According to the Centers for Medicare & Medicaid Services, 429,782 Utah residents were enrolled in Medicare in 2021 – that’s only 13% of the population! However, it is important to note that Utah has the youngest population in the US, with a median age of just 31 compared to 37 nationwide. Since people mainly sign up for Medicare after they turn 65, states with younger populations will naturally have a lower share of Medicare beneficiaries.
People who are diagnosed with a chronic illness or have been receiving disability payments for 24 months are also eligible for Medicare. Nearly 11% of Utah Medicare recipients receive benefits due to a disability.
Since Utah has a lower share of the population enrolled in Medicare, many enrollees lack awareness about the different plans available. Make sure you talk to one of our licensed Medicare insurance agents at Integrity Now Insurance Brokers to choose the most affordable and suitable plan for you.
Medicare Options in Utah
Original Medicare
Once a Utah resident turns 65, Medicare enrolls them automatically. Medicare, a federally funded health insurance program for seniors and the disabled, includes Medicare Parts A and B. It takes care of all your basic medical expenses.
Part A covers care received in a hospital or medical institution. This includes all hospitalizations, rehabilitation stays, and certain home healthcare. Part B includes preventative care like checkups and immunizations, diagnostic testing like X-rays and bloodwork, curative measures like hospital stays and oxygen tanks, and urgent care like ambulance rides.
Medicare Supplement (Medigap) Plans in Utah
Over half of the beneficiaries receiving Original Medicare also have coverage through an employer or government program like Medicaid. However, for people who don’t or for those who want additional benefits, Medicare Supplement or Medigap plans in Utah are an option.
These policies are meant to reimburse participants for all or a portion of their out-of-pocket expenses (such as deductibles and copayments). Due to the high out-of-pocket costs of Original Medicare, many beneficiaries choose to supplement their coverage with a Medigap policy.
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Enrollees can choose from 47 companies providing Medigap plans in Utah right now. About one in five Utah residents who are eligible for Medicare were enrolled in Medigap in 2019, according to the state’s Insurance Department.
There is no yearly open enrollment period for Medigap insurance like there is for Medicare Advantage and Medicare Part D plans in Utah. Instead, federal guidelines allow a standard six-month timeframe during which Medigap coverage is guaranteed issue. Enrollees must be 65 or older and enrolled in Original Medicare to qualify for this window.
Federal rules do not guarantee access to Medigap insurance for those under the age of 65, but they can enroll in Medicare if they suffer from a chronic health condition or have received at least 24 Social Security Disability payments. Unlike most states in the US, Utah has not enacted laws ensuring that Medigap insurance companies offer plans to Medicare recipients under 65 or those with disabilities.
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Medigap in Utah for People Under 65
Most Utah Medigap insurance companies do not provide Medigap coverage to Medicare beneficiaries younger than 65 who qualify due to a disability. Only three companies offer this at high premiums.
13% of Utah’s Medicare beneficiaries were under the age of 65, while only 1.2% of all Medigap beneficiaries were younger than 65 in 2018, according to the Utah Insurance Department. The Department’s findings indicate that the lack of enrollment is largely due to the exorbitant premiums and Utah’s lack of laws mandating Medigap coverage to beneficiaries under 65.
An individual who becomes eligible for Medicare due to a disability before reaching 65 will be granted the same Medigap open enrollment period as all other Medicare recipients. Once eligible, they can sign up for any Medicare Supplement (Medigap) Insurance Plan offered by an insurance company in Utah.
Medicare Part D in Utah
Original Medicare does not pay for non-hospital prescription medicines. All Medicare recipients who do not have prescription medication coverage through their employers or Medicaid must enroll in Medicare Part D.
Prescription drug coverage under Medicare Part D is available both as a stand-alone policy and as part of a Medicare Advantage plan. As of 2022, Utah residents can choose among there are 22 stand-alone Medicare Part D plans.
Medicare Advantage Plans in Utah
Like Original Medicare, Medicare Advantage plans (also known as Medicare Part C) include both Parts A and B of Medicare in one convenient policy. Many plans also include extras that Original Medicare doesn’t, such as coverage for prescription drugs, hearing, vision, and dental care.
Through the Value-Based Insurance Design (VBID) Model developed by the CMS Innovation Center, 17 plans will provide Medicare Advantage subscribers with free prescription drug coverage and wellness-focused rewards and incentives. For some underprivileged and/or chronically ill registrants, these benefits will also include innovative, individualized services to target social health issues like isolation and loneliness.
Medicare Advantage plans are growing in popularity across the country. Nearly 44% of the state’s Medicare population had Medicare Advantage coverage by the end of 2021.
Medicare Advantage plans are not confined to those over 65; anyone with a Medicare-eligible condition can sign up at the same price regardless of age. Medicare-eligible Utahns under the age of 65 can select a Medicare Advantage plan with a maximum out-of-pocket expense. However, enrollees with complex medical needs should remember that Medicare Advantage plans have smaller networks of doctors and hospitals to choose from.
These are the four types of Medicare Advantage plans in Utah:
Health Maintenance Organization (HMO)
Most HMOs require you to receive medical treatment exclusively from physicians inside their network.
- You need a primary care physician (PCP), referrals to specialists, and pre-approvals before you can get any treatments and medicines.
- Plans generally include prescription medicine coverage.
- Drug coverage is not sold separately.
- Keep costs low by staying within the provider network.
Preferred Provider Organization (PPO)
While Medicare PPO plans do have a preferred network of providers, beneficiaries are free to use any doctor or hospital they like at an increased cost.
- No primary care physician or specialty referrals are required.
- Most policies include some sort of drug coverage.
- You can’t buy prescription drug coverage separately.
- Costly premiums and out-of-network expenses.
Private Fee-For-Service (PFFS)
The PFFS programs do not require PCP or specialist referrals.
- You can go to any doctor or hospital approved by Medicare as long as they adhere to the plan’s guidelines.
- Drug coverage might be included, or you can buy a separate plan.
- If you choose a service provider who doesn’t participate in your insurance network, you will incur extra costs.
Special Needs Plan (SNP)
Only those with specified medical conditions are eligible for SNPs, which offer benefits and care coordination targeted to their unique needs.
- You need a PCP and referrals to specialists.
- Prescription drug coverage is always included.
All individuals who meet the requirements can join an SNP at any time.
Comparing Medicare Advantage Plans in Utah
There are 54 options for Medicare Advantage in Utah in 2022, up from 41 in 2021. The number of available plans varies widely across counties, with some offering as little as 10 and others offering 40 or more.
With all the options on the market, you need to make sure you’re picking a plan that fits your individual requirements and budget. Here are some factors to consider while weighing your options:
Provider Network
Since every Medicare Advantage plan has its own network of doctors and hospitals, you may be restricted to a certain geographic area. You may want to select Original Medicare with a Medigap plan and Part D coverage if the size of the provider network is an issue for you or if you intend to do a lot of traveling within the country during retirement.
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Even if you have a provider in mind, it’s wise to compare plans from multiple companies before settling on one. Some physicians have Medicare Advantage contracts but may not be a part of the Original Medicare network.
Amount of Coverage Required
Do you want a package that also includes things like health insurance, retirement benefits, and a gym membership? While Medigap policies don’t usually cover these perks, enrollees can look for Medicare Advantage plans that do. A Medicare insurance agent can help you find plans that meet your requirements.
Check Plan Ratings
Make sure you compare Part c and Part plans before open the enrollment period begins on the CMS website. The plans are rated on a scale of 1 to 5 (5 being the highest).
Out-of-Pocket Expenses
Expenses not covered by insurance are known as “out-of-pocket costs” and might include things like deductibles, copayments, and coinsurance. Sticking with a provider network is one way to keep these expenses down. Participants can use our plan finder tool to compare costs among available options.
Monthly Premium
Premiums are the costs you have to pay regardless of if you use your benefits. You should look for at least one zero-premium plan that provides adequate drug coverage in your area if you want to keep your expenditures down.
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Drug Coverage
Part C plans are a good option if you need help paying for your prescriptions. Coverage for the cost of your prescription drugs is provided through Medicare Part D, which is often bundled into Medicare Advantage plans. Medicare Part D is optional but highly recommended if you opt for Original Medicare and a Medigap policy.
Deductibles, Coinsurance & Copays
You will be responsible for these costs once you begin using your Medicare insurance coverage. Hence, you should be familiar with the hospital and medical coverage provided by your plan. This includes costs associated with doctor visits, prescriptions, and other medical care.
Freedom to Travel
Many Medigap policies extend coverage for overseas travel beyond what is available under Original Medicare. Depending on the provider, Medicare Advantage plans also offer more extensive coverage for international travel than Original Medicare. If foreign travel coverage is a concern, make sure you check the plan’s details before signing up.
Medicare Eligibility in Utah
Medicare eligibility begins at age 65 in Utah. You can sign up for Medicare at any time if you have a chronic or terminal illness, like end-stage renal disease (ESRD) and amyotrophic lateral sclerosis (ALS).
Medicare Enrollment in Utah
You will be automatically enrolled in Medicare if you are 65 years old or have received at least four Railroad Retirement Board or Social Security payments before turning 65. You can also apply for Social Security benefits online or by calling your local Social Security office. Since it may take several days for your application to reach the office and then be processed, we recommend you apply online.
Enrollment in Medicare is open during the following time frames:
Initial Enrollment
You can sign up for Medicare starting three months before your 65th birthday and continuing until the third month after. People who are eligible for Medicare but have not enrolled before should apply during this window.
General Enrollment
People who were unable to enroll during the initial window have another opportunity between January 1 and March 31. You have the option of enrolling in Original Medicare (Parts A and B), Medicare Advantage (Part C), Medigap coverage, or Medicare Part D during this time period.
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Open Enrollment
Each year, from October 15 to December 7, you have a three-month window in which you can make adjustments to your Part C plan.
Special Enrollment
You might be granted a special enrollment window in case your coverage or eligibility changes due to unforeseen circumstances, like losing a job or relocating to an out-of-coverage area.
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What Makes Us the Most Reliable Medicare Hope Insurance Agents in Utah?
The Medicare insurance brokers at Integrity Now Insurance Brokers renew their AHIP certification every year. We can help you with all your concerns about Medicare in Utah. People of all ages, especially the elderly and disabled youngsters, can count on us to help them afford life-saving medical care.
New Medicare insurance options enter the market every year, and existing plans also see changes to keep up with the needs of the public. We take the stress of keeping track of these developments off your shoulders.
Talk to one of our experienced Medicare insurance brokers in Utah about your specific medical and financial needs today, and they’ll help you compare quotes to find an affordable and suitable policy. Not sure if you should get a Medicare Part C Plan or a Medigap Policy? We’ll help you make the right decision.
Give us a call today to get started on debt-free and stress-free living right away!
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