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Utah Medicare Guide

Medicare doesn’t have to feel overwhelming
Speak with a Licensed Advisor

We’re here to help you:

Explore your options

Compare options, including Medicare Advantage, Medicare Supplement, and prescription plans.

Enroll in Medicare

Get the help you need to enroll in Medicare, from Original Medicare to supplemental coverage.

Use your coverage

Receive extended support to help you use your plan effectively, find doctors, and get savings.

Speak with one of our licensed Utah Medicare Advisors to ask questions and learn about your options. Schedule a free consultation or call us at (888) 604-0055 to get started. 


Learn the basics of what you need to know by reading through this guide for Medicare in Utah.


Use this table of contents to jump to specific sections:


Snapshot of Medicare in Utah

There are 428,000 Medicare beneficiaries in Utah, making up 13% of Utah’s total population. 10% of Utah’s Medicare beneficiaries also receive full or partial benefits from Medicaid.


Medicare Advantage vs. Original Medicare in Utah

After you enroll in Medicare, you can either stay on Original Medicare (with the option to add a Medicare Supplement and/or prescription drug plan) or switch to Medicare Advantage. 57% of Utah Medicare beneficiaries are on Original Medicare and the other 43% have chosen to enroll in a Medicare Advantage plan (source).


Utah Medicare Advantage Plans

43% of Utah Medicare beneficiaries choose to enroll in one of the 42 Medicare Advantage plans available statewide. Plan availability varies by zip code, and the details of every plan, including premiums, deductibles, and provider network also vary. To learn about and compare Utah Medicare plans in your zip code, schedule an appointment with one of our licensed Utah Medicare agents or call us at (888) 604-0055. 


Medicare Advantage (also known as Part C) plans offer an alternative to Original Medicare. Private insurance companies offer Medicare Advantage plans that provide a bundled approach to Medicare. These plans must provide at least the same coverage as Original Medicare (Part A & Part B), but they also often provide additional healthcare coverage and benefits. These plans do come with drawbacks though, including more limited provider networks, pre-authorization requirements, and higher out-of-pocket costs when compared to Original Medicare paired with a Medicare Supplement plan.


Utah Medicare Supplement Plans

Medicare Supplement (Medigap) plans don’t provide additional healthcare services or benefits, but instead pair with Original Medicare to help cover the 20% of costs that Original Medicare doesn’t. Medicare Supplement plans generally have higher premiums than Medicare Advantage plans, but significantly reduce your out-of-pocket costs. They also allow you to see any doctor that accepts Medicare (about 90% of doctors nationwide) and don’t require prior authorization for covered services. 


While you can technically apply for a Medicare Supplement plan at any time, the best time to enroll is during the Medigap Open Enrollment Period, which occurs within the first six months that you have Medicare Part B coverage. During this enrollment period, insurers cannot deny you coverage or charge you a different rate based on your age or medical history. Outside of this period, you’ll likely have to go through medical underwriting before you’re accepted, and you can be denied coverage. You can learn more about Medigap enrollment here.


Nationwide, Medicare beneficiaries have 10 Medigap plan options, and every plan within a type (e.g., every Plan F) has identical coverage, regardless of the insurance carrier or premium. Plan G is the most comprehensive Medicare Supplement plan, but you can find a complete comparison of Medigap plans here.


Utah Prescription Drug (Part D) Plans

Utah Medicare recipients can get prescription drug coverage through a Medicare Advantage plan that includes Part D coverage (MAPD plan) or through one of 23 stand-alone Part D plans available in Utah (the exact number of plans available to you will vary by zip code). The average monthly premium for a Medicare Part D stand-alone drug plan in Utah is $38.37, which is slightly lower than the national average ($39.87).


Getting help paying for prescription drug coverage

Medicare Extra Help Program

If you have limited income and resources, you may be eligible for Medicare’s Extra Help program. Extra Help (also referred to as low-income subsidy, or LIS) helps Medicare beneficiaries pay for Medicare Part D premiums and out-of-pocket costs. You qualify for Extra Help automatically if you get:

  • Full Medicaid coverage from Utah

  • Help from Utah to pay your Part B premiums

  • Supplemental Security Income (SSI) benefits


If you automatically qualify, you’ll receive a letter with important information concerning your Extra Help.


If you don’t automatically qualify for Extra Help, you can learn more about eligibility here. If you need assistance understanding eligibility and the application process, one of our licensed Utah Medicare Advisors would be happy to provide support! 


Other ways to save on Medicare prescription coverage in Utah

  1. Check pricing at different pharmacies - Prices for prescriptions can vary among pharmacies. Check to see if using one of your plan's preferred pharmacies or a mail order pharmacy can save you money.

  2. Opt for generic or comparable prescriptions - Switching the form of your drug (e.g., capsule vs. tablet vs. softgels) can sometimes result in significant savings.

  3. Review your prescription drug plan every year - Medicare plans and your prescription needs change. One of our licensed Utah Medicare advisors can help you compare your options each year to ensure you’re getting the best value from your Medicare Part D plan. 


Get help paying for Medicare in Utah

Extra Help only helps those with limited incomes and resources pay for prescription drug costs. The government has two additional programs that can help Utah Medicare beneficiaries pay for health-related expenses.


Medicaid

Medicaid is a joint state and federal program created to help cover the medical costs for American citizens with low income and resources. Because each state runs their own Medicaid programs, eligibility requirements and benefits are different. 


Utah’s Medicaid agency has a specific program for those who are aged, blind, or disabled (ABD). Medicare Cost-Sharing Programs (also commonly referred to as Medicare Savings Programs) are also available. Even if you are receiving Medicaid, you should be sure the paperwork is filed so you receive Medicare Savings Program benefits. Learn more about Utah Medicaid programs and eligibility here.


Supplemental Security Income (SSI) Benefits

Eligible US citizens receive monthly payments from the SSI program. You’re considered eligible if you meet the following criteria:


You can apply for SSI Benefits online or by calling 1-800-772-1213 / TTY 1-800-325-0778.


Utah Medicare Eligibility and Enrollment Steps

Medicare eligibility is the same across the US. You’re eligible for Medicare if you’re a US citizen who meets one of the following criteria:

  • You’re 65 or older

  • You have certain disabilities, like End-Stage Renal Disease or ALS

Three key steps for Utah Medicare enrollment:

  1. Enroll in Original Medicare (Part A & Part B)

  2. Choose your supplemental coverage options

    1. Medicare Supplement (Medigap)

    2. Medicare Advantage (Part C)

    3. Part D (drug coverage)

  3. Find doctors, share your plan information with your pharmacy, and set up additional benefits that come with your coverage.


Due to its multiple parts and supplemental options, Medicare can feel overwhelming, but it doesn’t have to! One of our Utah Medicare Advisors would be happy to answer any questions you have, help you understand and compare your options, and guide you through enrollment. Get started by scheduling your free consultation or calling us at (888) 604-0055.