Utah Health Insurance

Health insurance in Utah

● Utah uses the federally run health insurance market - HealthCare.gov - to enroll people.

● Open enrollment in Utah for 2021 health plans is November 1 to December 15, 2021; Residents with qualifying events can register outside the open sign-up window.

● Short-term health insurance plans can be sold in Utah with initial plan terms of up to 363 days.

● Regence joins the exchange for 2021, bringing the total number of market insurers in Utah to five.

● More than 200,000 Utah residents have enrolled in 2020 medical insurance through the market, which is a record for the state.

● Utah's CO-OP is one of 19 ACA CO-OPs that have folded.

● In 2018, Utah voters passed Proposition 3, offering Medicaid expansion coverage to the state. The partial expansion of Medicaid came in April 2019 and the full expansion in January 2020 is effective. A work requirement has been imposed, but has been suspended amid the COVID-19 pandemic.

● More than 413,000 Utah residents are enrolled in Medicare plans. About 40% of that population had Medicare Advantage plans in 2020.

This page is dedicated to helping consumers quickly find health insurance resources in the state of Utah. Here you will find information about the many types of health insurance coverage available. You can find the basics of Utah's health insurance market and the next open enrollment period; a brief overview of Medicaid expansion in Utah; a quick look at the availability of short-term health insurance in the state; statistics on state-specific Medicare rules; as well as a collection of health insurance resources for Utah residents.

Utah's health insurance marketplace

Utah uses federally managed trade/market, which means individuals and families sign up for health plans using HealthCare.gov.

The market is used by individuals and families who need to buy their own health insurance. This includes early retirees who are not yet eligible for Medicare, self-employed workers, and people employed in a small business that does not offer health benefits (small employers are not required to offer coverage under the ACA; this requirement applies only to a company with at least 50 employees).

Signing up for a plan offered through the exchange is the only way Utah residents can get financial assistance with their individual market coverage. This includes premium subsidies, which reduce monthly enrollee health insurance premiums, and cost-sharing reductions, which reduce out-of-pocket costs when people need medical care.

By 2020, BridgeSpan is back in utah's health insurance marketplace, after coming out in late 2015. Molina returned to the stock exchange in 2019 after exiting at the end of 2017. And for 2021, Utah's Regence BlueCross BlueShield is joining the exchange, having previously only offered plans outside of the exchange.

So Utah's health insurance marketplace has gone from having only two insurers in 2018 to having five insurers for 2021: Molina Healthcare of Utah, SelectHealth, Inc., University of Utah Health Insurance Plans, BridgeSpan, and Utah's Regence BlueCross BlueShield (some have limited coverage areas, so plan options vary from one part of the state to another).

Three of Utah's insurers have proposed premium cuts for 2021, while the other two have proposed modest rate hikes.

Open enrollment period and dates in Utah

Open enrollment for 2021 market individual health coverage in Utah runs from November 1, 2020 to December 15, 2020. This window applies in the Utah health insurance market and outside the market (for example, directly through insurance companies).

The open enrollment period allows new subscribers to select coverage in the individual market, and is also an opportunity for existing subscribers to renew or change their coverage for the following year. Enrollees should also update their financial information that is on file with the exchange, so that financial assistance (premium subsidies, cost-sharing reductions, and Medicaid eligibility) for next year is based on currently accurate information.

Outside of the open sign-up window, Utah residents with qualified events can sign up or make changes to their coverage.

During Utah's open enrollment period for 2020 health plans, a record 200,261 people selected the plans through the Utah exchange.  Utah has avoided year-on-year enrollment decreases that have occurred since 2016 in most states that use HealthCare.gov.

Does Utah have a health insurance CO-OP?

The ACA contained a provision providing funding for the creation of consumer-oriented and managed plans (CO-PO), and more than $2 billion was allocated for the creation of CO-POs in 22 states. Utah's Arches Mutual Insurance Company received $89.6 million.

As of early 2015, there were 22 CO-POs operating in 23 states. At the end of October 2015, however, Utah's CO-OP reported that it would cease operations at the end of the year. By December 2020, all but four of the original ACA CO-POs had been closed. And by 2021, there will only be three remaining CO-PoOs, as New Mexico's health connections will shut down at the end of 2020.

Medicaid expansion in Utah

Medicaid expansion became available as an option for states in 2014, but Utah was among the states that refused to accept federal funding to expand Medicaid coverage to more low-income adults.

But in the 2018 midterm elections, Utah residents voted for Proposition 3 passage with 54% of voters supporting expanding Medicaid coverage. The election initiative directed the state to fully expand Medicaid plans, as required in the ACA (for example, to people with incomes up to 138% of the poverty level)

The text of the election initiative called for the Medicaid expansion to take effect as of April 1, 2019, and this happened, even if only partially. Utah lawmakers balked at the idea of medicaid expansion and quickly enacted legislation in 2019 that would limit it. Although the expansion came into force in April 2019, it only applied to people with family incomes up to the poverty level, rather than 138% of the poverty level.

That meant there was no longer a coverage gap in Utah. But CMS rejected Utah's request to receive full federal funding (i.e. a 90/10 federal/state division starting in 2020) for the costs associated with the state's partial Medicaid expansion, so Utah was receiving their normal federal correspondence rate only for the partial expansion group in 2019. Ultimately, Utah has fully expanded Medicaid coverage since January 2020, even though a work requirement also applied at that point. The work requirement was soon suspended, however, due to the COVID-19 pandemic.

Short-term health insurance in Utah

Utah's state regulation of short-term health insurance plans is stricter than current federal regulations governing short-term health insurance policies. The maximum duration for a short-term health insurance plan in Utah is 363 days, and policies cannot be renewed.

Did Obamacare help Utah residents?

Utah hasn't exactly embraced the ACA, (also known as Obamacare), but the state's uninsured rate has still fallen significantly since the law was enacted. According to U.S. Census data, 14% of Utah residents were un insured in 2013, and this fell to 8.8% by 2016 , although it increased to 9.4% by 2018 and 9.7% by 2019.

But the full expansion of Medicaid took effect in Utah in early 2020 and likely led to a significant reduction in the uninsured rate. Medicaid expansion has been especially important in addressing the COVID-19 pandemic as people lose their jobs and employer-sponsored health insurance.

Utah and the Affordable Care Act

Utah initially took a unique approach to managing the health insurance marketplace. In a compromise with HHS, the state handled its own small business exchange "Avenue H" (SHOP), which pre-dated the ACA, while HHS managed the individual exchange.

But Utah ultimately decided that it would be more cost-effective to switch to the federally managed SHOP exchange and that the transition was made to from 2018.

Governor Gary Herbert was generally opposed to the ACA, but had been looking for a way to expand Medicaid coverage for several years, noting that "doing nothing is not an option." The vast majority of Utah residents favored the governor's approach to no Medicaid expansion, so it wasn't surprising that the campaign initiative to expand Medicaid coverage passed in 2018.

Does Utah have a high-risk pool?

Prior to the ACA, individual health insurance was underwritten in nearly every state, including Utah. This meant that pre-existing conditions could prevent an applicant from obtaining a policy or lead to higher premiums or exclusions of pre-existing conditions.

The Utah Comprehensive Health Insurance Pool (HIPUtah) was created to offer people an alternative if they couldn't get private individual health insurance because of their medical history.

Now that all health insurance plans are guaranteed, high-risk pools are largely outdated. Hiputah coverage ended on December 31, 2013, and members were able to move to guaranteed coverage of the issue through trade.

Medicare coverage and enrollment in Utah

Enrollment in Utah Medicare reached 413,193 as of August 2020.  About 40% were enrolled in private Medicare Advantage plans, and the other 60% were enrolled in Original Medicare.

Utah Health Insurance Resources

● Utah Insurance Department - Allows licenses and regulates health insurance companies, brokers and agents. It can provide information and assistance to consumers with a wide range of health insurance questions and claims.

● Utah Senior Services - Part of the state's Department of Human Services, it provides assistance, information, and resources for people with Medicare in Utah.

Utah Health Reform Legislation

SB96 was enacted in Utah in 2019, after voters approved an election initiative in 2018 calling for the full expansion of Medicaid. The legislation reiterated the state's proposal to expand Medicaid coverage only to those earning up to poverty level, while keeping people above that level on private plans subsidized in the exchange. In the end, however, the full expansion of Medicaid is effects in Utah in 2020. The work requirement initially applied was suspended in April 2020 due to the COVID-19 pandemic.