.

Medicare Advantage Plans in Utah

Utah’s Medicare Advantage program offers several plan types. Each plan must provide coverage comparable to what’s available under Original Medicare, but many plans offer additional benefits, including dental care, vision care, and coverage for hearing aids. Plans available in Utah include HMOs, PPOs, private fee-for-service plans, and special needs plans.

Types of Medicare Advantage Plans

Health Maintenance Organizations (HMO)

In an HMO plan, you generally have to get medical care from providers within your insurance network. If you decide to go outside your network for care, you’ll pay more for medical care than you would if you chose an in-network provider. Under an HMO plan, you typically have to choose a primary care provider to coordinate your care and refer you to medical specialists when needed.

Preferred Provider Organizations (PPO)

A Medicare PPO plan is a little more flexible than an HMO plan. You don’t need to choose a primary care provider, and you generally don’t need to get a referral for specialist care. Although it costs less to receive care from an in-network provider, you have the option of choosing someone outside the network. If you choose an out-of-network provider, your out-of-pocket costs will be higher.

Private Fee-For-Service Plans (PFFS)

Under a PFFS plan, you pay a set copay or coinsurance amount each time you receive medical care. The insurance company also determines how much it’s willing to pay doctors, hospitals, and other health care providers. You don’t need to choose a primary care physician or ask for a referral to a specialist if you need specialized care; however, a provider may decide not to accept the plan’s payment terms.

Special Needs Plans (SNP)

A Medicare SNP is designed especially for enrollees who meet specific guidelines. For example, an SNP may be set up to serve the needs of beneficiaries with heart failure. Under this type of plan, benefits are designed to best meet the needs of plan members. In most cases, SNP members must receive care from providers in the Medicare SNP network. You may also be required to choose a primary care provider or a care coordinator.

Enrollment and eligibility for Medicare Advantage Plans in Utah

Eligibility

In Utah, you must meet certain eligibility requirements to enroll in a Medicare Advantage Plan. First, you must be eligible for Original Medicare (Parts A and B). You must also be at least 65 years old, not already enrolled in a Medigap plan, and live in the service area of the plan you want to join. If you live in Utah part-time, contact Medicare to find out if a local plan will cover you.

Enrollment Periods

You can only enroll in a Medicare Advantage Plan at certain times.

  • Initial enrollment: The initial enrollment period starts three months before your 65th birthday and ends three months after you turn 65. If you were disabled and qualified for Medicare before you turned 65, you could use the initial enrollment period to switch from a previous Medicare plan to a new Medicare Advantage Plan.
  • Open enrollment: The open enrollment period runs from January 1 to March 31 each year. If you sign up during open enrollment, your coverage becomes active on July 1.
  • Medicare Advantage enrollment: The Medicare Advantage enrollment period also runs from January 1 to March 31. During this period, you can switch from one Medicare Advantage Plan to another or enroll in Original Medicare instead of Medicare Advantage.

Special enrollments occasionally open up for unique circumstances, such as losing a job with health care coverage or moving into or out of a covered area.

Prescription drug coverage

Most Medicare Advantage Plans include prescription coverage. If you choose a plan that doesn’t cover prescriptions, you can sometimes purchase Medicare Part D as a supplement. This typically applies to PFFS plans. If you’re enrolled in a Medicare Advantage HMO or PPO and sign up for a separate Medicare prescription plan, you’ll be dropped from Medicare Advantage and put back on Original Medicare.

Medicare Advantage Resources in Utah

As a Utah resident, you have many options when it comes to choosing a Medicare Advantage Plan and getting enrolled. Before you enroll in a plan, you’ll need to know how much it costs per month, how much your copays and coinsurance will be, and what services and providers are covered. If you need help finding this information, Utah has resources available to help older adults and their family members navigate the Medicare enrollment process.

Salt Lake County Aging & Adult Services

Salt Lake County Aging & Adult Services is the Area Agency on Aging for Salt Lake City, West Jordan, Murray, Herriman, and other areas of Utah’s largest county. The agency provides a wide variety of services to help older adults, including free screenings by Medicare specialists. These specialists are knowledgeable about Original Medicare, Medicare Advantage, and other aspects of Medicare enrollment. Staff members are also on hand to provide information about preventing Medicare fraud and qualifying for Medicaid.

Contact Information: Website|385-468-3200

Utah Aging & Adult Services

Utah’s Department of Human Services provides a wide range of services to seniors and vulnerable adults through Utah Aging & Adult Services. One of this agency’s primary roles is to protect older adults from financial exploitation, which includes fraud perpetrated by insurance companies and health care providers who accept Medicare. Utah Aging & Adult Services offers educational resources to help older adults learn to spot the signs of fraud. Anyone who suspects Medicare fraud can also file a report to be investigated by agency staff members.

Contact Information: Website | 801-538-4171

Utah Legal Services

Utah Legal Services provides free legal help to low-income residents who are involved in non-criminal cases. Attorneys with Utah Legal Services can help low-income seniors dealing with elder abuse, financial fraud, domestic violence, landlord-tenant disputes, and issues obtaining public benefits. This includes difficulty obtaining Medicaid coverage or signing up for Medicare. If Utah Legal Services is unable to take a case, staff members may be able to refer older adults to other resources to ensure they get the help they need.

Contact Information: Website | 801-328-8891

Utah SHIP

Utah participates in the national Senior Health Insurance Program, which helps older adults assess their health insurance options and choose a plan based on their medical needs, geographic location, and other factors. Trained staff provide face-to-face and telephone counseling to help people understand the intricacies of Medicare and ensure they meet all relevant enrollment deadlines. SHIP also offers public presentations to help older adults and their family members learn more about Medicare.

Contact Information: Website | -1800-541-7735

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