Medicare Plan Options
If you’re eligible for Medicare in Utah, you have several options. You can receive basic coverage for medically necessary services and add on supplemental plans to pay for out-of-pocket costs and prescription drugs. You could also sign up for an all-inclusive plan from Utah’s Medicare Advantage program, which covers a variety of health-related needs, including vision and dental. You should review your Medicare coverage annually. Should your needs change, you can switch plans at certain times each year.
Original Medicare covers physician consultations, diagnostic tests, preventive screenings, hospital stays, and treatments. This basic Medicare coverage is available in two parts. Part A pays for inpatient hospital services, and Part B covers medical services. When you first sign up for Medicare Parts A and B, you’re enrolled in the federal government’s Original Medicare program. Even though monthly premiums keep your coverage active, you’re responsible for the cost of your health care until you reach your annual deductible limits. Then, you only pay a portion of the costs of eligible services.
Medicare Advantage Plans
Once you have Medicare Parts A and B, you’re eligible to join a Part C Medicare Advantage Plan instead of Original Medicare. With this option, you receive your hospital and medical insurance through a private company. You also get additional benefits, such as prescription drugs, eyeglasses, hearing aids, dental care, and gym memberships. Make sure you understand the type of plan you’re signing up for, as some limit the health care providers you can use. You can only join a Medicare Advantage plan in your service area, and monthly premiums, deductibles, and copays vary by provider.
Medicare Prescription Drug Coverage Plans
A prescription drug plan pays for the medication your doctor prescribes. If you get Parts A and B insurance from Original Medicare, you can only get drug coverage by buying a Part D prescription drug plan. If you’re signed up for Medicare Advantage, it’s best to choose a plan with drug coverage to receive this benefit. You can only add a stand-alone drug plan to PFFS plan types. Either way, check your drug policy for a list of covered prescriptions, costs, and eligible pharmacies. You should consider getting drug coverage when you’re first eligible for Medicare, as a late enrollment penalty may apply if you sign up after more than 63 days in a row without drug coverage.
Medicare Supplement Insurance Plans
Some insurance companies sell Medicare Supplement Insurance Plans in Utah. Also known as Medigap, these plans help pay deductibles, coinsurance, and other out-of-pocket costs after Original Medicare pays its share. Some Medigap plans may also provide health coverage when you’re traveling outside of the United States. You have a six-month Medigap enrollment window that begins when you’re aged 65 and over and enrolled in Medicare Part B. During this period, you can’t be refused a Medigap policy for preexisting conditions or be charged more than someone in good health. Medicare Supplement Insurance only works if you receive Parts A and B through Original Medicare.
Medicare in Utah by the Numbers
|People enrolled in Original Medicare||Average plan cost||Annual state spending per beneficiary||Spending per beneficiary compared to the national average|
|247,159||Plan A: $0 to $471 per month*
Plan B: $148.50 per month**
*Most people pay no premium, but this can vary depending on how long they paid Medicare taxes.
**This is the average number, but it can vary based on income.
Medicare Resources in Utah
Everyone has unique health care needs. To choose the right Medicare plan and get the most value from your health insurance, it’s essential to do your research. Here are some Utah agencies and organizations that can provide up-to-date Medicare information and assist you if you have any difficulties.
Senior Health Insurance Program (SHIP)
SHIP provides personalized insurance counseling to Utah residents who are eligible for Medicare. By calling the statewide toll-free number, you can reach trained volunteers and counselors who can answer your specific Medicare questions. SHIP can help you compare plans and costs, get you enrolled, and assist with claims and appeals. This federally funded program is designed to provide objective assistance with your Medicare insurance choices.
Contact Information: Website | 800-541-7735
Salt Lake County Aging Services
Seniors in Salt Lake County can receive free Medicare counseling through Utah’s largest Area Agency on Aging. Medicare specialists provide one-on-one support to help you understand the plans available through the government and private insurance companies. The agency also helps detect and resolve billing errors and fraud. When calling the phone line for assistance in choosing a plan, have a list of your medications and doctors available.
Contact Information: Website | 385-468-3200
Utah Department of Health
The Utah Department of Health administers programs that provide low-income seniors and other individuals with help paying for health care services. This includes Medicare cost-sharing programs for those enrolled in Medicare Part A, as well as Medicaid. You can apply for these programs online, by mail, or in person.
Contact Information: Website | 800-662-9651
Utah Legal Services (ULS)
ULS offers free legal help to low-income seniors having difficulties with claims, benefits, and denials through programs, such as Medicare, Medicaid, and Social Security. The advocates can answer questions, give advice, prepare legal documents, and represent clients. While there are ULS offices in Provo, Ogden, St. George, and Salt Lake City, all Utah residents are asked to call the phone line or apply online to determine eligibility. If an intake screener determines you qualify for help, you’re referred to an advocate.
Contact Information: Website | 801-328-8891
Learn More From Our Sources
- Medicare | Medicare Costs at a glance | Last accessed May 2021
- Medicare | What Part A covers | Last accessed May 2021
- Medicare | What Part B covers | Last accessed May 2021
- Medicare | Medicare Advantage Plans | Last accessed May 2021
- Medicare | Your Guide to Medicare Prescription Drug Coverage | Last accessed May 2021
- Medicare | What’s Medicare Supplement Insurance (Medigap)? | Last accessed May 2021
- Medicare | Guaranteed issue rights | Last accessed May 2021