Are you familiar with the phrase, “Medicare coverage gaps?” If not, you need to be. Medicare coverage gaps are the thresholds between your effective benefits. As the name suggests, they are gaps in coverage. These coverage gaps have caused seniors in the Provo area of Utah to be left with one difficult choice: either go without the healthcare that you both need and deserve or pay thousands of dollars in out-of-pocket costs for treatment. And this isn’t just a problem in Provo, but the entire state of Utah as well as the rest of the country. Fortunately, there are two ways to avoid the financial burden of Medicare coverage gaps: enroll in a Medicare Advantage plan or enroll in a Medicare Supplement (a.k.a. Medigap) insurance plan.

Facts and Figures

  • There are 7,002 seniors living in Provo right now.
  • There are 4 hospitals in the Provo area where seniors can get emergency and/or in-patient care.
  • 35% of Utah seniors have a Medicare Advantage plan.
  • 15% of Utah seniors have a Medicare Supplement (Medigap) plan.
  • Which leaves 50% of seniors potentially uninsured or underinsured against costly Medicare coverage gaps!

3,501 seniors in the Provo area struggle to maintain reliable access to affordable healthcare. That means that one out of every two seniors you know is likely paying thousands of dollars out of pocket as a result of Medicare coverage gaps. If you happen to be among those 50% of seniors, then your situation is only going to worsen with time. As you continue to age, you become at greater risk of developing new or worsening symptoms of age-related illnesses. Even if you are currently in perfect and pristine health today, which would be a miracle in and of itself, you could be in the hospital with symptoms of coronary heart disease tomorrow morning. The chart below demonstrates just how prevalent a small handful of age-related illnesses are in the Provo area.

Disease Prevalence in Provo, UT
Arthritis 14%
High Blood Pressure 17%
Coronary Heart Disease 3%
Diabetes 6%
Kidney Disease 2%

Healthcare Costs in Provo, UT

As you might have guessed, developing new or worsening symptoms leads to new or worsening healthcare costs. The reason that this happens is because your need for treatment is directly related to the frequency and severity of your symptoms. If you only suffer mild joint pain every couple of days, you’re probably not going to be visiting the doctor as often as if you were to have severe joint paralysis and excruciating pain on a constant basis. Unfortunately, the worse your health gets, the bigger the risk faced by your financial independence. Since medical costs are rising every year, your healthcare costs can actually increase even if your need for treatment stays the same. Combine that with the fact that seniors are living longer lives now than ever before and you begin to see just how much time these bills have to add up.

Disease Prevalence in Provo, UT Annual Cost of Treatment
Arthritis 14% $280
High Blood Pressure 17% $288
Coronary Heart Disease 3% $7,557
Diabetes 6% $2,158
Kidney Disease 2% $6,974

Medicare Advantage Savings in Provo, UT

In Provo, Utah, Medicare Advantage is the most common method of the two plans used to avoid the costly out-of-pocket expenses of the Medicare coverage gaps. Just about 2,450 seniors in Provo have decided to replace their original, government-provided Medicare plan with a privately-provided Medicare Advantage plan. Since the government mandates the basic level of care provided by private providers of Medicare Advantage, you can rest easy knowing that you will receive at least the same level of care. That said, many seniors on Medicare Advantage plans actually receive a greater level of care because providers of Medicare Advantage plans tend to offer optional additional coverage options. Although those optional coverage options can cost quite a bit, the government will handle most or all of your premiums, leaving you with a monthly payment of $0.

One major benefit of Medicare Advantage plans is the ability to add prescription drug coverage and minor medical equipment coverage directly to your plan. These additions can be great options for you if you happen to be suffering from arthritis, high blood pressure, or diabetes. They specific drugs that are covered by the plan vary from provider to provider, but the general rule of thumb is that the benefits are significantly more expansive and inclusive than Medicare Part D prescription drug coverage, even going so far as to cover medical necessities such as glucose monitors and testing strips. As the graph below shows, the savings can really add up over the five- and ten-year periods. In some cases, you can even save as much as $21,903 in as little as ten years.

Medicare Advantage providers also frequently provide the option of adding dental and vision care coverage directly to your Medicare Advantage plan. This is particularly great because many seniors find that their need for vision and dental care begin to increase significantly as you age but Original Medicare provides little to no benefit of any kind related to either of those two treatment categories. In fact, neither Original Medicare nor Medicare Supplement Insurance are capable of adding anywhere near the same level of benefits related to vision care or dental care as are possible under Medicare Advantage.

Medicare Supplement (Medigap) Savings in Provo, UT

More than 1,000 of the 7,002 seniors living in Provo have enrolled in a Medicare Supplement insurance plan in order to meet their healthcare needs. Whereas Medicare Advantage plans completely replace your existing Medicare coverage, Medicare Supplement Insurance plans function solely to expand on the benefits provided by Original Medicare in order to protect you from the coverage gaps. In fact, that’s where the name “Medigap” comes from. In general, these plans are designed primarily to provide financial support related to the expenses of Medicare Part A coverage gaps, which can be particularly costly for seniors suffering from chronic age-related conditions such as heart disease and kidney disease. That said, each of the ten plans comes with its own costs and benefits. Before you make the decision on which plan is right for you, be sure to consider all of the specifics and speak with an expert first.

Medicare Supplement insurance plans of types A, D, K, and L provide great benefits related to costs that fall into the Medicare Part A coverage gaps, such as hospitalizations and skilled nursing care, but don’t provide any benefits at all related to Medicare Part B coverage gaps. If your particular circumstances require you to pay excessive amounts of out-of-pocket expenses related to Medicare Part A coverage gaps but none related to Medicare Part B coverage gaps, then one of these four plans might be the best option for you.

On the other hand, you might find that you need financial assistance paying for both Medicare Part A coverage gaps as well as Medicare Part B coverage gaps. If that’s the case, then you might want to look into Medicare Supplement insurance plans of types B, C, F, G, M, and N. Not only do these plans provide ample assistance when it comes to Medicare Part A coverage gaps, they also provide a suite of benefits related to Medicare Part B coverage gaps, making it possible to easily afford most medical treatments ranging from emergencies to hospitalizations and surgery. Unfortunately, Medigap type F is set to be discontinued come 2021. That means that you’ll have to find a different Medigap plan type in order to continue to receive the same quality of care if you can’t get enrolled and grandfathered into a Plan F policy before the deadline.

As mentioned earlier, it is impossible to add vision and dental care coverage directly to your Medicare Supplement plan. Unfortunately, the same goes for prescription drug coverage. That being said, there are plenty of private providers of vision and dental care insurance plans in the Provo area. All you need to do is contract one of them to provide you with those insurance needs, which can typically be done for fewer than $50 per payment period, and you’ll be good to go. Best of all, you don’t need to wait for an open-enrollment period in order to enroll in either of those coverage plans. For prescription drug coverage, all you have to do is apply for Medicare Part D prescription drug coverage. That plan tends to cover enough to satisfy the needs of most seniors; however, many still fall into the “donut hole,” which is just another form of Medicare coverage gaps.

In order to protect yourself against rising medical costs, increasing risk of new or worsening symptoms, and the constant threat of Medicare coverage gaps, you need to enroll in a Medicare Advantage or Medicare Supplement insurance plan as soon as possible. The longer you wait, the more you risk losing your financial security and personal independence due to high medical costs and the need for emergency treatment. So don’t wait! Head over to today and start shopping for the plan that is right for you.

Medigap Plan Minimum Monthly Premium Maximum Monthly Premium Average Estimated Monthly Premium (Part B Premium Included)
Plan A $67 $181 $260
Plan B $97 $210 $289
Plan C $112 $234 $309
Plan D $99 $206 $288
Plan F $114 $241 $313
Plan F (high deductible) $26 $56 $177
Plan G $92 $207 $285
Plan K $40 $106 $209
Plan L $68 $150 $245
Plan M $103 $159 $267
Plan N $81 $187 $270
by Lindsay Malzone, Lindsay Malzone is the Medicare expert for 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.