Medicare Advantage in Utah

A different way to receive Medicare

Medicare Advantage is offered by private companies approved by Medicare. These plans provide Part A and Part B benefits, and many include Part D. You must have Part A and Part B to join and generally keep paying your Part B premium.

HMO and PPO: check the actual rules

HMOs generally use a provider network and may require specialist referrals. PPOs generally allow covered care outside the network at a higher cost and typically do not require referrals. Exceptions and plan details matter, so verify the Evidence of Coverage.

Look at the medical costs

Plans use copays or coinsurance that vary by service. An annual maximum limits your share of covered medical services under plan rules. Premiums and Part D drug expenses do not count toward that medical maximum. Check any separate network and combined limits.

Coverage is more than a provider name

• Confirm the specific doctor, location, hospital, and plan
• Review referral and prior authorization requirements
• Check each medication and pharmacy if drug coverage is included
• Compare additional benefits, their limits, and participating providers

Emergency care and travel

Emergency and urgently needed care have protections outside the usual network. Routine care while traveling may work differently. Ask about extended time outside the service area and any foreign emergency benefit; do not assume worldwide routine coverage.