Medicare Advantage (MA) may be a good option if you need coverage beyond what you get with Original Medicare. Also known as Medicare Part C, over half of eligible Medicare beneficiaries are now enrolled in an Advantage plan. This page explains Medicare Advantage plans in Utah and describes how the program works.
What is Medicare Advantage?
Every Utah Medicare Advantage plan must provide the same benefits as Original Medicare. This includes Medicare Part A, hospital insurance, and Medicare Part B, medical insurance.
Original Medicare does not provide prescription drug coverage. Those benefits are included with Medicare Part D.
Around 90% of Medicare Advantage plans offer additional services, such as prescription drugs and routine vision and dental care.
Even if you join an Advantage plan, you must still pay the Medicare Part B premium.
Utah Medicare Advantage plans with prescription drug coverage
Medicare Advantage Prescription Drug plans (MA-PD) combine your Parts A, B, and D benefits. Although most Utah MA plans include prescription drug coverage, around 10% do not. If you join one of these, you'll need a standalone Medicare Part D plan as well.
Who is eligible for Medicare Advantage in Utah?
If you have Medicare Parts A and B, you qualify for Medicare Advantage in Utah.
You become eligible for Medicare when you turn 65. People who collect Railroad Retirement Board (RRB) or Social Security disability benefits for 24 months may qualify for Medicare before their 65th birthday.
When can you sign up for a Medicare Advantage plan in Utah?
The Medicare Advantage sign-up periods are:
- Initial Enrollment Period (IEP): Starts 3 months before your Medicare eligibility month and lasts for a full 7 months. So, if your birthday or 25th month of disability is in September, your IEP starts on June 1 and ends December 31.
- General Enrollment Period: Lasts from January 1 through March 31 and allows anyone who did not sign up for Medicare Part A and/or Part B to do so. From April 1 through June 30, you may join an Advantage plan.
- Medicare Annual Enrollment Period (AEP): From October 15 through December 7, current Medicare beneficiaries can join an Advantage plan.
- Medicare Advantage Open Enrollment Period (OEP): If you already have an MA plan, you may participate in OEP from January 1 through March 31. Your options are switching to a new MA plan or returning to Original Medicare. You can also join a standalone Medicare Part D plan if you lose your prescription drug coverage because of that change.
- Special Enrollment Periods (SEP): A variety of special circumstances may qualify you for an SEP. The full list is on Medicare.gov.
Types of Medicare Advantage plans in Utah
There are four main types of Medicare Advantage plans in Utah.
- Health maintenance organizations: HMO plan members must use the provider network for all covered services. Additional requirements include choosing a primary care doctor and getting a referral before seeing a specialist.
- Preferred provider organizations: PPO plans also use a provider network but allow plan members to go out-of-network for a higher copay. You don't need a primary doctor or specialist referrals with a PPO plan.
- Private fee-for-service: PFFS plans establish price guidelines for covered services. You don't have to choose a primary doctor, but some PFFS plans have a provider network. Your copay is higher for out-of-network services.
- Special needs plans: SNPs limit membership to people who have certain chronic illnesses, qualify for both Medicare or Medicaid, or who live in a nursing home or require at-home care.
Comparing Medicare Advantage plans in Utah
When comparing Medicare Advantage plans in Utah, look at the following metrics:
- Coverage (including the drug formulary for an MA-PD plan)
Our Find a Plan tool makes it easy to compare Medicare Advantage plans in Utah. Just enter your location information and coverage start date to review Medicare plans in your area.
Find a Medicare Plan in your area
It’s FREE with no obligation