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Guide to Medicare in Utah

What do you know about Medicare in Utah? Original Medicare is the same regardless of which state you live in, but Medicare Advantage, Medicare Supplement, and Part D plans will vary based on your state, county, and zip code. This means you and the other 390,000 beneficiaries across Utah have a unique set of plans to choose from. Do you know which option is right for you?

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What Does Utah Medicare Cover?

Original Medicare consists of Part A (hospital insurance) and Part B (medical insurance). Part A covers hospital stays, nursing homes, hospice, and home health services. Part B covers ambulance travel, medical equipment, mental health, partial hospitalization, lab tests, and X-rays. Once you enroll in parts A and B, you can start exploring other types of plans that are specific to your area and provide additional benefits (like financial/health benefits and prescription drug coverage).

Turning 65 and Medicare

Types of Utah Medicare Plans

You will have a range of plans (based on your location) that you can choose to enroll in. You can enroll in a Medicare Advantage plan for additional health benefits like hearing, vision, or dental coverage. If you’d prefer financial benefits, like help paying your coinsurance and copayments, you can enroll in a Medicare Supplement plan (these must be purchased to work alongside Original Medicare, they cannot be purchased as a stand-alone plan). Lastly, if you are looking for prescription drug coverage, you can enroll in a Part D plan. You should consider enrolling in some type of prescription drug coverage to avoid incurring any late-enrollment penalties down the road. Alongside Part D plans, some Medicare Advantage plans provide prescription drug coverage, as well as some Medicare Supplement plans (but this is rare).

Medicare Advantage Plans in Utah

There are more than 140,000 beneficiaries enrolled in Medicare Advantage plans in Utah. Medicare Advantage (MA) plans are sold through private insurance companies and offer coverage and benefits that Original Medicare does not. Some of the most popular benefits are hearing, vision, dental, over-the-counter drugs, non-emergency transportation, and group fitness classes like SilverSneakers and Silver & Fit. If these benefits sound like something you’re interested in, one of our licensed agents can help you enroll. To get started, click here or call 833-438-3676.

Medicare Advantage | Medicare Plan Finder

Medicare Supplements in Utah

Medicare Supplement (Medigap) plans work alongside Original Medicare and provide financial benefits and protection. These benefits include:

  • Blood work copays (up to three pints)
  • Foreign emergency travel
  • Hospice coinsurance and copayments
  • Part A coinsurance and hospital costs
  • Part A deductible
  • Part B coinsurance and copayments
  • Part B deductible
  • Part B excess charges
  • Skilled nursing facility coinsurance

There are ten different types of Medigap plans (A, B, C, D, F, G, K, L, M, N), and each letter represents a different combination of benefits. Generally, the more benefits a plan has, the higher the monthly premium you will pay. One of our licensed agents can help you find a Medicare Supplement in your area. To get started, click here or call 833-438-3676.

Medicare Supplements | Medicare Plan Finder

Part D Plans in Utah

Part D plans provide prescription drug coverage and work alongside Original Medicare. When you first enroll, you will have to meet your deductible before your coverage begins ($415 in 2019, but some plans waive or reduce this amount). After the deductible is met, you will be responsible for a copay per each prescription drug you purchase. This will continue until you reach $3,820 in spending. Once you reach the spending limit, you will be in the “donut hole” and be responsible for 37% of generic drug costs and 25% of brand-name drug costs. (Don’t worry, the donut hole is going away in 2020.) Once your annual spending reaches $5,100, you are considered to be in the catastrophic coverage phase, and you will only be responsible for 5% of your total drug costs.

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Cost of Utah Medicare

The cost of Medicare in Utah will vary depending on which type of plan you select. You will get Part A premium-free if you have worked and paid Medicare taxes for at least 40 quarters. If you only worked 30-39 quarters, you will pay $240/month. Any amount worked less than 30 quarters will cost you $437/month. The Part B premium will depend on your income, but most beneficiaries will pay $135.50/month in 2019. The plan premium and deductible for Medicare Advantage, Medicare Supplement, or Part D plans will vary depending on the carrier, location, and benefits.

Medicare in Utah Eligibility

Most people become eligible for Medicare by turning 65. However, you can still qualify for Medicare regardless of your age if you have ESRD (end-stage renal disease) or ALS (Lou Gehrig’s Disease). You will be automatically enrolled in Medicare if you have been receiving SSDI (Social Security Disability Income) for at least 24 months. To be eligible for Medicare Advantage, Medicare Supplements, or Part D, you need to be enrolled in parts A and B first.

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Can I Have Medicaid and Medicare in Utah?

Yes, you can have Medicaid and Medicare in Utah. If you qualify for Medicaid, you may also qualify for a Dual Specials Needs Plan (DSNP). DSNPs are a special type of Medicare Advantage plan that provide extra benefits at lower costs. They also grant you a Special Enrollment Period (SEP). Most people can only make changes to their health coverage once per year, but a SEP allows you to make changes regardless of the time of year.

If you qualify for a DSNP, you may be eligible for other cost-saving programs. Medicare’s prescription drug program, Extra Help, can help you save more than $4,000/year on prescription drug costs. Other Medicare Saving Programs can help provide coverage for other Medicare-related costs like premiums, deductibles, copayments, and coinsurance.

Additional Programs in Utah

Meals: The Nutrition Program provides nutrition assessment, education, resources for healthy living, and meals delivered to the homes of older adults who may be unable to leave for food or groceries.

Transportation: The Transportation Program provides reliable transportation to older adults over the age of 60. This helps with dental and medical care, medication pick-up, and personal business needs (Social Security, legal services, Medicare, etc.)

Legal: The Legal Services Program helps older adults who are facing complicated legal issues. It also provides a downloadable guide that walks individuals through their legal issues one step at a time.

Ombudsman: The Long-Term Care Ombudsman Program helps older adults maintain and protect their rights in a long-term care setting. It educates people on their rights and advocates for those who can not.

Caregiver Support: The Caregiver Support Program provides caregivers with information about available resources, supportive services, counseling, respite care, and supplemental services (like assistive technologies, emergency response systems, grab bars, etc.)

How to Apply for Utah Medicare

You can sign up for Original Medicare through Social Security. You can visit www.SocialSecurity.gov, call 1-800-772-1213 Monday through Friday 7 AM to 7 PM, or apply in person at your local Social Security office.

Once you are enrolled in Original Medicare, you can schedule an appointment with a licensed agent and discuss other types of Medicare plans. Click here or call 833-438-3676 to speak with a licensed agent.

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