If you think you don’t have to worry about coverage gaps from Medicare Parts A and B, think again. Eventually, those gaps will catch up to you, and you may be stuck paying thousands in out of pocket medical bills if you aren’t careful. Thankfully, Medicare Advantage (a.k.a. Medicare “replacement”) is one of many options you can choose from to protect your finances. With the extra protection, your life savings won’t be vulnerable to Medicare coverage gaps.

Federal Regulations for Medicare Advantage

Purchasing a Medicare Advantage policy transfers responsibility for paying out your Medicare-related claims from the government to a private insurance provider of your choice. This is why it is sometimes called a “Medicare replacement” policy. But don’t worry – federal regulations make sure that no matter what plan you purchase from what company, you will get at least the same benefits as Traditional Medicare. Many plans provide much more coverage than that.

Medicare Advantage Enrollment In Utah

Utah seniors are no strangers to Medicare Advantage. Around 35% of retired persons who have successfully enrolled in Medicare have replaced those benefits with a Medicare Advantage plan. To see which Advantage plans are the most popular in Utah, take a look at this chart:

Plan Type Enrollment Percentage
HMO Plans 59%
Local PPO Plans 13%
Special Needs Plans 11%
Regional PPO Plans 9%
Private Fee-For-Service Plans 5%
Other (Cost Plans, MSA’s, etc.) 3%

Plan Coverage & Cost

Do you use tobacco products? Are you male, or female? Did you enroll in Medicare soon after turning 65? All of these are important questions when it comes to determining your monthly rate. To get an idea of what seniors near you are being quoted, take a look at these Advantage plan near you:

Most Popular Medicare Advantage Plans in Utah

Five star review systems make shopping easier in every aspect of life. Medicare Advantage is no different. We have dozens of reviews for Medicare Advantage plans in your area that you can peruse. We rate them based on overall affordability, care management expertise, their claims process, and financial stability. The more stars they earn, the better the plan. It can cut your shopping time by half or more.

Helpful Medicare Advantage Tips & Tricks

Doctor/Provider Network Restrictions

The cost of a plan is related to its doctor/provider network restrictions. And those restrictions are related to the size of the provider network. Small networks with high restrictions, such as HMOs, are less expensive because they keep costs low. Larger, more flexible networks cost more, but give you more choice. Some networks simply cast a wide net, whereas others will permit you to go to a non-network doctor or facility for a higher cost.

  • HMO Plans – The best part about an HMO plan is the fact that it costs less than most other healthcare plans. HMO networks keep your medical costs low by restricting you to affordable healthcare providers in your area. After you choose a primary care doctor, they must give you a referral to get care anywhere else in the event that they deem it necessary. And those referrals can only be for other in-network healthcare providers. There are very few exceptions to out-of-network care, the most common of which is emergency care.
  • PPO Plans – PPO plans give you the greatest amount of variety and flexibility with your healthcare. But you’ll have to pay a premium for this advantage. You have a network of preferred providers which your insurance company has picked out just for its customers, but you can also go out of network at any doctors office or facility. Either way, your insurance company will help you cover your costs – but those costs will be more expensive when you go out-of-network.
  • PFFS Plans – Private Fee-For-Service plans can be a little tricky. On the one hand, you can see any care provider you want; you aren’t necessarily tied down to a specific network. But your insurance company and your care provider will negotiate price terms on a case-by-case basis. If they don’t agree on terms, you will pay for your medical costs. If they do agree on terms, you get your care subsidized by your insurance company.
  • Special Needs Plans – Do you have specific medical needs? Do you require frequent care for a chronic illness? Is your medical costs budget and/or income limited? Then you might qualify for a Special Needs Plan. Keep in mind that your network of doctors and facilities will be restricted to try and keep a medical costs more affordable. Like an HMO, you can get emergency care out-of-network if you absolutely cannot make it to an in-network hospital or doctor. Rare exceptions can be made for out-of-network care in advance if you negotiate successfully with your insurance company.

Doctor/Providers List

Finding a doctor who accepts your Medicare Advantage plan:

  • HMO Plans – Did you know that a Medicare Advantage HMO can be even more affordable than a regular private HMO plan? With the assistance of the federal Medicare program, you’ll have fewer Insurance costs on your end. You’ll still have to follow the rules of an HMO program like staying in network exclusively and letting your primary care physician handle your needs, but the affordability can be crucial if your budget is limited.
  • PPO Plans – The affordability of a Medicare Advantage PPO plan is considerably higher than a PPO Plan offered by a private insurance company. When you get help with your insurance costs thanks to Medicare subsidies, you won’t have to pay as much for your monthly premiums as you normally would. This can give you more access to qualified doctors, hospitals, and facilities that you normally might not have access to on other plans. And it gives you this access at a cost that most seniors can actually afford.
  • PFFS Plans – Under a Medicare Advantage Private Fee-For-Service plan, your insurance provider and your healthcare provider still have to agree on payment terms before you can receive care at an affordable cost. These payment terms will still be evaluated on a case-by-case, appointment-by-appointment basis. But the fact that Medicare is more widely accepted than most private health insurance plans means that you may have less of a struggle finding providers who will accept your insurance company’s payment terms.
  • Special Needs Plans – Your medical network with an SNP Medicare Advantage plan will still be fairly restricted because it’s the best way to keep costs affordable. You’ll still be required to stay within your network unless you’re willing to pay for your costs out-of-pocket. You’ll still have exceptions for emergency situations, and you’ll still be able to negotiate for out-of-network care with your insurance company, but it may be an uphill battle. Thankfully, Medicare Advantage can make all of these costs more affordable to you, and you may even get a slightly better network of healthcare providers to choose from.

Even if you’ve already had a discussion with your doctor and they told you they accept Medicare, they might not necessarily be in your network if you switch to a Medicare Advantage plan. That’s why you should use the Physician Search Tool on the Medicare website to double-check and make sure your future Medicare Advantage plan will have your preferred doctors and facilities in its network. Otherwise, you may have to go through the hassle of finding new doctors through painful and potentially harmful trial-and-error.

Drug, Vision and Dental Coverage

Do you want vision coverage in addition to your other Medicare benefits? Do you want to manage all of your benefits under a single policy, instead of purchasing separate vision coverage from a different company? Then you might want to take a closer look at Medicare Advantage. If vision coverage is available in your area, they will likely give you the option to purchase it. Such options are unfortunately unavailable for Medigap policies or through regular Medicare.

Dental is another type of optional health insurance coverage that cannot be added to your Original Medicare benefits or a Medigap supplement insurance policy. But you can add it to a Medicare Advantage policy if the coverage is available in your area, and if your Medicare Advantage insurance provider allows you to purchase it. After that, it’s a matter of picking a dentist and showing up for your appointments.

Enrollment Options & Best Time To Enroll

If you have just turned 65, you’re probably still within the 6-month window known as your IEP (see below) to get approved for coverage with little hassle. Enrolling in your IEP is the best time to enroll, because most companies won’t require you to answer private health questions or undergo a physical exam before approving you. For seniors who wait to enroll, or for seniors with severe medical conditions, however, the process can be more complicated. If you are having trouble getting covered due to a pre-existing condition, contact your state department of insurance or your local insurance agent for more information on your options. And while you’re here, take a look at our Medicare Advantage Enrollment Options page.

  • Initial Enrollment Period: The enrollment period during your first 6 months of being enrolled in Medicare.
  • Annual Enrollment Period (AEP): This timeframe runs from October 15th through December 7th every year, and during this time you can change or cancel your Medicare Advantage and part D drug plan.
  • Special Enrollment Period (SEP): Circumstances which happen outside of the AEP window, such as employer coverage loss or moving out of state, which may require you to find new coverage immediately.

What Medicare Advantage Plan Is Best For Me?

Do you want an overpriced Medicare Advantage plan from a financially unstable company with a poor customer service track record? Of course not! But if you try to shop around all by yourself, that’s what you might end up getting. Fortunately, you have us on your side. And we won’t let that happen.

Your narrow enrollment window means that you only have a limited amount of time to make a decision. This small time frame makes it easy to choose the wrong plan if you aren’t careful. But if you contact us and give us a few basic details, we can narrow your search to the right plans at the right price available near you. The clock is ticking – so call us today!

by Lindsay Malzone, Lindsay Malzone is the Medicare expert for Medigap.com. She's been contributing to many well-known publications as an industry expert since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.