Choosing a Medicare Advantage plan isn’t just about finding the lowest premium or the plan with the most “extra benefits”. The right plan can save you thousands of dollars and make it much easier to get the care you need throughout the year.

With about 30 Medicare Advantage plans available in Utah, asking the right questions before enrolling can help you avoid surprises later. Here are the most important questions you should ask before choosing a Medicare Advantage plan.

1. Are My Doctors and Specialists In-Network?

One of the biggest differences between Medicare Advantage plans is their provider network.

Before enrolling, ask:

• Is my primary care physician in-network?
• Are my specialists in-network?
• Is my preferred hospital in-network?
• If I travel within Utah, will I still have access to care
• If I travel outside of Utah, where can I get care?

Even if your doctor accepted a plan last year, always verify they still participate for the upcoming plan year.

2. Are My Prescription Drugs Covered?

Every Medicare Advantage plan has its own UNIQUE drug formulary.

Ask:

• Are all of my medications covered?
• What tier are they on?
• Will I need prior authorization?
• Can I use my preferred pharmacy
• What will be my estimated out of pocket cost for medication for the year?

A plan with a lower premium can sometimes cost much more if your medications aren’t covered well.

3. What Is the Maximum Out-of-Pocket Cost?

Unlike Traditional Medicare, Medicare Advantage plans have an annual Maximum Out-of-Pocket (MOOP).

This is the most you’ll pay for covered medical services during the year before the plan pays 100% for covered services.

Ask:

• What is the in-network MOOP?
• Is there a separate out-of-network MOOP if it’s a PPO plan?
• How much could I realistically pay if I had a major illness?

Understanding your financial risk is one of the most important parts of choosing a plan.

4. Do I Need Referrals?

Some Utah Medicare Advantage plans require referrals to see specialists.  Most HMO plans do.

Others allow you to schedule specialist appointments without needing approval from your primary care doctor.

Ask:

• Do I need referrals?
• How easy is the referral process?
• Can I see specialists directly?

5. How Much Will I Pay When I Actually Use the Plan?

Many people focus only on the monthly premium or “extra benefits”.

Instead, ask about the costs you’ll actually pay throughout the year.

Examples include:

• Primary care visits
• Specialist visits
• Urgent care
• Emergency room visits
• Hospital stays
• Outpatient surgery
• MRI and CT scans
• Physical therapy
• Chemotherapy
• Skilled nursing care

Sometimes a plan with a slightly higher premium or lower “extra benefits” actually saves money if you regularly use healthcare.

6. Are My Preferred Hospitals Included?

Utah has several excellent health systems (IHC, UofU, Mountain Star, Common Spirit Holy Cross).

If you have a preferred hospital or healthcare system, verify that it’s in-network before enrolling.

This becomes especially important if you already receive care from specialists within a particular health system.

7. Will I Need Prior Authorization?

One of the most common questions people ask about Medicare Advantage plans is whether certain services require prior authorization.

Ask about:

• MRIs
• CT scans
• Physical therapy
• Skilled nursing
• Surgeries
• Home health services
• Expensive medications

Knowing what requires approval can help prevent delays in care.

8. What Extra Benefits Are Included?

Many Medicare Advantage plans include benefits Original Medicare doesn’t cover.

These may include:

• Dental coverage
• Vision exams and eyewear
• Hearing exams and hearing aids
• Fitness memberships
• Over-the-counter allowances
• Transportation assistance
• Telehealth services

Compare the value of these benefits, but don’t let them outweigh the importance of your doctors, hospitals, and medical coverage.

9. Can I Travel?

If you spend winters in another state or travel frequently, ask:

• Am I covered outside Utah?
• Is emergency care covered nationwide?
• Can I receive routine care while traveling?

Some PPO plans offer more flexibility than HMO plans for travelers.

10. How Stable Has the Plan Been?

It’s also helpful to understand the plan’s history.

Ask:

• Have premiums changed significantly?
• Have provider networks remained stable?
• Have benefits been consistent?
• Has the company maintained strong Medicare Star Ratings?

Past performance doesn’t guarantee the future, but it can provide valuable insight.

11. Is Medicare Advantage the Right Choice for Me?

Before choosing any Medicare Advantage plan, ask yourself:

• Do I prefer lower monthly premiums?
• Am I comfortable using provider networks?
• Do I travel frequently?
• Would I rather have more predictable healthcare costs?
• Would a Medicare Supplement plan better fit my needs?

The answer depends on your health, budget, travel habits, and personal preferences.

Final Thoughts

There isn’t one Medicare Advantage plan that’s best for everyone in Utah. The right choice depends on your doctors, medications, healthcare needs, and financial goals.

Taking time to compare plans and ask the right questions can help you avoid costly mistakes and choose coverage you’ll be happy with throughout the year.

Need Help Comparing Medicare Advantage Plans in Utah?

At Professional Insurance Solutions, we help Utah residents compare Medicare Advantage plans from multiple insurance companies at no additional cost.

We’ll review:

• Your doctors and specialists
• Your prescription medications
• Your preferred pharmacies
• Your expected healthcare usage
• Your travel habits
• Your budget

Our goal is simple: help you choose the Medicare Advantage plan that best fits your needs—not just the one with the lowest premium.

Have questions? Contact Professional Insurance Solutions today for a personalized Medicare Advantage review.

Tyler Haskell, CFP®

801-369-3090