What are Medicare Advantage Plans and Can I Get One in Utah?
Unlike Original Medicare, which only covers major medical, a Medicare Advantage plan can include many extras, including prescriptions, vision, hearing, dental, and fitness, just to name a few. And, good news, they are available in Utah.
Althought the extra benefits are nice to have, it's important to fully understand what you're getting if you join a Medicare Advantage plan in Utah. Specifically, Medicare Advantage is managed care health insurance and the plan controls your access to healthcare providers. If you have ever had an HMO plan through your employer's group health insurance, you have a good idea of what managed care is all about.
Original Medicare vs. Medicare Advantage
One way to better understand how different Original Medicare is from Medicare Advantage is to have a look at the pros and cons of each type of health insurance. So, let's do that.
Pros and Cons: Medicare vs. Utah Medicare Advantage Plans
- When you have Original Medicare you are free to use any Medicare-approved doctor you choose. When you join a Medicare Advantage plan, your choices are limited to the plan's network of Utah providers.
- If you travel frequently or you are a snowbird and winter or summer in another state, your Original Medicare coverage remains the same. It goes where you go. This is not true with Utah Medicare Advantage plans, which are only required to cover you if you have a medical emergency.
- With OriginalMedicare there are no limits on your out-of-pocket costs. However, all Utah Medicare Advantage plans have an annual maximum out-of-pocket (MOOP) limit. If you reach the MOOP spending limit on your copays and coinsurance, the plan picks up the tab for the remainder of the year.
- If you want prescription coverage and have Original Medicare you must purchase a Medicare Part D plan. However, most Medicare Advantage plans include a Utah Medicare Part D plan. Just be aware that a stand-alone Part D plan gives you the best opportunity to get your most expensive prescriptions at the lowest cost.
- In the Medicare Advantage program, the government allows plans to set their own copays and coinsurance for each healthcare service offered. This makes comparing plans difficult, at best. However, in the Original Medicare system deductibles and coinsurance are fixed, making them predictable. Plus, you can get a Medigap plan to help pay these costs.
Medigap vs. Medicare Advantage
Three of the most common questions we get are:
- Why are Medicare Advantage plans bad?
- What are the disadvantages of Medicare Advantage plans?
- Is it better to have Medicare Advantage or Medigap?
Let's answer these three questions right now.
Why Utah Medicare Advantage Plans are Bad
This is a myth. There's nothing wrong with Medicare Advantage plans. In fact, over 20 percent of all Medicare beneficiaries in Utah choose Medicare Advantage.
What you really need to know is that these plans are not for everyone. Some people are better served with traditional Medicare and a Medicare supplement. The question is, which option is best for you?
In particular, if you have one or more chronic conditions, Original Medicare could be a better option because you have the ability to choose your doctors. MedicareWire believes that Medicare Advantage is the best option for healthy people and for people who qualify for both Medicare and Medicaid.
Conversely, Original Medicare and a Medicare supplement work best for people with chronic health conditions (based on overall cost), as well as those who can afford a higher monthly premium, even when they are well.
Are There Disadvantages to Joining a Medicare Advantage Plan in Utah?
As you have already read, both Medicare Advantage and traditional Medicare have their benefits. But the two types of coverage are like apples and oranges. However, if you remove the issue of doctor choice from the equation, the primary difference is when and how you pay.
With most Medicare Advantage plans you pay a little each month (the monthly premium) and a copay when you use medical services. With most Medigap plans you pay most of your costs upfront with your monthly premium. As a result, your costs are more predictable than they might be if you have Medicare Advantage and use a lot of healthcare services
Is it better to have Medicare Advantage in Utah or Medigap?
- If you can afford Medigap Plan F or G, then keep your Original Medicare and add one of these supplements.
- If you are a healthy senior and have good health in your family heritage, Medigap Plan N will let you save money by sharing some costs when you see your doctor.
- If you are a healthy senior but you cannot afford a Medigap Plan F, G, or N, Medicare Advantage is a good choice.
- If you are turning age 65, have one or more chronic health conditions that require frequent doctor visits, and you do not qualify for both Medicare and Medicaid (dual eligible), the most Medigap coverage you can afford is the best option.
- If you qualify for both Medicare and Medicaid, regardless of your health condition, Medicare Advantage is your best option.
- If you have special needs (i.e., a full-time nursing home resident, diabetes, etc.) and an appropriate Medicare Advantage Special Needs Plan (SNP) is available, this is your best option.
Frequently Asked Questions About Utah Medicare Advantage Plans
Medicare Advantage plans vary from County to County in Utah. This is due to the local nature of healthcare provider networks. If you enter your zipcode into this tool it will show you all of your plan options and 5-star ratings.
Most Medicare Advantage plans available in Utah include a Part D plan, but not all. Before joining a plan, be sure to check that all of your most important medications are covered. You can do that with this tool.
While not for everyone, Medicare Advantage plans have their benefits. The best way to understand these plans is to evaluate your health and financial situation. Here is an article that will help you make the right choice.