- Only about 12 percent of Utah residents are enrolled in Medicare.
- 40 percent of Utah Medicare beneficiaries have Medicare Advantage plans; some counties only have one plan available.
- 46 insurers offer Medigap plans in Utah, and nearly 84,000 people are enrolled. Insurers are not required to offer Medigap plans to people under age 65, and only United American and Transamerica do so.
- Premiums for stand-alone Part D prescription plans in Utah range from about $13 to $119 per month in 2020.
- Per-enrollee Original Medicare spending in Utah is 10 percent lower than the national average.
Medicare enrollment in Utah
As of mid-2020, there were 410,853 people with Medicare in Utah. That’s only about 12.5 percent of the state’s population, compared with nearly 19 percent of the United States population enrolled in Medicare. But Utah also has the youngest population in the country, with a median age of 31 years, versus a US median age of 38. Since Medicare coverage enrollment happens for most people when they turn 65, a state with an overall younger population will have a smaller percentage of its residents enrolled in Medicare.
Medicare eligibility is also triggered once a person has been receiving disability benefits for 24 months, or is diagnosed with ALS or kidney failure. Nationwide, 15 percent of all Medicare beneficiaries are under 65 and eligible due to disability. In Utah, 13 percent of Medicare beneficiaries are eligible because they’re disabled.
In most areas of the country, Medicare beneficiaries can choose Original Medicare or a Medicare Advantage plan. (Medicare Advantage plans are available in most, but not all counties across the United States.)
Original Medicare includes Part A (which helps pay for inpatient stays, like at a hospital, skilled nursing facility, or hospice center) and Part B (which helps pay for outpatient care like a doctor appointment or a preventive healthcare service, such as a vaccination).
Medicare Advantage plans are administered by private insurance companies, and all of the benefits of Original Medicare are covered. In addition, Medicare Advantage plans typically have offer additional benefits, such as prescription drug, dental, and vision coverage. However, healthcare provider networks are limited with Medicare Advantage, and out-of-pocket costs are typically higher than an individual would have if they opted for Original Medicare plus a Medigap plan. In short, there are pros and cons either way, and no one-size-fits-all solution.
Medicare Advantage in Utah
36 percent of people with Medicare in Utah were enrolled in Medicare Advantage plans as of 2018, compared with an average of 34 percent nationwide. The other 64 percent of Utah’s Medicare beneficiaries had opted for Original Medicare instead. But as is the case nationwide, Medicare Advantage plans are becoming increasingly popular: As of mid-2020, Medicare Advantage plans covered 40 percent of the state’s total Medicare population.
Medicare Advantage plans are available throughout Utah, but some counties only have one plan available for purchase in 2020. On the other end of the spectrum, residents in Davis, Salt Lake, and Utah counties can select from among 23 Medicare Advantage plans in 2020.
Medicare beneficiaries can switch between Medicare Advantage plans and Original Medicare (and can add or drop a Medicare Part D prescription plan) during the Medicare annual election period, which runs from October 15 to December 7 each year. Medicare Advantage enrollees also have the option to switch to a different Medicare Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.
- Read our guide to Medicare’s open enrollment.
- Understand the difference between Medigap, Medicare Advantage, and Medicare Part D.
Medigap in Utah
More than half of Original Medicare beneficiaries have supplemental coverage provided by an employer-sponsored plan or Medicaid. But for those who don’t, Medigap plans (also known as Medicare supplement plans) are designed to pay some or all of the out-of-pocket costs (deductibles and coinsurance) that enrollees would otherwise have to pay themselves. Since Original Medicare does not include a cap on out-of-pocket costs, most enrollees maintain some form of supplemental coverage, and Medigap plans are one option.
Although Medigap plans are sold by private insurers, the plans are standardized under federal rules. There are ten different plan designs (differentiated by letters, A through N), and the benefits offered by a particular plan (Plan A, Plan G, etc.) do not differ from one insurer to another. This allows consumers to compare plans based on price and less tangible things like customer service, since the benefits themselves are uniform.
There are 46 insurers currently offering Medigap plans in Utah (the Utah Insurance Department is working to create a state-based Medigap comparison website, but it’s under developments as of mid-2020). And according to an AHIP analysis, there were 82,505 people enrolled in Medigap plans in Utah in 2018. The Utah Insurance Department reported a slightly higher total Medigap enrollment of 83,714 as of 2019, which is about one out of five people with Medicare in Utah.
Unlike other private Medicare coverage (Medicare Advantage plans and Medicare Part D plans), there is no annual open enrollment window for Medigap plans. Instead, federal rules provide a one-time six-month window when Medigap coverage is guaranteed-issue. This window starts when a person is at least 65 and enrolled in Medicare Part B (you have to be enrolled in both Part A and Part B to buy a Medigap plan).
But although people under the age of 65 can enroll in Medicare if they’re disabled and have been receiving disability benefits for at least two years, federal rules do not guarantee access to Medigap plans for people who are under 65. The majority of the states have implemented rules to ensure that disabled Medicare beneficiaries have at least some access to Medigap plans, but Utah is not among them.
Most of the Medigap insurers in Utah do not offer Medigap plans to people under the age of 65 who are eligible for Medicare due to a disability. Only two appear to do so, at significantly higher premiums: Transamerica offers all of its plans to people under age 65, and United American offers Plan B and high-deductible Plan F.
The Utah Insurance Department reported that as of 2018, only 1.2 percent of all Medigap enrollees in Utah were under the age of 65, although 13 percent of Medicare beneficiaries in the state were under the age of 65. The Insurance Department’s report notes that the low enrollment among people under age 65 is likely due to the fact that Utah does not require Medigap insurers to make their products available to people under the age of 65.
Medicare Advantage plans are available to anyone eligible for Medicare, except people with end-stage renal disease (as of 2021, this restriction will no longer apply; people with kidney failure will be able to enroll in Medicare Advantage plans). So people under the age of 65 in Utah who are eligible for Medicare can choose a Medicare Advantage plan in order to have a cap on out-of-pocket costs. But again, Medicare Advantage plans have limited provider networks, which is an important consideration for people with serious health issues.
A person enrolled in Medicare prior to age 65 as a result of a disability will have the same Medigap open enrollment period as other Medicare beneficiaries upon turning 65. At that point, they can enroll in any Medigap plan offered by any insurer in their area.
Although the Affordable Care Act eliminated pre-existing condition exclusions in most of the private health insurance market, those regulations don’t apply to Medigap plans. Medigap insurers can impose a pre-existing condition waiting period of up to six months, if you didn’t have at least six months of continuous coverage prior to your enrollment. And if you apply for a Medigap plan after your initial enrollment window closes (assuming you aren’t eligible for one of the limited guaranteed-issue rights), the insurer can look back at your medical history in determining whether to accept your application, and at what premium.
Medicare Part D in Utah
Original Medicare does not cover outpatient prescription drugs. As noted above, more than half of Original Medicare beneficiaries have supplemental coverage via an employer-sponsored plan (from a current or former employer or spouse’s employer) or Medicaid, and these plans often include prescription coverage. But Medicare beneficiaries who don’t have drug coverage through Medicaid or an employer-sponsored plan need to obtain Medicare Part D prescription coverage. Part D coverage can be purchased as a stand-alone plan, or as part of a Medicare Advantage plan that includes Part D prescription drug coverage.
In 2020 in Utah, there are 28 stand-alone Medicare Part D plans for sale, with premiums that range from about $13 to $119/month.
139,741 Medicare beneficiaries in Utah had stand-alone Medicare Part D plans as of mid-2020. A slightly larger number — 157,975 — had Part D prescription coverage as part of their Medicare Advantage plans.
Medicare Part D enrollment follows the same schedule as Medicare Advantage plans: Beneficiaries can select a Medicare Part D plan when they’re first eligible for Medicare, and there’s an annual window (October 15 to December 7) when beneficiaries can enroll or make changes to their Part D coverage.
Medicare spending in Utah
In 2018, Original Medicare’s per-beneficiary spending in Utah averaged $9,103. That’s based on data that were standardized to eliminate regional differences in payment rates, but it did not include costs for Medicare Advantage.
Nationwide, average per beneficiary Original Medicare spending was $10,096 per enrollee, so Medicare spending in Utah was about 10 percent lower than average. Louisiana had the highest average per-beneficiary Original Medicare spending, at $11,932, while Hawaii had the lowest, at just $6,971.
How does Medicaid provide financial assistance to Medicare beneficiaries in Utah?
Many Medicare beneficiaries receive financial assistance through Medicaid with the cost of Medicare premiums and services Medicare doesn’t cover – such as long-term care.
Our guide to financial assistance for Medicare enrollees in Utah includes overviews of these benefits, including Medicare Savings Programs, long-term care coverage, and eligibility guidelines for assistance.
Additional information and resources
Need help with your Medicare application in Utah, or have questions about Medicare eligibility in Utah? These resources provide free assistance and information.
- Contact the Utah Senior Health Insurance Information Program (SHIP), for questions about Medicare coverage in Utah.
- Visit the Utah Insurance Department website.
- Learn how Medicaid helps Medicare beneficiaries who have limited income and assets.
- Go to the Medicare Rights Center website, which provides offer helpful content geared to Medicare beneficiaries, caregivers, and professionals.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.