Choosing the Right Medicare
Health Insurance Plan
Thank you for letting
us help you with this important decision.
You may be turning 65, or
have been eligible for years.
You may be eligible for
medicare from a disability (Note: you can only
use Medicare Advantage if under 65 on Medicare).
You may just be looking
at options for when you are eligible in the
future and are still have group health coverage
through an employer.
Whatever the situation, we
are glad you stopped by! Please browse the
various sections below to see what interests you the
most. We are able to help you no matter what
your situation. We serve Utah, Nevada and
Arizona from right here in Sunny St George, Utah.
Let us answer whatever questions you have.
Make an Appointment for a Phone Call or Office
Greg Directly at (435) 767-1415 to see if he
can take your call right now!
Appointment (Medicare Eligible, or 65 and over)
During AEP (Oct 1 - Dec 7) - Schedule a
Medicare Appointment in Greg's office in St George,
Click for Medicare Office Appointment
AEP Annual Enrollment
Period: From October 15 - December 7 each year to
change your plan for the following January 1st.
If you are interested in an appointment outside of
the AEP Annual Enrollment Period, Call Greg directly
at (435) 767-1415 to make an appointment.
ACA Health Insurance (Under 65, non Medicare)
a Phone Consulation With Greg Davies:
Click for ACA Health Insurance Phone
ACA Health Insurance AEP
Annual Enrollment Period: November 1 - December 15
for the following January 1st.
If you would
rather come to Greg's Office in St George, Call Greg
Directly at (435) 767-1415 to ake an appointment.
Medicare or ACA Health - January to
appointment outside of the AEP Annual Enrollment
Period, or not in the St George Utah area?
Call Greg at (435) 767-1415 or email to
What is Medicare and how does it work?
Medicare is a federal health care program, managed
by the Centers for Medicare & Medicaid Services
(CMS), which provides health insurance to retired
individuals regardless of medical condition and to
certain people with disabilities. Original Medicare
is a fee-for-service plan with two components,
Medicare Part A and Medicare Part B. Medicare Part A
provides coverage for hospital bills (inpatient
hospital care, hospice care, and home health care).
This is financed by payroll taxes, with no premium
to beneficiaries who have at least 40 quarters of
The beneficiary pays a Part A deductible (that
changes each year) for hospital stays up to 60 days,
with additional copays required for each stay longer
than 60 days. There is a Premium cost for Part B. or
example in 2019 the cost is $135.50/month. The Part
B cost for future years is announced each year near
the end of the year.
The beneficiary pays a Part B deductible for
treatment outside a hospital. they then pay 20%
after the Part B deductible is met. There is no cap
or out of pocket maximums in Medicare. For this
reason many people choose a Medicare Supplement or
Medicare Advantage Plan to help pay for what
Medicare does not pay.
AEP Annual Enrollment Period: October 15 -
December 7 each year
During the MAPD Medicare Annual Enrollment Period,
Medicare recipients can choose to change their Part
D Prescription Plan, or enroll in the Part C
Medicare Advantage plan. You will know
Medicare's AEP is coming by the many advertisements
you receive by TV, Radio and mail. The reason
there is so much information coming to you is that
the AEP is the only time (outside of an SEP) that
you can make the changes mentioned above. Any
changes you make during the AEP will go into effect
on January 1 of the following year. If you are
on a MAPD Medicare Advantage Plan, you have one
chance to change your mind during the OEP discussed
below. After the OEP, unless you have an SEP
(Special Enrollment Period - see below), you
generally are locked into the plan you chose for the
rest of the calendar year.
Enrollment Period - January to March each year
The 21st Century Cures Act eliminates the existing MA disenrollment period
that currently takes place from January 1st through
February 14th of every year and, effective for 2019,
replaces it with a new Medicare Advantage open
enrollment period (OEP) that will take place from
January 1st through March 31st annually. The new OEP
allows individuals enrolled in an MA plan, including
newly MA-eligible individuals, to make a one-time
election to go to another MA plan or Original
Medicare. Individuals using the OEP to make a change
may make a coordinating change to add or drop Part D
coverage.Medicare beneficiaries will
be able to make the following ‘like plan’ changes
during the OEP:
• Switch from one
Medicare Advantage plan to another Medicare
• Disenroll from a Medicare
Advantage plan and return to Original Medicare, with
or without a Part D drug plan
The Medicare OEP does not
allow a beneficiary to change from one Part D plan
to another.What does this
mean to You?
It means you have a "second
chance" to make a change that you might have made
but regretted during AEP Annual Enrollment Period
from October 15 - December 7. It also is a
"second chance" in case you missed making the change
you wanted to make during AEP for some reason.
Switch MAPD to a new MAPD
An example would be that you have a Medicare
Advantage plan (MA or MAPD) from one company and
didn't realize another company had an offering in
your County that was a lot less money with about the
same or better benefits, then you can switch ONE
TIME only. From January 1 to March 31 you
could make a "one time" change and drop your current
MA and pick the other plan. Likewise, you
could switch back to your original MA or MAPDplan
you dropped during AEP.Can't change
to a new PDP
But if you have original
medicare (maybe with a Medicare Supplement) with a
Prescription Drug Plan (PDP), you are pretty much
stuck with that PDP option for the rest of the year.
This new OEP won't help you.Change
your Medicare Supplement/Medigap Plan Anytime
Some are confused on this one. With all the
AEP and OEP rules, some don't realize that you can
change your Medicare Supplement (also known as
Medigap) Plans anytime during the year. You
would have to aswer some medical questions, but if
you answer them correctly and qualify, you can move
from one Medicare Supplement plan to another.
SEP Special Enrollment Period - Anytime during
the year if eligible
The SEP Special
happens when you have a
that allows you to make
changes to your Medicare
Advantage and Medicare
coverage. The SEP
occurs when certain
events happen in your
life, like if you move
or you lose other
These chances to make
changes are called
Periods (SEPs). Rules
about when you can make
changes and the type of
changes you can make are
different for each SEP.
The following are
examples of SEP Special
You change where you
You lose your
You have a chance to
get other coverage
Your plan changes
its contract with
Utah Medicare Advantage General Information -
Serving all of Utah from Sunny St George
Call Licensed Insurance
Agent Greg Davies today at (435) 767-1415
and Abbreviations Discussed Below:
Medicare Part A - Hospital
Coverage for Medicare recipients
Medicare Part B - Outpatient Medical
Coverage for Medicare Recipients
Medicare Part C - Medicare Advantage Plans / MAPD
Medicare Part C Medicare Advantage Prescription with
Prescription Drug Coverage
PDP - Medicare Prescription Drug Plan
HMO - Health Maintenance Organization
PPO - Preferred Provider Organization
HMO-POS - HMO with a Point of Service (out of
PFFS - Private Fee For Service Plan that is an MA or
MAPD with no network
There are many options when you are Medicare
eligible. Medicare Parts A & B can be supplemented
with a Medicare Supplement Plan. You could also pick
a Medicare Advantage plan that usually has a lower
cost and includes a PDP Prescription Drug Plan. But
there is a lot of difference between Medicare
Supplement Plans and Medicare Advantage (MAPD)
Plans. Let us help you find the right plan for you!
Medicare Supplement vs
Medicare Advantage Plans?
What is the difference between a Medicare Supplement
plan and Medicare Advantage? That is a great
question. Basically, the Medicare Supplement Plan F
(most popular) steps in a pays all of the Medicare
Eligible expenses for the client. That means you pay
nothing in most every case! Medicare Advantage Plans
are also known by their abreviation "MAPD" for
Medicare Advantage Prescription Drug plans. have
copays. They usually cost a fraction of the cost of
Medicare Supplement Plans, but also your out of
pocket expense can be much higher. So with a
Medicare Supplement plan you "set it and forget it"
while you pay copays for most every service with
Medicare Advantage plans. Call Greg at (435)
767-1415 to get the details of the plans available
in Utah, Nevada & Arizona.
AEP Annual Enrollement begins October 15 and goes
until December 7th each Medicare season. During AEP
you can choose a new Utah Medicare Advantage plan
regardless of your health (except End Stage Renal
Disease.) Let us help you pick the right plan to fit
your specific needs.
Are you eligible for Medicare? Are you turning 65 in
St George Utah, Iron County or anywhere in Utah? Let
Greg help you pick the right Medicare Insurance plan
for your needs. Maybe you have a loved one over 65,
or someone under 65 who is eligible for Medicare and
is in need of a Medicare Insurance plan? We can help
you find out which plan would fit your needs. We
offer Regence, SelectHealth, University of Utah
Plan, AARP Medicare Complete, Molina, Sierra
Spectrum & Humana (if available in your county).
Medicare Plan G
Note: Those becoming
eligible for Medicare after January 1, 2020 will not
have the option of choosing Plan F as per new
Medicare rules. If you were eligible for Medicare
prior to January 1, 2020 then you will
still be able to change to a Plan F in the future.
Medicare Supplement Plan G is the most
comprehensive medicare supplement plan as of January
1, 2020. After you pay the Part B deductible,
you are covered for 100% for all medicare eligible
health expenses and treatment.
Without having one of these two plans, you’ll be
left responsible for those excess charges. However,
not all states allow doctors to charge you excess
Benefits for Medicare Plan G
Plan G include the
Coinsurance for hospital
costs for up to 365 days after Part A benefits have
been used up
Part B coinsurance or co-payments
Coinsurance for skilled nursing facility care
Pays the Part A deductible
Pays any Part B excess
Foreign travel emergency costs, up to
Part B preventive care coinsurance
Additional Questions for Medigap Plan F vs Plan G
Is it true that first-dollar coverage plans are
Additional Questions for Medicare
Plan F vs Plan G
Get all your questions regarding
Plan F vs Plan G answeredYes.
Starting in January 2020, all first-dollar coverage plans
will be discontinued.
Plan F, as well as High-Deductible Plan F.
However, as long as you were Medicare eligible
before 2020, you can still enroll in a first-dollar
coverage plan after 2020. This change is only
impacting those who are newly eligible after 2020.
This may cause the cost of Plan F to rise more
sharply in the future due to no new people being
added to the Plan F. But it is impossible to
predict any future rate increases.
If am already on a Plan F
prior to January 2020. Will I lose that plan?
No. You are "Grandfathered" into that plan for as
long as you want to keep it.
Does Plan G have a high deductible version?
No, Medigap Plan G does not have a high-deductible
version. However, come 2020 when High-Deductible
Plan F is no longer available to newly eligible
Medicare insurance beneficiaries, we will see a new
high-deductible Plan G introduced.
Can I change from my current Medicare Advantage plan
to a Supplement Plan G?
you can change from a Medicare Advantage plan to a
Medigap plan at any time. However, Guarantee Issue rights
(meaning no medical questions) would
only apply if you changed within the first 12 months
of enrolling into a Medicare Advantage plan.
Those Guanrantee Issue rights could only be used to
enroll in a plan that accepts Guarantee Issue.
Plan G will be the new Guarantee Issue Medicare
Supplment Plan as of Jan 1, 2020 for all new
medicare eligible enrollees.
Does Medigap Plan G or any other
Medicare Supplement Plan cover
No, no supplement plan
covers prescriptions. That’s where Part D comes into
play. If you’re given medications at the doctors’
office that are covered under Part B, then both
these plans will pay the 20% coinsurance.
Is there a difference in benefits between
carriers when enrolling in Medicare Supplement Plan?
Regardless of the carrier you choose, the benefits
are going to be the same. The only difference
between the carriers is the pricing method they use
to determine your premiums. The only difference
between one company's Plan G vs another company's Plan G is the
Since we work with all the
insurance carriers in the State of Utah, we can
provide you with unbiased expert advice. Contact us
and compare rates for all Medigap policies,
including G with all
the top insurance companies. We’ll answer your
questions and help you get a policy that works for
you. If you prefer, you can use our online rate
comparison tool to see rates local to you now.
Why does Part A have no Premium, and what does
Part A Cover?
Medicare Part A covers
inpatient hospital stays among other things.
Part A has no cost for most people (depending on
In general, Part A covers:
Why does Part B have a Premium when Part A has
no premium (for most people)?
Unlike Part A, Part B has a premium of $135.50 /
month (as of 2019). The reason for the highter
rate is that most of your treatment is usually
"outpatient" meaning while you are not a patient in
the hospital. For that reason, most people use
Part B Medicare coverage and participate in the cost
by paying the Part B Premium.
Part B covers 2 types of services
- Medically necessary services:
Services or supplies that are needed to diagnose
or treat your medical condition and that meet
accepted standards of medical practice.
Preventive services: Health care to
prevent illness (like the flu) or detect it at
an early stage, when treatment is most likely to
You pay nothing for most preventive services if
you get the services from a health care provider who
Part B covers things like:
What is a Medicare Advantage Prescription Drug Plan (MA,
Medicare Advantage is the name for a few different
types of plans that contract with the federal
government. Medicare Advantage plans include
Medicare Managed Care Plan (HMO), Medicare Preferred
Provider Organization (PPO), Medicare Private
Fee-for-Service plan (PFFS) and Medicare Cost and
other specialty plans. Essentially, these plans
reduce out-of-pocket expenses and provide greater
coverage than traditional Medicare alone, providing
all the benefits of Medicare Parts A and B, plus
additional benefits. The beneficiary continues to
pay the Medicare Part B premium as well as any
additional premium charged by the Medicare Advantage
Many Medicare Advantage plans are offered at no
premium in addition to the Part B premium. They can
also include a Medicare Part D Prescription Drug
plan benefit at little or no cost. They require
copays for using services much as a "pay as you go"
Who is eligible for an MA Medicare Advantage or MAPD
Potential members need to be at least 65 years old
or qualified as disabled by Medicare if they are
under age 65. They must have Medicare Parts A and B,
live within the plan's service area, and not have
end-stage renal disease [ESRD]. If they do not have
Part B, they are only eligible to purchase a
Medicare Part D drug plan.
What should you consider before purchasing a
Many Medicare Advantage (MedAdvantage MA or MAPD)
plans provide coverage at no additional cost to the
Part B premium. The Zero cost plans require copays
and coinsurance but most have no deductibles.
There are three types of health care plans that help
protect you from unexpected costs. Health
Maintenance Organizations (HMOs) are managed care
plans that require the member to use only contracted
doctors and hospitals and typically referrals are
required to see specialists.
Preferred Provider Organizations (PPOs) also have a
contracted network of providers, but members can
still see any provider that accepts Medicare
patients and receive coverage. The plan pays more if
you receive your care and services in-network. HMOs
and PPOs offer increased benefits over Original
Medicare such as physicals and vision care. HMOs and
PPOs roll original Medicare benefits and
supplemental benefits into one plan that usually
also includes a prescription drug plan (PDP).
What is a Medicare Supplement plan?
Medicare Supplement plans are secondary policies to
Medicare. With only a few exceptions, they do not
have a network of providers. Medicare Beneficiaries
pay a monthly premium and also need to purchase a
Medicare Part D Drug Card also. Medicare Supplement
(Medigap) plans help reduce your out-of-pocket
medical expenses for unexpected medical costs
associated with Medicare deductibles and
coinsurance. This coverage can include the Part A
and Part B deductibles and coinsurance, the skilled
nursing facility coinsurance, as well as other
There are twelve standardized Medigap plans, labeled
"A" through "L" each with different sets of benefits
and premiums. Plan A has basic supplemental
benefits, Plan J the most comprehensive. All plans
include basic benefits but not all insurance
companies offer all Supplement plans.
If you choose a "Select" C or F plan available in
many markets, you would get a greatly discounted
premium for agreeing to go to a certain network of
Hospitals. Medicare Beneficiaries are still able to
go to any doctor or provider that accepts Medicare.
Some companies have a "Select" C or F plan. You can
choose this Medicare Supplement plan at a greatly
discounted price and only go to Hospitals in the
Network they specify. You are still free to see any
doctor that accepts Medicare as payment for
What providers can I see on a Medicare Advantage Part C
With an HMO Medicare Advantage Plan members usually
must get their health care from Network Doctors and
Hospitals. In a PPO Medicare Advantage Plan members
are free to see any contracted provider accepting
Medicare patients but usually pay more for services
from non-network providers. With a PFFSYour provider
network booklet will show you many qualified
providers to choose from. When a member chooses to
see a provider that is not in our network, the
member's share of the costs will be greater. Members
are encouraged to see in-network providers to
receive the best benefit from the plan and lower
out-of-pocket costs. The opportunity for members to
choose out of network providers for their care is
one of the advantages of PPO or HMO/POS plan as
opposed to a strict HMO plan that does not allow out
of network coverage.
How do I choose between a Medicare Supplement Plan vs a
Medicare Advantage Plan?
If you want 100% coverage of everything that
Medicare doesn't pay, you might consider a Plan F
Medicare Supplement plan and a Part D Drug plan. But
the cost of such plans can be into the thousands of
dollars a year even if you never see a doctor, go to
a hospital or fill a drug prescription. On the other
hand, a Medicare Supplemental plan gives the peace
of mind that there is no additional cost in addition
to the monthly premium. You would still need to
purchase an additional Medicare Part D Drug plan
If you want low cost or even Zero cost plan and only
pay small copays and/or coinsurance as you receive
treatment, a Medicare Advantage (MA or MAPD) plan
might be right for you. And an MAPD plan usually
includes a Prescription Drug Plan (PDP) at no
It is very important to discuss your options with a
qualified Licensed Insurance Agent.
Call us at (435) 767-1415 or (801) 406-9502 to learn
What do I need to look for in Medicare Part D
Prescription Drug Plan?
Let us help you discover which Part D Prescription
Drug Plan will work for you. We need to consider all
of your current medications to see what plan would
result in the lowest annual cost. You also need to
see what the Generic copay is vs the Name Brand drug
copays are on the plan. Some plans classify drugs in
different categories. Other plans exclude some drugs
altogether. The only way to know if a certain plan
is right for you is to discuss it with a qualified
professional. We would love to help!
What if I don't get a Medicare Part D Prescription Drug
Plan when I am eligible?
If you choose not to purchase a Medicare Part D
Prescription Drug Plan when you become eligible for
Part A, then you would incur a penalty if you ever
purchase a Part D Drug benefit in the future. The
penalty is apx 1% per month for each month you go
without a drug benefit. For example if you waited 5
years (60 months) before getting a plan, then you
would pay approximately 60% surcharge compared to
someone that had a drug plan in force without a gap
in coverage. So if the national average for a Part D
Drug plan is $35/month, then you would pay $35 x
1.60 or $56/month. And this additional surcharge
NEVER GOES AWAY as long as you have a drug plan. The
only way to stop paying the surcharge would be to
drop the Prescription Part D drug plan altogether.
But then the penalty continues to accrue until you
purchase a Part D plan again. Let us help you decide
if a Prescription Drug Plan (PDP) is right for your
When can I change my Medicare Part D Prescription Drug
Plan or Medicare Advantage (MA or MAPD) plan?
Starting in 2011, the Annual Enrollment Period (AEP)
is October 15 to December 7th each year. During that
AEP period, you can pick a new Part D Drug plan, or
enroll in a MAPD plan. The effective date for the
change would be the 1st of January following the AEP
period. If you want to switch to a Medicare
Supplement plan from a MAPD plan, you would have to
wait until the AEP period.
What if I am on a MAPD plan and it cancels or decides
not to continue the following year?
This would result in a Special Enrollment Period
(SEP) that allows you to choose another MAPD plan
available in your area, or switch to a guarantee
issue Medicare Supplemental plan. That means that
even if you have a serious health problem, and your
MAPD plan cancels, then you can go on the Medicare
Supplemental plan, or a Medicare Advantage plan
without going through underwriting, or getting rated
up for any health problems. This can be a very good
situation for those that wish to switch but can't
due to health issues.
When am I eligible for a MAPD Medicare Advantage or
Medicare Supplement Plan?
There is generally a 7 month window for enrollment
without a Part D Drug penalty. Three months before
you turn 65, the month you turn 65 and three months
after the month you turn 65. Example: You turn 65 on
April 12. Jan, Feb and Mar + April + May Jun & July
would be your 7 month Initial Enrollment Period
(IEP). If you miss that IEP, you could start
accruing a Part D Penalty. You are usually given 6
months after your birth date and still not receive a
What if I continue with my Employer Group Insurance plan
past age 65?
Usually there would be no penalty accrued for not
enrolling in a Part D drug plan after age 65 if it
is done within the Medicare timeframe after you drop
or lose your Group Health and/or Prescription Drug
coverage. This is only true though if the Employer
group plan was deemed "Qualified" coverage in that
it was at least as good as the Part D plans as
determined by Medicare. As soon as you decide to
drop your group benefit or it is canceled, you would
have 60 days to choose an MAPD or Medicare Part D
Drug plan to avoid a Medicare Part D Prescription
penalty from accruing. You would also be able to
choose a Medicare Supplemental Health plan during
those 60 days and get approved even if you have
serious pre-existing health problems. Missing that
60 day timeframe would require you to qualify
medically in an underwriting process with the
Medicare Supplemental Plan. If you chose an MAPD,
you can get covered regardless of your health during
the AEP which is October 15 - December 7 each year.
But you may have a gap in coverage if you miss your
60 day window after losing group coverage.
What if I receive a Medicare Disability prior to age 65?
In Utah someone under the age of 65 that is eligible
for Medicare cannot choose a Medicare Supplement
plan. They can however choose a Medicare Advantage
plan if one is available in their county. They have
a 60 day period following the month they are found
Medicare eligible to choose a Medicare Advantage
plan. They could also choose to not have a Medicare
health plan in addition to Medicare benefits and
only choose a Part D Drug plan (PDP). This allows
them to avoid a penalty that would accrue for not
having a PDP in place when they became eligible for
What if I am under 65 and eligible for both Medicare AND
Medicaid? (Dual Eligible)
This would mean you are "Dual Eligible" or eligible
for a Special Needs Plan (SNP). There are different
levels of Medicaid. If you eligible to pay nothing
for your Medicaid, then you can change your MAPD or
Part D plan as often as you like. If you do a "spend
down" when it comes to Medicaid - or in other words
you have to pay part of your Medicaid premium - you
can only make changes to your MAPD or Part D drug
plan during the AEP Annual Enrollment Period of
October 15 to December 7 each year.
How do I choose which plan is right for me?
Contact Greg Davies - a qualified Licensed Utah
Insurance Agent who specializes in Medicare
Advantage, Medicare Supplement and Medicare
Prescription Drug Plans in the Utah market. Greg has
been in the Utah Insurance industry since 1997 and
knows the plans that work well for Medicare Eligible
Beneficiaries in Utah. Let Greg help you with any
questions you may have in any of the above
Greg Davies - Licensed Utah Insurance Agent
40 N 300 E #203
St George UT
Office also in
South Jordan, UT
We can help you get a health plan on or
off the ACA "ObamaCare" Exchange. We help
you apply for the subsidy and pick the right
Get Health Quote
If you are eligible for Medicare, we
have all the plans that work with Medicare
Parts A & B. Get Medicare Supplement Plans
or the popular Medicare Advantage MAPD
See Medicare Plans
Is an MAPD right for you? We can get you
all the information you will need to make
Picking the right PDP is very important.
We carry all the major plans in the market.
Call us today to see if you qualify.