Utah Medicare insurance is a program funded by the federal government, and it provides coverage to US citizens who are over the age of 65. Workers with certain disabilities may also qualify for the said program. Utah also provides programs that assist and educate Medicare beneficiaries in the state.
The coverage provided by Medicare begins with the Original Medicare, which is composed of Part A and Part B. Part A revolves around hospital insurance, covering services such as inpatient hospital care and inpatient psychiatric care. Part B is about medical insurance, covering medically necessary treatments and durable medical supplies along with preventive services.
Premiums for Original Medicare are much more affordable than average premiums for health insurance in Utah, which is $423 a month. Typically, Part A doesn’t require a premium and the Part B premium for those who earn less than $85,000 a month is only $134 a month. Both Part A and Part B will require the beneficiary to cover the out of pocket expenses, which include deductibles, copays, and coinsurance costs.
Some Medicare beneficiaries can purchase supplemental Medicare plans to cover any “gaps” in their Original Medicare coverage. These plans will require a separate premium paid to the Medicare-approved private carriers that offer them. The most common of these “Medigap” policies provide coverage for Medicare prescription drugs, and this is called Medicare Part D.
Some plans may cover healthcare services that are not covered by Original Medicare. The supplemental plan may also help cover the out of pocket expenses in Part A and Part B.
Instead of obtaining Original Medicare and supplemental Medicare plans separately, the medical beneficiary may instead purchase a Medicare Advantage Plan. These plans are also available from the Medicare-approved private health insurance companies.
All of these plans provide the same basic coverage provided by Original Medicare. However, they may also provide Medicare Part D coverage, and each plan may cover different health services that are not covered by Part A and Part B.
Utah has an 11.7% poverty rate, and among them may be Medicare beneficiaries who cannot afford to cover all their Medicare expenses. The Utah state government offers Medicare Savings Programs that can help pay for some of these expenses. These programs do have eligibility limits for income and assets.
For the Qualified Medicare Beneficiaries (QMB) program, the income limit for an individual is $1,032 a month, while the combined monthly income of a married couple cannot exceed $1,392 a month. However, once an application is granted, the QMB program pays for virtually all Medicare expenses. It pays for the premiums for Part A and Part B, along with the deductibles, coinsurance, and copays.
The Specified Low-Income Medicare Beneficiary (SLMB) program only pays for the Part B premium, but that still saves the beneficiary from paying $1,608 a year. To qualify for the SLMB program, an individual cannot earn more than $1,234 a month. The monthly income limit for a married couple is $1,666.
The Qualifying Individual program also pays for the Part B premium, but this is granted on a first-come-first-served basis due to limited funding. To qualify, the income of an individual has to be less than $1,386 while the income limit for a married couple is $1,872. Those who are eligible for the QI program also cannot receive Medicaid benefits.
The QMB, SLMB, and QI programs all have an asset limit of $7,560 for individual applicants. For a married couple, the asset limit is $11,340. The counted assets do not include the inhabited house and the (one) car of the beneficiary.
These programs also automatically qualify beneficiaries for the Low-Income Subsidy (LIS) program that helps pay for Medicare Part D prescription drug costs. The income and asset levels of the beneficiary will determine whether the LIS will pay for all or just some of the expenses for Medicare Part D.
The Qualified Disabled and Working Individual (QDWI) program pays for the premium for Medicare Part A when the beneficiary has lost their premium-free Part A after going back to work. To qualify, an individual has an income limit of $4,132 a month and $4,000 of assets. Married couples have an income limit of $5,572 and an asset limit of $6,000.
Utah has a State Health Insurance Assistance Program (SHIP) that gives clarifications and answers regarding Medicare matters. Medicare beneficiaries in the state can call 800-541-7735 for information.