Medicare in Utah: At a glance
- Only about 12 percent of Utah residents are enrolled in Medicare.
- Of Utah beneficiaries, 36 percent had Medicare Advantage plans as of 2017; some counties only have one plan available.
- In Utah, 23 insurers offer Medigap plans, and about 73,000 people are enrolled. Insurers are not required to offer Medigap plans to people under age 65, and only United American does so.
- Premiums for stand-alone Part D prescription plans in Utah range from about $16 to $110 per month in 2019.
- Per-enrollee Original Medicare spending in Utah is 10 percent lower than the national average.
Medicare enrollment in Utah
387,306 Utah residents were enrolled in Medicare as of November 2018. That’s only about 12 percent of the state’s population, compared with a little more than 18 percent of the United States population enrolled in Medicare. But Utah also has the youngest population in the country, with a median age of under 31 years, versus a US median age of nearly 38. Since most people become eligible for Medicare when they turn 65, a state with an overall younger population will have a smaller percentage of its residents enrolled in Medicare.
Utah’s Medicare enrollees accounted for 12 percent of the state’s population in 2015 as well, and only Alaska had a lower percentage (11 percent) at that point. But Alaska’s Medicare population now comprises about 13 percent of the state’s population, and although Alaska’s population is still much younger than average, its senior population is growing faster than any other state’s.
Medicare eligibility is also triggered once a person has been receiving disability benefits for 24 months. Nationwide, 16 percent of all Medicare beneficiaries are eligible due to disability. In Utah, 14 percent of Medicare beneficiaries are eligible because they’re disabled.
Medicare Advantage in Utah
In most areas of the country, Medicare beneficiaries can choose Original Medicare or a Medicare Advantage plan. Original Medicare is provided directly by the federal government, and includes Medicare Parts A and B. Medicare Advantage is administered by private insurance companies, and while it includes all of the benefits of Medicare Parts A and B, Advantage plans typically have additional benefits, such as integrated Part D prescription drug coverage and extras like dental and vision. But provider networks are limited with Medicare Advantage, and out-of-pocket costs are typically higher than a person 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.
36 percent of Medicare beneficiaries in Utah were enrolled in Medicare Advantage plans as of 2017, compared with an average of 33 percent nationwide. The other 64 percent of Utah’s Medicare beneficiaries had opted for Original Medicare instead.
Medicare Advantage plans are available throughout Utah, but some counties only have one plan available for purchase in 2019. On the other end of the spectrum, residents in Davis, Salt Lake, Utah, and Weber counties can select from among 21 Medicare Advantage plans in 2019.
Minnesota is the only state where more than half (56 percent) of Medicare enrollees have selected Medicare Advantage plans. But in Alaska, only 1 percent of Medicare beneficiaries are enrolled in Advantage plans (via employer-sponsored Medicare Advantage plans, as there are no Advantage plans available for individuals to purchase in Alaska).
Medicare beneficiaries can switch between Medicare Advantage 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. As of 2019, Medicare Advantage enrollees also have the option to switch to a different Advantage plan or to Original Medicare during the Medicare Advantage open enrollment period, which runs from January 1 to March 31.
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 F, 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 23 insurers currently offering Medigap plans in Utah. And according to an AHIP analysis, there were 72,672 people enrolled in Medigap plans in Utah in 2016 (note that the Utah Insurance Department reports a slightly higher total enrollment of 73,525).
Unlike other private Medicare coverage (Medicare Advantage 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.
Plan availability in Utah is shown on the Utah Insurance Department’s website; you can click on an insurer or a plan type (Plan A, Plan F, etc.) to see pricing and availability. If you click on a plan type, you can then select a demographic for pricing information: Standard premium, Medicare SELECT premiums, or Under-65 premiums. The only plan type where anything is available for people under age 65 is Plan B, offered by United American Insurance (United American has chosen to offer Medigap plans to people under age 65 in several other states that don’t require insurers to do so). The premium is steep: $4,900 a year, compared with United American’s standard rate of $1,625/year. But there appear to be no other options for Medigap plans in Utah for people under age 65.
The Utah Insurance Department reported that as of 2016, only 1.7 percent of all Medigap enrollees in Utah were under the age of 65, although 14 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. 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.
Part D coverage in Utah
Original Medicare does not cover for 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 2019 in Utah, there are 26 stand-alone Part D plans for sale, with premiums that range from about $16 to $110/month.
137,261 Medicare beneficiaries in Utah had stand-alone Part D plans as of late 2018. Roughly the same number — 136,091 — had Part D prescription coverage as part of their Medicare Advantage plans.
Medicare spending in Utah
In 2016, Original Medicare’s per-beneficiary spending in Utah averaged $8,558. 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 $9,533 per enrollee, so Medicare spending in Utah was about 10 percent lower than average, and Utah was among only 18 states where average Original Medicare spending was uder $9,000 per enrollee. Louisiana had the highest average per-beneficiary Original Medicare spending, at $11,399, while Hawaii had the lowest, at just $6,441.
Health insurance in Utah if you’re not eligible for Medicare
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.