Medicare Advantage Plans in Southern Utah

What is Medicare Advantage?

Medicare Advantage, also called Medicare Part C, is a way to get your Medicare benefits through a private insurance company that contracts with Medicare. Instead of Original Medicare (Part A for hospital care and Part B for medical care) plus separate add-ons, you enroll in one plan that must cover everything Original Medicare covers, and many plans add more.

You still have Medicare. You keep paying your Part B premium, you must be enrolled in both Part A and Part B to join, and your plan is paid by Medicare to manage your care. Plans, costs, and benefits differ by insurance company and by where you live, which is why comparing matters.

What a Medicare Advantage plan typically includes

• Hospital and medical coverage equal to Original Medicare (Parts A and B).
• Prescription drug coverage in many plans (often called an MA-PD plan). Some plan types do not include it.
• Extra benefits that vary by plan, such as dental, vision, hearing, or fitness programs. Never assume a benefit is included; check the plan documents.
• A yearly limit on what you pay for covered medical services (an out-of-pocket maximum). The amount differs by plan.

Costs also vary. Some plans have low or $0 monthly premiums depending on where you live, but copays, coinsurance, and deductibles still apply when you use care. We look at the whole picture, not only the premium.

How the networks work

Most Medicare Advantage plans use a provider network. The plan type tells you how strict it is:

• HMO: you generally use doctors and hospitals in the plan network and may need referrals to see specialists.
• PPO: you can usually go outside the network, often at a higher cost.
• Special Needs Plans (SNP): designed for people with certain conditions or who qualify for both Medicare and Medicaid.
• Other types exist, such as private fee-for-service plans, and not every type is offered in every county.

Plans may also require prior authorization for some services. Before you choose, confirm that your doctors, your hospital, and your pharmacy are in the plan network.

What to compare before you choose

1. Your doctors and hospital. Are they in the network, and will referrals be needed?
2. Your prescriptions. Is each drug on the plan formulary, at what tier, and at which pharmacies?
3. Your likely costs. Compare copays for primary care, specialists, urgent care, the emergency room, and hospital stays, along with the out-of-pocket maximum.
4. Extra benefits you will actually use. A dental or vision benefit only helps if your dentist or eye doctor accepts the plan.
5. Rules that affect you. Referrals, prior authorization, and how the plan handles care when you travel.
6. Plan ratings. Medicare publishes Star Ratings for many plans, which can be a useful data point.

Medicare Advantage or Medicare Supplement?

Both are ways to add to your Medicare coverage, and neither is right for everyone. Here is a fair side-by-side:

• Medicare Advantage may appeal if you want one plan that can bundle drug coverage and extras, are comfortable using a network, and prefer lower or no monthly premiums with costs shared when you use care.
• Medicare Supplement (Medigap) may appeal if you want to keep Original Medicare, want the freedom to see any provider that accepts Medicare, and prefer more predictable costs in exchange for a monthly premium. You would add a separate Part D plan for drugs.

You cannot use a Medigap policy with a Medicare Advantage plan. Read our Medicare Supplement guide to compare in more detail, or ask us to walk through both with your doctors and prescriptions.

Medicare Advantage in Southern Utah

In smaller communities, a plan network may include fewer doctors and hospitals close to home, and some people travel for specialty care. If that could be you, check that your regular specialists, and the facilities you would use, are in the plan network, not just your primary care doctor.

Plans available to you depend on your county, so options in Cedar City and Iron County can differ from those in St. George and Washington County. We check the plans available where you live, from the carriers we represent.

When you can join or change plans

• Initial Enrollment Period: the 7-month window around your 65th birthday. See our Turning 65 guide.
• Annual Enrollment Period: October 15 through December 7 each year, with changes effective January 1. See our Annual Enrollment page.
• Medicare Advantage Open Enrollment Period: January 1 through March 31 for people already in a Medicare Advantage plan, who can switch plans or return to Original Medicare.
• Special Enrollment Periods: certain events, such as moving out of your plan service area or losing other coverage, may let you change plans outside those windows.

How we help

We compare Medicare Advantage options from the carriers we represent, check your doctors and prescriptions against each plan, and explain the trade-offs in plain English. Our help is free to you, because carriers pay our commission, and your premium is the same whether you enroll through us or directly. You decide, and there is no pressure.