Introduction to Medicare Advantage in Utah (Part C)

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 34% 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

For the most part, the popularity of Advantage plans has to do with their overall cost. Also, for the most part, the cost of your plan will be significantly influenced by your plan’s provider network. Less expensive plans, such as those with an HMO network, tend to have more beneficiaries than plans which are more costly (like PPOs or PFFS plans).

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.

Doctor/Providers List

Drug, Vision and Dental Coverage

Do you have poor vision, or require dental work? With Medicare, as with most Medicare supplements, you would have to purchase vision and dental coverage separately (or pay 100% of the costs). Medicare Advantage, however, gives you the option of incorporating such benefits into your existing policy. You can even add prescription drug coverage if you purchase an MAPD plan.

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?

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