If you're turning 65 in Utah or helping a parent navigate Medicare, you're working through four parts, dozens of plan choices, and costs that reset every January. The standard Part B premium for 2026 is $202.90 a month, the Part D out-of-pocket cap is now $2,100, and free counseling is available through the Utah SHIP at the Utah Insurance Department.
This guide walks through every piece of Medicare as it applies to Utah residents in 2026: what it costs, how plan choices break down across the state, and how to get help paying for it.
In This Guide
- Key Takeaways
- Original Medicare: Parts A and B
- Medicare Advantage in Utah (Part C)
- Medicare Part D: Prescription Drugs
- Medigap in Utah
- Help Paying for Medicare in Utah
- Medicare Enrollment Periods
- Free Medicare Help: Utah SHIP
- Frequently Asked Questions
About these numbers: The premiums and deductibles below come from CMS for calendar year 2026, effective January 1. Medicare costs change every year. For the most current figures, contact Medicare at 1-800-633-4227 (1-800-MEDICARE) or Utah SHIP at the Utah Insurance Department.
Original Medicare: Parts A and B
Original Medicare is run directly by the federal government and comes in two parts.
Part A (Hospital Insurance)
Part A covers inpatient hospital stays, limited skilled nursing facility care, hospice, and some home health care.
| Cost | Amount |
|---|---|
| Monthly premium | $0 for most people (40+ quarters of work history) |
| Hospital deductible | $1,736 per benefit period |
| Hospital coinsurance, days 61-90 | $434 per day |
| Lifetime reserve days | $868 per day |
| SNF coinsurance, days 21-100 | $217 per day |
The hospital deductible resets each benefit period. A benefit period starts the day you're admitted and ends 60 days after discharge. A readmission after that gap triggers a new deductible.
Part B (Medical Insurance)
Part B covers doctor visits, outpatient care, preventive services, durable medical equipment, and mental health care. It does not cover routine dental, vision, or hearing.
- Monthly premium: $202.90 (higher if your income exceeds $109,000 single or $218,000 married, under the income-related adjustment)
- Annual deductible: $283
- After the deductible: you pay 20% of the Medicare-approved amount for most services
Part B is optional in name only. Nearly everyone enrolls. Delay past your initial window without other creditable coverage and you owe a late penalty of 10% for every 12 months you could have had it, permanently added to your premium.
Medicare Advantage in Utah (Part C)
Medicare Advantage plans are an alternative to Original Medicare, sold by private insurers. They cover everything Parts A and B do, and most bundle Part D drug coverage along with extras like dental, vision, and hearing.
Plan availability in Utah varies by geography. The Salt Lake City, Provo, and Ogden metro areas have the widest selection, with multiple carriers competing. Rural counties, particularly in the west desert and eastern canyon lands, typically have fewer plans and in some areas only one or two options. Use the Medicare Plan Finder at medicare.gov to see exactly which plans are available in your ZIP code.
How These Plans Work
- You keep paying your Part B premium ($202.90) on top of any plan premium, though many plans charge $0 extra.
- Plans run on networks (HMO, PPO, or HMO-POS). Confirm your doctors are in-network before you enroll.
- Every plan caps your annual out-of-pocket spending. Original Medicare has no such cap; the federal maximum for in-network Medicare Advantage spending is $9,250 in 2026, and many plans set lower caps.
- Extras vary. Compare the dental, vision, hearing, and transportation benefits, not just the premium.
Enter your doctors and prescriptions into the Medicare Plan Finder and it shows which plans cover them and your estimated annual cost.
Medicare Part D: Prescription Drugs
Part D covers outpatient prescription drugs. You can get it as a standalone plan paired with Original Medicare, or bundled into a Medicare Advantage plan.
The Inflation Reduction Act eliminated the old coverage gap (the donut hole), so that higher-cost middle stage is gone. Part D now moves through three phases:
- Deductible: you pay full price until you meet your plan's deductible (up to $615 in 2026).
- Initial coverage: you pay copays or coinsurance while your plan and drug makers cover the rest.
- Catastrophic: once your out-of-pocket spending reaches $2,100, you pay $0 for covered drugs the rest of the year.
That $2,100 cap is the number that matters most. The base standalone Part D premium averages $46.50 a month nationally, though actual plan premiums vary by plan and county. People who qualify for Extra Help often pay much less, sometimes nothing.
Not sure which Part D plan fits your prescriptions? Chat with Brevy's care navigator at brevy.com.
Medigap in Utah
Medigap policies are sold by private insurers to fill the gaps in Original Medicare: the deductibles, coinsurance, and copays. They work only with Original Medicare, never with Medicare Advantage. In Utah, these policies are regulated by the Utah Insurance Department.
Utah offers the federally standardized plans, labeled A, B, C, D, F, G, K, L, M, and N. Plans C and F are closed to anyone who first became Medicare-eligible on or after January 1, 2020. Plan G is the popular pick for people newly eligible: it covers the Part A deductible, Part A and Part B coinsurance, and skilled nursing coinsurance, leaving only the $283 Part B deductible on you.
Your One Guaranteed Window
Your strongest opening is the federal Medigap Open Enrollment Period, the six months that begin when you're 65 and enrolled in Part B. During that window an insurer must sell you any plan it offers at the standard rate, no matter your health history.
Utah has no annual "birthday rule" and no other state-created yearly window that lets you switch Medigap plans without health questions. Once your six-month window closes, an insurer in Utah can use medical underwriting, meaning it can charge you more or turn you down based on your health, unless a federal guaranteed-issue right applies. The choice you make in those first six months carries real weight.
Medigap or Medicare Advantage?
You can't hold both. Choose Medigap and you stay on Original Medicare with the freedom to see any provider who accepts Medicare nationwide, at a higher monthly premium. Choose Medicare Advantage and you trade some of that flexibility for a network structure and, often, a lower upfront cost. Because Utah won't guarantee you a second shot at Medigap once your first six months pass, weigh that trade carefully before your window closes.
Help Paying for Medicare in Utah
Two programs can significantly reduce Medicare costs for people on fixed incomes.
Medicare Savings Programs
Utah administers Medicare Savings Programs through Utah DHHS Medicaid. They pay some or all of your Medicare premiums and cost-sharing based on your income and resources.
| Program | Individual | Couple | What it pays |
|---|---|---|---|
| QMB | Up to about $1,350 | Up to about $1,824 | Part A and B premiums, deductibles, coinsurance |
| SLMB | Up to about $1,616 | Up to about $2,184 | Part B premium |
| QI | Up to about $1,816 | Up to about $2,455 | Part B premium |
QMB is the most generous: it covers your Part B premium plus your deductibles and coinsurance, which can mean thousands of dollars saved a year. The 2026 resource limit for QMB and SLMB is $9,950 for one person and $14,910 for a couple, not counting your home, one car, and certain burial funds. Income limits are tied to the federal poverty level and typically update in the spring, so confirm current figures with Utah DHHS Medicaid before ruling yourself in or out. Utah SHIP counselors at insurance.utah.gov/consumers/seniors/ can also walk you through the application.
Extra Help for Part D
Extra Help, also called the Low-Income Subsidy, pays Part D premiums, deductibles, and copays for people with limited income and resources.
- Income limit: about $1,995 a month for an individual, $2,705 for a couple (150% FPL)
- Resource limits: $16,590 for an individual, $33,100 for a married couple
- If you qualify for QMB, SLMB, or QI, you're automatically enrolled in Extra Help
Apply through Social Security at ssa.gov or call 1-800-772-1213. Utah SHIP counselors can also walk you through the application.
Medicare Enrollment Periods
Miss a deadline and you can face coverage gaps or permanent penalties.
| Period | Dates | What you can do |
|---|---|---|
| Initial Enrollment | 7 months around your 65th birthday | Sign up for Parts A, B, and D; pick MA or Medigap |
| Annual Open Enrollment | Oct 15 - Dec 7 | Switch MA plans, move between MA and Original Medicare, change Part D |
| MA Open Enrollment | Jan 1 - Mar 31 | Switch MA plans or drop MA for Original Medicare (if already in MA) |
| General Enrollment | Jan 1 - Mar 31 | Sign up for Part B if you missed your initial window (coverage starts July 1) |
| Medigap Open Enrollment | 6 months from age 65 + Part B | Buy any Medigap plan at the standard rate, no health screening |
Changes made during Annual Open Enrollment take effect January 1 of the following year. If you miss your Initial Enrollment Period without other creditable coverage, Part B and Part D late penalties apply and compound over time.
Free Medicare Help: Utah SHIP
You don't have to sort this out alone, and you shouldn't pay a broker to help. Utah's State Health Insurance Assistance Program, or SHIP, gives free, unbiased Medicare counseling through the Utah Insurance Department. SHIP counselors don't sell insurance and take no commissions.
A SHIP counselor can help you:
- Understand your Medicare options and what each part covers
- Compare Medicare Advantage, Part D, and Medigap plans side by side
- Apply for Medicare Savings Programs and Extra Help
- Sort out billing disputes, denials, and appeals
- Spot and report Medicare fraud through the Senior Medicare Patrol
For local SHIP contact information and appointment scheduling, visit insurance.utah.gov/consumers/seniors/.
Frequently Asked Questions
Most people pay $0 for Part A. The standard Part B premium is $202.90 a month with a $283 annual deductible. Part D premiums average $46.50 a month nationally, and many Medicare Advantage plans charge no extra premium. Your total depends on the plan you choose and the care you use.
No. Utah has no annual birthday rule or other state-created yearly window to switch Medigap plans without health questions. Your one guaranteed-issue window is the six months that begin when you're 65 and enrolled in Part B. After that window closes, insurers can use medical underwriting, so the safest time to buy Medigap is during that initial period.
Apply for a Medicare Savings Program through Utah DHHS Medicaid and apply for Extra Help with Part D through Social Security at 1-800-772-1213 or ssa.gov. QMB covers all your Medicare premiums and cost-sharing if your income and resources are under the 2026 limits. A Utah SHIP counselor can walk you through both applications for free; visit insurance.utah.gov/consumers/seniors/ to find local contacts.
No. The Salt Lake City, Provo, and Ogden metro areas have the most choices. Rural counties have fewer options. Use the Medicare Plan Finder at medicare.gov to check what's available by ZIP code.
Missing your Initial Enrollment Period without other creditable coverage triggers late penalties. The Part B penalty is 10% added to your premium for each full 12-month period you delayed, and it lasts as long as you have Part B. The Part D penalty is 1% of the national base beneficiary premium per month of delay. Both penalties are permanent.
Learn More
- Medicare National Overview
- Original Medicare vs. Medicare Advantage
- Medicare Medigap Guide
- Medicare Part D Guide
- Medicare Enrollment Periods
Find personalized help with Medicare in Utah at brevy.com.
The information on Brevy.com is for educational purposes only and is not a substitute for professional legal, financial, or medical advice. Rules vary by state and program and change frequently. Always verify with the relevant agency or a qualified professional. Brevy is not a law firm, financial advisor, or healthcare provider.