Utah Medicare Advantage Plans | A Guide to Your Options

What Are Medicare Advantage Plans in Utah? 

Medicare Advantage (MA) plans in Utah are bundled, all-in-one alternatives to Original Medicare. As such, these plans replace Medicare Parts A and B and often Part D, which is Medicare’s prescription drug coverage. Medicare Advantage plans may include extra benefits that aren’t covered by Original Medicare, including dental, vision and hearing care.¹ 

What You Need to Know 

Utah Medicare Advantage plans are bundled alternatives to Original Medicare. 

They typically include prescription drug coverage and may offer other benefits like dental, vision, hearing and fitness club membership. 

The average premium for MA plans in Utah is $20.06, but many plans have a zero premium. 

What Types of Medicare Advantage Plans Are Available?

Several types of MA plans are available in Utah. They include:

• HMOs (health maintenance organizations): HMOs require you to see healthcare providers who belong to a network. A network is a group of doctors, other healthcare providers and healthcare facilities that agree to work with a health insurance plan and provide services. Typically you need a referral to see a specialist. 
• PPOs (preferred provider organization): A PPO also has a network, and you pay less if you see in-network providers. You usually don’t need a referral to see a specialist. 
• SNPs (special needs plans): These plans are for Medicare members with specific needs. There are three types of SNPs:
  • C-SNPs (chronic condition special needs plans): These plans are for those with one or more chronic health conditions, including:
    • Cancer
    • Autoimmune disorders
    • Diabetes
    • Chronic heart failure
    • HIV/AIDS
    • Chronic and disabling mental health conditions
  • D-SNPs (dual eligible special needs plans): These plans are for those eligible for both Medicare and Medicaid. 
  • I-SNPs (institutional special needs plans): These plans are for those receiving nursing home care or who need nursing care at home. 
• PFFS (private fee-for-service) plans: These plans let you go to any healthcare provider who agrees to accept your insurance plan. Some PFFS plans have a network, and you pay more if you see out-of-network providers.  
• MSA (medical savings account) plans: These plans combine a high-deductible health plan with a medical savings account. Your deductible is the amount you pay for covered services before your plan starts paying. Your plan deposits money into the account on your behalf, and you use that money to pay for healthcare. You may also need to spend some of your own funds until you meet your plan’s deductible.² 

The majority of plans are HMOs, but local PPOs are becoming more available as well.³

What Are Prescription Drug Options with Medicare Advantage?

Most MA plans include prescription drug coverage, also known as Medicare Part D. If you join an MSA plan or PFFS plan without drug coverage, you can purchase a separate Part D plan. If you join an HMO or PPO without drug coverage, you cannot purchase a separate Part D plan. 

If you don’t enroll in a plan with Part D benefits and you don’t purchase a separate Part D plan when you’re first eligible, you may have to pay an ongoing penalty if you enroll in a Part D plan later.⁴

How Do You Choose Medicare Advantage Plans?

Choose an MA plan based on your budget and the plan’s benefits. You’ll need to budget for the plan premiums (monthly payments) as well as other costs. Most Medicare beneficiaries have access to a zero-premium MA plan, although you will still have to pay for Medicare Part B unless you’re on Medicaid or receiving other financial assistance. One in five Medicare members enrolled in an MA plan pay $50 or more per month for their coverage.⁵ 

Your other out-of-pocket costs may include:

• Coinsurance: This is a percentage you pay for a covered service. For example, you might pay 20% for a hospital stay. 
• Copayment: A copay is a fixed dollar amount you pay for a service or medical supply. You might have a $5 copay for a generic prescription, for example. 
• Deductible: This is the amount you pay for covered services before your plan starts to pay.⁶
• Maximum: This is the most you’ll pay in a year for covered medical services.⁷ 

You should also consider other plan benefits. Almost all plans offer telehealth, and the majority of plans offer dental, vision, hearing and fitness benefits, which may include membership at a local gym.⁸

When and How to Enroll in Medicare Advantage?

You have many options for when you can join, change or drop your MA plan.

• Initial Enrollment Period: You can enroll in an MA plan when you’re first eligible for Medicare. Initial enrollment starts three months before the month you turn 65 and ends three months after the month you turn 65. 
• Open Enrollment Period: Also known as the Annual Election Period, open enrollment lasts from October 15 – December 7 each year. During this time, anyone with Medicare can join, change or drop an MA plan. 
• Medicare Advantage Open Enrollment Period: This period lasts from January 1 – March 31 each year. During this time, you can drop your MA plan and go back to Original Medicare or switch to a different MA plan. 
• General Enrollment Period: This period is also from January 1 – March 31. People who start Medicare Part B during this period can also enroll in an MA plan.⁹ 
• Special Enrollment Period: You are entitled to a special enrollment period in certain circumstances, including:
  • Moving to a different service area.
  • Losing coverage from a health insurance plan.
  • Qualifying for coverage from an employer or Medicaid.
  • Changes to your plan, such as Medicare terminating your plan’s contract.
  • Special circumstances, such as being diagnosed with a chronic condition that would be better served by a C-SNP.¹⁰

How Much Do Medicare Advantage Plans Cost in Utah?

The average premium for MA plans in Utah is $20.06.¹¹ This is just below the national average of $21.¹² 

In Salt Lake City, you can choose among 25 plans from 10 insurance companies. Twenty plans have a zero premium and the rest range from $31 to one plan’s high of $178 per month. In Provo, you can choose among 23 plans from nine insurance companies. Seventeen plans have a zero premium and the rest, as in Salt Lake City, range from $31 to a single plan’s high of $178 per month.¹³

What If You Want to Change Your Medicare Advantage Plan?

You can change your MA plan during Open Enrollment, which is from October 15 – December 7 each year, and during Medicare Advantage Open Enrollment, which is from January 1 – March 31 each year.¹⁴

What Are Medicare Resources in Utah?

Utah offers several resources for people with Medicare. The State Health Insurance Assistance Program (SHIP) offers counseling and advice on Medicare and Medicare programs. You can call SHIP at 1-800-541-7735 or find a local office on the Utah Department of Human Services website.¹⁵ 

If you have a complaint about a specific Medicare insurance company, contact the Utah Department of Insurance at 1-801-538-3077.¹⁶

If you’re concerned about your ability to pay for healthcare, consider applying for Medicaid. Medicaid provides health insurance to those with limited incomes and assets. You can apply for Medicaid and learn more about it on the Utah Department of Health Medicaid website. 

State Medicare Advantage Data in Utah

Next Steps

Whether you’re just starting Medicare or looking into changing plans, Utah has many options when it comes to Medicare Advantage plans. Take the time to look at multiple plans and consider their premiums, potential out-of-pocket costs and benefits. The Medicare Plan Finder is a good resource for finding local MA plans. Choose the plan that makes the most sense for you, your budget and your health.