Medicare in Utah: Eligibility, Cost, & More

Medicare is a federal health insurance program that helps individuals who are 65 or over or younger individuals with qualifying disabilities. You can get Medicare Parts A and B when you turn 65. You should apply for Medicare three months prior to your 65th birthday.

With so many different parts and options, choosing the best Medicare plan for you can be confusing. Here, we answer some of the most frequently asked questions about Medicare and Medicare Advantage in Utah.

Does Utah Have Medicare?

Medicare is available in Utah for those who are eligible. More than three million Utah residents are enrolled in a Medicare plan including:

• 1.8 million Medicare Advantage beneficiaries
• 1.3 million Medicare Prescription Drug Plan beneficiaries

Basic Medicare includes Part A and Part B. Part A covers inpatient hospitalization, some home health care, hospice care, and skilled nursing facilities. Part B covers doctors' visits, lab tests, some home health care, screenings for preventative care, and other outpatient appointments.

There are additional options for Medicare, including:

• Part D is a prescription drug plan you can add to Original Medicare to help cover prescription drug costs
• Medicare Advantage (Part C) is an alternative to Original Medicare that provides additional benefits like vision and dental coverage, health club discounts, prescription drug coverage, and more.
• Medicare Supplement (Medigap) plans are designed to fill the gaps from Original Medicare. These plans can potentially reduce your out-of-pocket costs. Some Medicare Supplement plans may offer additional benefits including gym memberships and fitness programs like SilverSneakers.

Who is Eligible for Medicare in Utah?

You are eligible for Medicare in Utah if you are 65 years of age. Medicare has a special enrollment period that starts three months prior to your 65th birthday and ends three months after your birthday month.

If you apply three months before your 65th birthday, coverage starts at the beginning of the month you turn 65. If you wait to apply during the month you turn 65; coverage starts the next month. If you wait for a month after you turn 65 to apply, your coverage won't start for two months after you sign up. Finally, if you wait for two or three months after you turn 65, your coverage won't begin until three months after you sign up.

Additionally, if you are under 65 years of age and you have end-stage renal disease or amyotrophic lateral sclerosis (ALS), or Lou Gehrig's disease, you are eligible for Medicare regardless of your age.

How Do I Apply for Medicare in Utah?

If you apply for disability or retirement benefits from Social Security or the Railroad Retirement Board, you can get Medicare automatically. Your application for retirement or disability is also the application for Medicare. You will automatically start receiving Part A. The system automatically signs you up for Part B. If you do not want Part B, you must send a form back to Social Security / Medicare stating that you do not want Part B.

Some people do not choose to sign up for retirement on or before their 65th birthday. If you choose to wait until you are over 65, you can still get Medicare at 65, but you will have to contact Social Security to manually sign up for Medicare.

If you elect to decline Part B, you won't be able to sign up for it until open enrollment. Additionally, you'll have to pay a late enrollment penalty. Learn more about the different Medicare enrollment periods in this guide.

You can apply for Medicare Part A and Part B online, by calling Social Security, visiting your local Social Security Office, or the Railroad Retirement Board if you worked for the railroad.

How Much is Medicare in Utah?

If you worked 40 quarters (at least 10 years) for a job where you paid Social Security taxes, you can get premium-free Medicare Part A. You can also receive premium-free Part A if you have a spouse who qualifies. Otherwise, you will pay a premium for Part A. Most people also pay premiums on Part B, including copayments and deductibles.

You can, however, offset some of those costs with Medicare Supplement (Medigap). Should you wish to have prescription coverage, you could also enroll in Part D, which also has a cost.

In 2021, the standard premium for Part B is $148.50. Additionally, Parts A and B cover only 80 percent of your medical expenses. Thus, in addition to the Parts B and D premiums, you pay 20 percent of all medical expenses, plus copayments. Should you opt for Medicare Supplement, you also have to pay a premium for the supplement, but it covers most of the 20 percent of your coinsurance payments for health care under original Medicare.

Does Medicare Cover Assisted Living in Utah?

Medicare does not cover assisted living in Utah. However, Medicaid does cover some costs in some cases. You would have to apply for the New Choices Waiver. Other options for covering assisted living include long-term care insurance and the aid and attendance program through the Veterans Affairs for veterans.

Medicare Advantage in Utah

If you need additional coverage beyond what Medicare pays for, you could choose one of the Medicare Advantage programs. To qualify for Medicare Advantage, you must be enrolled in Part A and Part B. If you choose a Medicare Advantage plan, you still pay the Medicare Part B premiums, plus another premium for the Medicare Advantage Plan. However, you do not need Medicare Part D for prescriptions or Medigap.

In many cases, Medicare Advantage can be less expensive than paying three separate premiums for Part B, Part D, and Medigap.

Is Medicare Advantage Available in Utah?

Yes. You can get Medicare Advantage in Utah. Enter your zip code using our plan comparison tool to see the plans available in your area. You can choose from several HMO or PPO plans.

Contact Us to Learn More About Medicare in Utah

Medicare provides many benefits for the care you need if you choose the plan that is right for you. With so many options, it can be difficult to choose the best plan for your needs. You can browse Medicare plans on our site. If you need help choosing a plan or have general Medicare questions, contact us at (800) 596-1715 (TTY 711).