Medicare Advantage Plans in Utah

Medicare Advantage plans are an alternative to Original Medicare, offered by private insurance companies approved by Medicare. These plans include Part A (hospital) and Part B (medical), and most also include prescription drug coverage under Part D. Many plans provide additional benefits such as dental, vision, hearing services, fitness memberships, and telehealth access.

Medicare Eligibility

To enroll in a Medicare Advantage plan, you must first sign up for Original Medicare (Parts A and B). Most people qualify for Medicare enrollment at age 65. However, individuals under 65 may also qualify due to a disability, ALS, or End-Stage Renal Disease (ESRD). Utah residents should be aware of key enrollment periods—Initial, General, and Special Enrollment—to avoid late enrollment penalties or issues accessing premium-free coverage.

What Types of Medicare Advantage Plans Are Available in Utah?

Utah residents have access to various Medicare Advantage (MA) plan types:

• Health Maintenance Organizations (HMOs): Require use of in-network providers and referrals for specialists. HMOs are the most common plan type in Utah.
• Preferred Provider Organizations (PPOs): Allow access to out-of-network providers at a higher cost and usually don’t require referrals.
• Private Fee-for-Service (PFFS) Plans: Let you visit any provider who accepts the plan’s terms. Some include provider networks.
• Special Needs Plans (SNPs): Tailored to specific populations:
  • C-SNPs: For chronic conditions such as cancer, diabetes, heart failure, HIV/AIDS, and mental health conditions.
  • I-SNPs: For individuals receiving nursing home care or in-home nursing services.
  • Dual Eligible Special Needs Plans (D-SNPs): For those eligible for both Medicare and Medicaid. These plans often include extra benefits like drug coverage, dental, and care coordination at low or no cost.
• Medical Savings Accounts (MSAs): Combine a high-deductible health plan with a savings account funded by the insurer to cover medical expenses.

What Are Your Prescription Drug Options with Medicare Advantage?

Most Medicare Advantage plans include Part D drug coverage. However, MSAs and some PFFS plans do not. In those cases:

• You may enroll in a standalone Part D plan if eligible.
• Failing to get drug coverage when first eligible could lead to a late enrollment penalty if you don’t have other creditable prescription coverage.

How Do You Choose a Medicare Advantage Plan?

Before selecting a plan, review this guide to Medicare Advantage costs:

• Premiums: Utah’s average MA plan premium is $20.06, though many options offer $0 premiums.
• Deductibles, Coinsurance & Copays: Expect to pay out-of-pocket for many services. For example:
  • Copays: Fixed amounts (e.g., $5 for a generic drug)
  • Coinsurance: A percentage of service costs (e.g., 20% for a hospital stay)
  • Deductibles: The amount you must pay before the plan covers costs
• Out-of-Pocket Maximums: These caps protect you from excessive spending.
• Extra Benefits: Many Utah plans include dental, vision, hearing, telehealth, gym memberships, and OTC allowances.

In Salt Lake City, residents can choose from 25 plans across 10 insurers; 20 of them have $0 premiums. In Provo, 23 plans are available from 9 insurers, with 17 offering $0 premiums.

When and How Do You Enroll in a Medicare Advantage Plan?

You can enroll in Medicare during several specific enrollment periods:

• Initial Enrollment: 3 months before through 3 months after your 65th birthday month.
• Annual Open Enrollment (Oct 15–Dec 7): Join, switch, or drop a Medicare Advantage plan.
• General Enrollment (Jan 1–Mar 31): For those who enrolled in Medicare Part B during this time.
• Medicare Advantage Open Enrollment (Jan 1–Mar 31): Switch between MA plans or return to Original Medicare.
• Special Enrollment Periods: Triggered by events such as:
  • Moving outside your plan’s service area
  • Losing employer or union coverage
  • Diagnosis of a chronic condition that aligns with a C-SNP
  • Plan termination

What If You Want to Change Your Medicare Advantage Plan?

You can change your Medicare Advantage plan during:

• Open Enrollment (Oct 15–Dec 7)
• Medicare Advantage Open Enrollment (Jan 1–Mar 31)

Understanding Medicare Advantage Star Ratings

The CMS star ratings help consumers evaluate MA plans based on quality and performance:

• 1 star: Poor
• 2 stars: Below average
• 3 stars: Average
• 4 stars: Above average
• 5 stars: Excellent

These ratings are updated annually and reflect both MA (Part C) and Part D drug plan performance.

What Are Medicare Resources in Utah?

Utah residents can access several helpful programs:

• Utah SHIP Program: Provides free Medicare counseling and guidance. Call 1-800-541-7735.
• Utah SMP Program: Educates Medicare beneficiaries on avoiding healthcare fraud.
• Utah Insurance Department: Handles insurance complaints.
• Utah Medicaid: May help with medical costs for low-income residents. Visit the website or call 1-866-608-9422. Learn more about the differences between Medicare and Medicaid.

Other Medicare Plan Options to Help with Out-of-Pocket Costs

Medicare Supplement Plans, or Medigap, help cover costs not paid by Original Medicare such as deductibles, copays, and coinsurance.

• You must be enrolled in Parts A and B to buy a Medigap plan.
• The ideal time to enroll is during your 6-month Medigap Open Enrollment Period (starts when you enroll in Part B).
• Medigap plans don’t include drug coverage—consider a separate Part D plan.
• Popular plans include F, G, and N. Medicare Supplement Plan G had the highest enrollment in 2023.
• Plan F is no longer available to newly eligible enrollees.
• Medigap offers predictable costs, no referrals, and nationwide coverage.

Learn more about Medicare Supplement plans in Utah.

Next Steps

If you’re considering a Medicare Advantage plan in Utah, compare plans based on premiums, provider networks, drug coverage, and added benefits. Use tools like the Medicare Plan Finder and reach out to local SHIP counselors for help navigating your options and enrollment.