Finding the best Medicare coverage in the Beehive State

Utah is home to some of the most beautiful natural wonders in the United States. It also boasts a steady economy, low crime rates, and top-quality healthcare. Though the Medicare system may be smaller in Utah than the national average, Medicare beneficiaries access a better-than-average healthcare system. 

Plus, even though it’s smaller, there are still hundreds of combinations of options available to most beneficiaries in the state. We created this quick and easy guide to help you sort through those options and get the most out of your Medicare enrollment

Did you know that you can use the Insurify Medicare comparison tool to find the right Medicare plan for you? Start with your ZIP code, and you’ll be comparing plans in less than two minutes. Try it today!

Utah Medicare at a Glance

Number of Original Medicare Enrollees 254,031
Number of Medicare Advantage Enrollees 135,734
Total Number of Medicare Beneficiaries 389,765

*Source: Kaiser Family Foundation

What Is Medicare?

Medicare is a federal health insurance program. In 1966, Medicare was the answer to a huge problem: how do we insure people left behind by the free market? Millions of seniors and people with certain health conditions were being left behind in the medical revolution. As healthcare improved, costs for healthcare increased, and people became increasingly unable to afford it. 

For people in the workforce, an employer-based system emerged to solve this problem. But for those who weren’t employed or only employed part-time, this solution was out of reach. 

Enter Medicare: a multi-part federal health insurance program. The U.S. government regulates Medicare through the Centers for Medicare & Medicaid Services (CMS). By design, the program is subject to change and improvement. As the medical world changes, so too does Medicare.

Medicare is divided into a few parts. These parts work together to address different parts of healthcare costs or to offer alternatives. These parts are:

  • Original Medicare, often referred to as Medicare Parts A and B. Medicare Part A, addresses inpatient care, and it’s often called “Hospital Insurance.” Medicare Part B addresses outpatient care, and it’s often called “Medical Insurance.”
  • Medicare Advantage, often referred to as Medicare Part C, is an alternative to Original Medicare. It is regulated by the federal government but administered by a private health insurance company.
  • Medicare prescription drug coverage, or Medicare Part D, covers medications. A Medicare prescription drug plan can be used in conjunction with Original Medicare or Medicare Advantage. 
  • Medigap plans, more formally known as Medicare Supplement Insurance plans, cover some of the costs of Original Medicare—mainly deductibles and coinsurance.  

Who Qualifies for Medicare in Utah?

Medicare eligibility is straightforward. First, you need to be either an American citizen or a permanent resident of at least five years. Second, you need to meet one of the following criteria:

  • You are 65 years of age or older.
  • You have been diagnosed with amyotrophic lateral sclerosis (ALS).
  • You have been diagnosed with end-stage renal disease (ESRD).
  • You have been drawing from disability for at least 24 months.

If you are unsure whether you qualify, you can always contact Medicare to learn more about your specific situation and whether you’re eligible.

How Much Does Medicare Cost in Utah?

While some costs for Medicare are standard, the overall costs are different for each person. That’s because your expenses are made up of several costs:

  • Monthly premiums
  • Deductibles
  • Co-payment and coinsurance rates
  • Health conditions treated
  • Your location/where you receive treatment

Additionally, costs can be curbed if your plan has out-of-pocket maximums. Most Medicare plans do not come with those limits, so be sure to consider that when you buy. 

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The Cost of Original Medicare in Utah

Original Medicare is a nationwide program, so costs are consistent from state to state. Unfortunately, Original Medicare is the bare necessities—it doesn’t cover dental, vision, hearing, or prescriptions on its own. Additionally, it is expensive, covering just 80 percent of costs in the best-case scenario.

These costs are too high for many people, and so many beneficiaries add a Medigap plan (with an additional premium) to control costs, which we think is a great idea. (More on this below). 

Here’s how Original Medicare works: you pay a monthly premium for Medicare Part A and Medicare Part B. For most, the Medicare Part A premium is free because the premium is based on your work credits. People with 40 work credits (roughly 10 years of work) qualify for premium-free Medicare Part A

Medicare Part B is not based on work history, and most people pay $144.60 for their Medicare Part B premium. This premium works on a sliding scale, with low-income seniors paying less and high-income seniors paying more. The most anyone can pay is $491.60—but this only applies to people making more than $500,000 ($750,000 for couples). 

Beyond the monthly premiums, you’ll also need to cover deductibles and coinsurance:

  • Medicare Part A has a $1,408 deductible. Coinsurance rates vary depending on the facility you stay in and the level of care you receive there. 
  • Medicare Part B has a $198 deductible. You pay a 20 percent coinsurance rate for care after you meet the deductible. 

The Cost of Medigap Plans in Utah

Medigap, formally known as Medicare Supplement Insurance, is a Medicare health plan that helps cover the cost of deductibles or coinsurance with an Original Medicare plan. These plans are regulated by the CMS but fulfilled by private insurance companies. 

There are 10 types of Medigap plans, designated by letters—Medigap Plan F, for example. Medigap plans of the same plan type are virtually identical. They must cover the same things in the same way as any other Medigap plan of the same kind. That is, all Medigap Plan F plans have the same coverage.

However, plans can vary by price, accessibility, and customer satisfaction, depending on the insurance company administering the program. When comparing plans, be sure to look at customer reviews, the website, and the mobile app. Check when customer service agents are available as well. 

The Cost of Medicare Advantage in Utah

Utah Medicare Advantage plans at a glance:

Total Number of Plans 189
Average Monthly Premium $51.21
Average Drug Deductible $200.33

Medicare Advantage plans come in a wide array of options and costs. Some plans are very inexpensive, as low as $0 a month in premiums. However, be aware that monthly premiums aren’t everything. Low-cost plans often cover only the bare minimum of health services

Paying a little more— or even a lot more—for your monthly premium can save you money in the long run. For example, the cost of care goes down considerably if you spend a few hundred dollars a month for a Medicare Advantage plan that includes:

  • Dental
  • Vision
  • Hearing
  • Prescriptions

As we age, our teeth, eyes, and ears all need care, whether our insurance covers it or not. Paying for a plan that provides you with regular health maintenance at a low cost means you spend less annually for (generally) better health. That’s because regular, preventative care tends to keep people healthier.  

You can buy stand-alone plans for dental, vision, hearing, and prescription coverage. It may be more complicated than purchasing a comprehensive plan, but you may be happier with that solution or find that it saves you more money. 

The Cost of Prescription Drug Plans in Utah

Utah prescription drug plans at a glance:

Total Number of Plans 196
Average Monthly Premium $31.57
Average Annual Deductible $256.07

Prescription drug prices are through the roof, and these costs come down hardest on people with Medicare. That’s because people with Medicare are more likely to take one or more prescriptions regularly. 

Medicare did not cover prescriptions for most of its history. In the early 2000s, Medicare Part D plans were created to help people cover the rising cost of pharmaceuticals. 

When comparing prescription plans, be sure to review each plan’s formulary. The formulary is the pricing structure the plan uses for medications. Different plans have different ways of pricing things, but pricing is always separated into four tiers:

  • Tier 1: The least expensive tier is typically for cheap generics. 
  • Tier 2: A little more expensive, this tier is for expensive generics or cheap name brands.
  • Tier 3: Even more expensive, this tier is for expensive name brands.
  • Tier 4: The most expensive tier is typically reserved for specialty drugs.

You want to be sure that any medications you take are covered in Tier 1 or 2, if possible. 

Cost of Special Needs Plans in Utah

Utah Special Needs Plans at a glance:

Total Number of Plans 28
Average Monthly Drug Premium $36.89
Average Annual Deductible $351.07

Special Needs Plans (SNPs) work like Medicare Advantage plans but are meant for people who could not otherwise afford Medicare. This could be because the person has too low an income, and they qualify for Medicaid. In other words, dual-eligible Medicare beneficiaries

People with certain health conditions, like an HIV/AIDS diagnosis, are also eligible. People living in institutions like skilled nursing facilities and people needing long-term care may also qualify.

Like Medicare Advantage plans, SNPs are typically structured as health maintenance organizations (HMOs). HMOs require beneficiaries to use a preselected network of healthcare providers. Alternatively, SNPs can be structured as a preferred provider organization (PPO), where beneficiaries choose a primary care physician and receive care based on referrals.

How Do I Choose Between Original Medicare and Medicare Advantage?

Public or private Medicare—that is the question on everyone’s minds when they first become eligible for Medicare. Unfortunately, there isn’t an easy answer here. For some, the public option is obviously the best plan. For others, a private option offers better care. And for most, either a public or private option could work.

The key is to find the plan that fits your needs, preferences, lifestyle, and budget. To help you understand the big-picture differences between the public and private options, we’ve made this chart:  

Plan Type Advantages Disadvantages
Original Medicare
  • Extensive network of providers
  • Large service area across the U.S.
  • Low monthly premiums
  • Many Medigap plan options to help cover costs
  • No caps on out-of-pocket costs
  • Must purchase add-ons like Medigap, prescription drug coverage, and stand-alone dental, vision, and hearing 
Medicare Advantage
  • Can purchase a comprehensive plan to cover medical, medication, vision, dental, and hearing
  • Many plan options, including types of plans like HMO, PPO, or PFFS (private fee-for-service)
  • A smaller network of providers
  • Small service area restricted to your state or a region within your state
  • Premiums can be more expensive

How Do I Apply for Original Medicare in Utah?

Applying for Medicare is painless and typically takes only a few minutes. The easiest way to apply is to use the online form either through your account at SSA.org or Medicare.gov. You may need to submit pictures of your identification cards and other information.

The next most effortless way to apply is over the phone. You can call 1 (800) MEDICARE. TTY users call 1 (877) 486-2048. A Medicare representative will help you enroll, though you may be required to fax or mail in additional information. 

Finally, you can also apply in person by going to your local Social Security office. However, during the coronavirus pandemic, we advise you to avoid this option if possible.

How Do I Apply for Medicare Advantage in Utah?

To apply for Medicare Advantage, you first need to enroll in Original Medicare. Once you’ve enrolled in Original Medicare and received your Medicare number, you can then enroll in a Medicare Advantage plan.

To enroll, you’ll need to contact the health insurance company administering the plan. You can usually call or fill out a form online. Depending on the company, you may also receive your insurance cards and insurance paperwork online within a few minutes of signing up. 

What’s the Best Medicare Advantage Plan in Utah?

We wish there were an easy answer to this question. However, Medicare Advantage plans are not uniformly best for everyone. People have different health needs and preferences. You should start with your needs and preferences first.

From there, you can compare companies, removing any plans that don’t fit your needs. When deciding between similar plans, look at the websites and customer reviews. Look for companies that have reviews reflecting on the services you plan to use the most. 

FAQ Utah Medicare

Do I qualify for Medicaid in Utah?

There are many ways to qualify for Medicaid in Utah. You do need to be a resident of Utah to be eligible. For the most part, Medicaid is reserved for American citizens or permanent residents. However, new refugees can also qualify for Medicaid for the first eight months they’re in the country. Finally, you’ll also need to meet specific income and asset limitations. 

What is the income limit for Medicaid in Utah?

For Utah residents, the income limit for Medicaid recipients is $1,063 a month for a single person or $1,437 for a couple. The asset limit is $2,000 for a single person or $3,000 for a couple. Assets do not include your primary residence, personal belongings, one vehicle, and appliances. If you are near these income and asset levels, you should still contact the Utah Department of Health Medicaid to learn about your options. 

Which states have the best Medicare programs?

States with more seniors tend to have more extensive Medicare programs. States that have excellent healthcare systems tend to do better at administering health plans. Yet, some people prefer smaller systems—more comfortable to navigate—or prefer the system they know compared to learning a new system.  That being said, California and Texas have two of the most extensive Medicare programs. Massachusetts, Minnesota, and Vermont have some of the best healthcare systems in the country. 

Conclusion: Compare Utah Medicare Plans Before You Buy

Whether you’re in Salt Lake or Blanding, with so many options, research is vital. Remember that your research should start with you: your needs, preferences, and budget. From there, you should compare Medicare health coverage. Be sure to take into account the full cost of care, not just the monthly premiums

Ready to start? Check out the Insurify Medicare comparison tool. Just enter your ZIP code, and you’ll uncover your options. Try it today!

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Updated November 28, 2020

J.J. Starr is a health and finance copywriter who enjoys helping readers find the information they need. In addition to her background in banking and financial advising, she is also a poet with an MFA from New York University. She lives in Amherst, Massachusetts. You can learn more at jjstarrwrites.com.