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Overview of Medicare in Utah

If you’re a Utah resident who’s wondering how Medicare works, we’d like to help you get a better understanding of Medicare coverage.

As a Medicare beneficiary, you can choose from a variety of Medicare coverage options in Utah. To help you understand your options, let’s look at how Medicare works and the more common Medicare coverage options available in your state.

First, there’s Original Medicare, Part A and Part B, which is the federally administered health-care program. In Utah, as in the rest of the country, you’re eligible for Medicare if you’re 65 or older and either an American citizen or a legal permanent resident who has lived here at least five continuous years. You may also be eligible for Medicare before 65 through disability or having certain health conditions, such as end stage renal disease (permanent kidney failure requiring a kidney transplant or continuous dialysis treatments) or amyotrophic lateral sclerosis (Lou Gehrig’s disease).

Original Medicare is made up of two parts: Part A and Part B.

  • Medicare Part A covers inpatient hospital, skilled nursing facility, some home health visits, and hospice care.
  • Medicare Part B covers outpatient services, including doctor visits, some preventive care screenings, lab tests, durable medical equipment, and some home health care costs.

Be aware, however, that Original Medicare does not pay for all services that Medicare beneficiaries may need. Some of the services or items you may be responsible for paying include:

  • Most prescription drugs (except medications you receive while in a hospital, skilled nursing facility, or outpatient setting)
  • Custodial long-term services (nursing home care)
  • Routine dental care
  • Dentures
  • Routine vision care
  • Eyeglasses or contacts
  • Health services received outside of the country

Most people get Medicare Part A without paying a premium if they’ve worked at least 10 years (40 quarters) and paid Medicare taxes; otherwise, you may owe a premium for your Part A coverage. Most Medicare beneficiaries pay a premium for Part B coverage, along with any deductibles, copayments, and coinsurance costs that may come with Medicare Part A and Part B coverage. Deductibles and coinsurance costs can climb to very high amounts if you are hospitalized several times during the year or require extended care in a skilled nursing facility following a hospitalization.

To offset some of the potential costs from gaps in Original Medicare coverage, you may want to consider supplementing your coverage with another option: a Medigap (Medicare Supplement) insurance plan. Medigap insurance plans are offered by private insurance companies and can help you pay your out-of-pocket costs for services covered under Original Medicare.

As mentioned, Original Medicare coverage of prescription drugs is limited. However, you have the option of enrolling in a stand-alone Medicare Part D Prescription Drug Plan (PDP) to help pay for prescription drug costs. These are separate Medicare plans, available through Medicare-approved private insurance companies, which work alongside your Original Medicare coverage.

You may be eligible to enroll in a Medicare Advantage plan in Utah as an alternative way to receive your Original Medicare benefits. Medicare Advantage plans are offered by private insurance companies that contract with the Centers for Medicare & Medicaid Services (CMS) and are required to cover at least the same level of coverage as Original Medicare, with the exception of the hospice benefit, which is paid by Medicare Part A.

One of the attractive features of Medicare Advantage plans is that they are required to limit beneficiaries’ out-of-pocket spending for services covered under Medicare Part A and Part B. All Medicare Advantage plans must include a yearly out-of-pocket spending limit; once your out-of-pocket costs reach this limit (including the deductible), your Medicare Advantage plan pays 100% of covered health-care costs for the remainder of the year. In contrast, Original Medicare doesn’t have a maximum spending cap, so there’s no limit to how high your out-of-pocket costs could be.

Another attraction is that many Medicare Advantage plans include additional benefits not found in Original Medicare. These benefits may include routine dental and vision care, hearing, wellness programs, or prescription drug coverage. Medicare Advantage plans that include prescription drug coverage are known as Medicare Advantage Prescription Drug (MA-PD) plans. An MA-PD plan gives you the convenience of having your Medicare medical and prescription drug benefits through one plan.

If you’re interested in enrolling in a Medicare Advantage plan, you must:

  • Have Medicare Part A and Medicare Part B.
  • Live in the Medicare Advantage plan’s service area.
  • Not have end-stage renal disease (unless you meet certain exceptions).

Keep in mind that, generally, Medicare Advantage plan members must continue to pay their Medicare Part B premium and may also pay an additional premium directly to their Medicare Advantage plan.

If you would like to compare Medicare plan options where you live, the eHealth plan finder tool makes it easy to do so. Simply type your zip code into the tool on this web page to get started.

Medicare resources in Utah

Division of Aging and Adult Services – This division is a component of the Utah Department of Human Services, which focuses on services and programs specifically for senior residents in the state. Utah Medicare beneficiaries will find helpful information at this website about their Medicare options, plan eligibility requirements, and financial assistance for qualified beneficiaries. This division also operates the Health Insurance Information Program, which provides free counseling services to Medicare beneficiaries to ensure they get the right health-care coverage for their specific needs. Local offices are available in every county in the state to help beneficiaries at a location that is convenient for them.

Utah Department of Health – For beneficiaries who have difficulty paying their Medicare premiums and deductibles, the Utah Department of Health provides resources for assistance. This department is the go-to office for Medicaid information, for which some low-income Medicare recipients may also qualify. The Medicare Cost-Sharing Programs are outlined on this website, which explains eligibility requirements and the types of assistance available. In addition, Utah Medicare beneficiaries can find the forms they need to complete to apply for federal aid on the website for the Department of Health.

Utah Aging and Disability Resource Connection – This office is a collaboration between two federal agencies: the U.S. Administration on Aging and the Centers for Medicare and Medicaid Services. This website, as the title suggests, serves as a central repository for information that Utah Medicare beneficiaries may need. The network also provides resources for disabled residents of the state. In addition to assistance over the phone, Utah residents can also get one-on-one help from one of the many ADRC sites located throughout the state.

Medicare statistical trends in Utah

Perhaps you are wondering what your neighbors in Utah are choosing for their Medicare coverage. Below is 2018 statistical information from the Centers for Medicare & Medicaid Services on Medicare trends in Utah.

  • Approximately 37% ( 139,270) of Medicare beneficiaries enrolled in Medicare Advantage plans and other health plans in Utah.
  • 237,738 Utah beneficiaries enrolled in Original Medicare Part A and/or Part B.
  •  265,685 people included Part D in their Medicare coverage to help pay their prescription drug costs.
  • About 50% of Utah beneficiaries with Part D chose to get their Medicare prescription drug coverage by enrolling in a Medicare Advantage plan.
  •  The other 50% ( 133,033) of people with Part D opted to get their Medicare prescription drug coverage by enrolling in a stand-alone Medicare Prescription Drug Plan.

As you are planning for your Medicare coverage, you may be interested in some statistics and 2018 projections about Medicare in Utah that CMS recently published:

  • 23 Medicare Advantage plans and 25 Medicare Prescription Drug Plans are available in Utah.
  • 95% of Utah’s Medicare beneficiaries have access to at least one Medicare Advantage plan.
  • 70% of Utah’s beneficiaries with Part D have access to a plan with a lower premium than what they paid in 2017.
  • $20.40 is the lowest monthly premium for a Medicare Prescription Drug Plan
  • 19% of people with Medicare Part D get Extra Help (also called the low-income subsidy, or LIS) in Utah.

*Sources Used:
Statistical data from the Centers for Medicare & Medicaid Services, Medicare Enrollment Dashboard ; and “2018 MA Part D Landscape State-by-State Fact Sheet”.

This information is not a complete description of benefits. Contact the plan for more information. Limitations, copayments, and restrictions may apply.

Benefits, premiums and/or copayments/co-insurance may change on January 1 of each year.

This website and its contents are for informational purposes only. Nothing on the website should ever be used as a substitute for professional medical advice. You should always consult with your medical provider regarding diagnosis or treatment for a health condition, including decisions about the correct medication for your condition, as well as prior to undertaking any specific exercise or dietary routine.

The product and service descriptions, if any, provided on these Web pages are not intended to constitute offers to sell or solicitations in connection with any product or service. All products are not available in all areas and are subject to applicable laws, rules, and regulations.

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