What is a Utah Medicare Advantage Plan?
Traditional Medicare covers about 80% of all major medical costs. It does not cover minor medical for things like vision, hearing, dental, and prescriptions. The Medicare Advantage plans available in Utah can include minor medical benefits, but are not required to. Most do include coverage for prescriptions.
While it is nice to have coverage for minor medical costs, it is critical that you understand exactly what you get when you join a Medicare Advantage plan in Utah. In particular, you need to know that these plans have complete control over your access to doctors and other healthcare providers. If you've ever had a managed care plan (HMO, PPO, etc.) through an employer, then you already know what to expect.
Medicare Advantage vs. Medicare: Is There a Big Difference?
The best way to understand the differences between Medicare Advantage and traditional Medicare is to evaluate the pros and cons of each type of coverage.
The Pros and Cons of Utah Medicare Advantage Plans vs Original Medicare
- With Medicare Advantage you must use Utah healthcare providers within the plan's network. With Original Medicare, you can use the Medicare-approved provider of your choice.
- If you travel and have a medical emergency, Medicare Advantage covers you. However, if you are a snowbird and winter or summer in another state, non-emergency doctor outside of your plan's network won't be covered.
- All Medicare Advantage plans sold in Utah protect you with an annual maximum out-of-pocket (MOOP) limit. Once you reach this spending limit the plan pays all additional copays and coinsurance that you'd normally pay out-of-pocket. Original Medicare does not have an out-of-pocket maximum.
- Most Medicare Advantage plans come bundled with a Utah Medicare Part D plan for prescription coverage. With Original Medicare, you must enroll in a stand-alone Part D plan. But, the stand-alone plans offer more choices to get lower-cost prescriptions.
- With Original Medicare your costs (copays, coinsurance, etc) are predictable, and you can get a Medicare supplement to help pay these costs. In the Medicare Advantage program, each plan can charge what they want for copays and coinsurance, making it very difficult to compare actual costs.
Medicare Advantage vs. Medigap
Most Utah seniors just getting their Medicare benefits want to know which type of plan is better. We commonly see these three questions:
- 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 take a minute or two to compare and contrast, shall we?
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.
What are the Disadvantages of Utah Medicare Advantage Plans?
We have already highlighted the issue of doctor choice in Medicare Advantage. If this is not an issue for you, then consider the financial differences.
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.