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Utah health insurance exchange

UT rates increasing just 5.7 percent; Medicaid expansion in the works

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  • By
  • healthinsurance.org contributor
  • December 7, 2014

Open enrollment began on November 15, and continues through February 15.  If you’re in Utah and you want your new policy to begin on January 1, you’ll need to complete your enrollment by December 15.  Enrollments submitted between December 16 and January 15 will have a February 1 effective date, while enrollments submitted between January 16 and February 15 will have a March 1 effective date.

Utah residents use HealthCare.gov to enroll.  While HHS has not released state-by-state enrollment numbers yet for the current open enrollment period, they are providing weekly updates on total HealthCare.gov enrollment (37 states), which reached 765,135 after just two weeks (November 15 – 28).  We’ll likely know by late December how many enrollees have signed up in Utah, but in 2014 the state got a little more than 1.5 percent of the total HealthCare.gov enrollment.

2015 rates

Overall, individual rates in the Utah exchange are increasing by an average of just 5.7 percent for 2015.  For small groups, the average increase is even smaller, at 3.5 percent.   Rate increases are slightly higher in rural areas (about 7 percent), but overall, the state will be seeing a respite from the double digit rate hikes that have been common for many years.  Across the entire individual market, including on and off-exchange policies, the average rate increase in Utah is a weighted average of 7.6 percent.

The modest rate increases are especially good news considering rates in Utah were already lower than the national average.  For 2014 plans, across all age groups, the average lowest cost bronze plan in Utah is $201/month before subsidies, compared with a national average of $249.

A report released in February 2014 found that Davis and Salt Lake were among the least expensive regions to purchase health insurance in the US in 2014; the two county region ranked 7th on a list of the ten least expensive health insurance areas.

The benchmark plan (second lowest cost silver plan) in most areas in Utah is only slightly more expensive than the benchmark plan in 2014, and in some cases, even less expensive.  But the Salt Lake area is an exception according to a November report issued by the NY Times.  They show the benchmark plan in the Salt Lake area an average of 14.3 percent more expensive in 2015 than it was in 2014.  On the other hand, a Kaiser Family Foundation analysis published in November found that a 40 year old enrollee in Salt Lake would pay just 2.7 percent more for the benchmark plan in 2015 compared with the benchmark plan in 2014.

Carriers in the Utah exchange

For 2015, six health insurance carriers are offering a total of 108 policies (up from 96 in 2014) through Utah’s federally-run individual exchange: Altius Health Plans, Arches Mutual Insurance, BridgeSpan Health, Humana Medical Plan of Utah, Molina and SelectHealth.

The carriers themselves are unchanged from 2014, although they are offering more plans in 2015.  In addition to the exchange options, six carriers (including three new ones) will be offering 148 different plans outside the exchange.

In 2014, some health plans in the Utah exchange offered plans with dental riders available as an add-on purchase.  In 2015, the Department of Insurance is requiring that plans either be sold with or without dental and pediatric dental – it’s no longer something that consumers will have to add to a policy, rather the plans will simply come with it if consumers opt for dental coverage.

2014 enrollments

As of April 19, the number of people who had finalized their private plan selections in the Utah exchange had grown to 84,601 (HHS will released updated enrollment numbers in November).  An additional 50,268 people had enrolled in the state’s existing Medicaid program through the Utah exchange by April 19.

In June, HHS released a report showing the average pre-subsidy and after-subsidy premiums in each of the 36 states that have federally-facilitated marketplaces (FFM).  Utah had the lowest average pre-subsidy premiums, at $243 per month ( the next lowest was $272 per month in Arizona, and rates reached as high as $536 per month in Wyoming).

But in a demonstration of how well the ACA’s premium tax credits level the field when it comes to health insurance premiums, the 86 percent of Utah enrollees who received a subsidy paid an average after-subsidy premium of $84, nearly the same as the $82 average across all 36 FFMs.

Enrollment assistance available

The Utah Health Policy Project and the Urban Indian Center of Salt Lake were both awarded navigator grants by CMS in September and are providing enrollment assistance during the current open enrollment period.  Take Care Utah is a navigator organization that provides enrollment assistance around the state, and the People’s Health Clinic in Park City has navigators and enrollment assistance available at least once per week throughout open enrollment (schedule here).

Medicaid expansion – nearly there

In October, Governor Gary Herbert announced that he had reached a deal with HHS – after months of negotiations – to expand Medicaid in Utah using his “Healthy Utah” approach that would be unique to the state rather than following the guidelines laid out in the ACA.

Governor Herbert’s proposal draws on aspects of programs that have been implemented in several other states, including Iowa, Arkansas, and Pennsylvania.  Healthy Utah is a privatized version of Medicaid expansion and would use Medicaid funds to purchase private insurance through the exchange for eligible enrollees (those between 100% and 138% would pay a small portion of the premiums).

In early December, Governor Herbert unveiled his proposal for the state legislature.  Lawmakers in Utah have the final say over whether or not the Healthy Utah program is implemented.  It’s unclear whether the 2015 legislative session will approve Healthy Utah or not.  Leaders in the legislature have their own versions of Medicaid expansion that they’ve been working on, although they would be less generous for beneficiaries than Healthy Utah, and lawmakers are concerned that all of the options on the table will be expensive for the state (Healthy Utah is a privatized version of Medicaid expansion, so it’s more expensive than straight expansion under the ACA).

Utah has been politically divided on the ACA, with some lawmakers championing HCR10, a non-binding resolution detailing the “devastating impacts of the ACA” that was signed by Governer Herbert in April 2013.  But on January 23, Gov. Herbert announced that Utah would look for a way to expand Medicaid, saying that “doing nothing is not an option” and noting that there are 60,000 people in Utah who would be left in a coverage gap if the state did not expand Medicaid (a University of Utah study in 2014 pegged this number at 77,000 people).

Gov. Herbert’s “block grant” approach to Medicaid expansion failed to win enough support in the 2014 legislative session in Utah.  But the governor kept working with HHS to get his plan approved, and neighboring states have been watching his progress to see if a similar approach might work for them too.

In late June, a poll indicated that 88 percent of Utah residents favor Gov. Herbert’s “Healthy Utah” plan over doing nothing at all to assist low-income residents in securing health insurance.  And 70 percent of the poll respondents prefer the Governor’s privatized version over a straight Medicaid expansion as outlined in the ACA.

But even though an overwhelming majority of the state’s population would like to see some form of Medicaid expansion, expansion of the program is still uncertain given that it must be approved by state lawmakers.  Unfortunately, that leaves up to 77,000 Utah residents in the coverage gap, unable to qualify for Medicaid, and also ineligible for subsidies to purchase private insurance in the exchange.

Grandmothered plans

The Utah Department of Insurance accepted the Obama Administration’s March offer to allow pre-2014 (but non-grandfathered) health plans to be extended into 2015 or even 2016, and by mid-June, the state’s two largest insurers had also accepted the offer.

Regence Blue Cross and Blue Shield and SelectHealth – covering a total of 60 percent of the individual health insurance market in Utah – have both said that their members who still have pre-2014 plans will be able to renew them this fall, and may be able to do so again in the fall of 2015.

Insureds with these plans can opt to switch to an ACA-compliant plan instead, either during general open enrollment or when their plan renews (renewal of an individual plan outside of general open enrollment is a qualifying event that triggers a special enrollment period).

Avenue H – Utah’s state-run SHOP exchange

Along with Massachusetts, Utah has a health insurance exchange that predates the Affordable Care Act. However, unlike the exchanges called for by the Affordable Care Act, Utah’s exchange is not open to individual consumers to purchase health insurance. That fact has led to a series of discussions and negotiations between the state and the U.S. Department of Health and Humans Services (HHS) — and ultimately, a unique approach that is attracting interest from other states.

The Utah Health Exchange for small businesses was established in 2009 and rebranded as Avenue H in October 2012. Avenue H offers a “fixed contribution” approach for small employers. An employer contributes a fixed amount toward each employee’s health insurance. An employee then uses the exchange website to pick an insurer and policy to fit his or her individual or family needs. According to an article in The Salt Lake Tribune, about 350 businesses provided health insurance to about 7,800 people through Avenue H.

In 2015, small-businesses will have their choice of 75 plans from three carriers on Avenue H (Arches Mutual Insurance, SelectHealth and UnitedHealthcare of Utah), and 576 plans from seven companies that are selling small group plans outside the exchange.

Exchange history – a unique approach

Gov. Herbert asked President Obama to direct the U.S. Department of Health and Human Services (HHS) to approve Utah’s exchange and to consider it a “minimum standard” for an ACA-compliant state-based exchange. In January 2013, HHS granted conditional approval for Utah’s exchange while maintaining that it must be expanded to serve individual consumers.

Herbert continued to lobby for HHS to accept the Avenue H “as is” and proposed in February that the state continue running its small business exchange and that the federal government operate the individual exchange. In May, HHS and Utah reached an agreement for this dual-model approach, and Utah moved forward with two separate exchanges – small business run by the state and individual run by HHS – when open enrollment began for individual policies in October.

New Mexico has also adopted a hybrid approach, but the specifics are different.

Contact the exchange

HealthCare.gov
Use the federal marketplace to enroll in individual or family coverage beginning Oct. 1, 2013

More Utah health insurance exchange links

Avenue H
Utah’s exchange for small businesses (Small Business Health Options Program, or SHOP)
877-213-1993

Health Insurance Division Consumer Service
Assists consumers who have purchased insurance on the individual market or who have insurance through an employer who only does business in Utah.
(801) 538-3077

Office of Consumer Health Assistance (OCHA)
Serves residents with health care complaints.
(801) 538-9674 / Toll-Free: 1-800-439-3805 / health.uid@utah.gov

State Exchange Profile: Utah
The Henry J. Kaiser Family Foundation overview of Utah’s progress toward creating a state health insurance exchange.