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Utah health insurance exchange

UT rates increasing just 5.7 percent; Medicaid expansion very close

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  • By
  • healthinsurance.org contributor
  • October 11, 2014

2015 rates

By mid-September, Utah insurance regulators had finished reviewing 2015 plans and rates, and had recommended them to HHS for final approval.  Although they are not yet finalized, it’s likely that they will be changed little – if any – by the time they are publicized on HealthCare.gov during the second week in November.  Open enrollment begins on November 15.

Overall, individual rates are expected to increase by an average of just 5.7 percent.  For small groups, the average expected increase is even smaller, at 3.5 percent.   Rate increases will be 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.

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 are among the least expensive regions to purchase health insurance in the US; the two county region ranked 7th on a list of the ten least expensive health insurance areas.

Carriers in the Utah exchange

For 2015, six health insurance carriers will be 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.

Medicaid expansion – nearly there

In mid-September, it was announced that HHS had “agreed in concept” to Governor Herbert’s “Healthy Utah” approach to Medicaid expansion.  At the time, the hope was that a final agreement would be forthcoming within just a few weeks.  At the annual health summit on September 30, Herbert told the audience that final approval was at most two weeks away, so it’s possible that a Medicaid expansion deal could be announced in Utah by mid-October.

Even if HHS grants official approval to Herbert’s Medicaid expansion proposal, there will still need to be legislative support – possibly in a special session, but more likely during the upcoming 2015 session.

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.

However, Gov. Herbert did not want to go with the ACA’s version of Medicaid expansion, and has instead pushed for an option that would utilize Medicaid funds to purchase private insurance.

Gov. Herbert’s “block grant” approach to Medicaid expansion failed to win enough support in the 2014 legislative session in Utah, so an expansion this year is basically off the table.  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.

Gov. Herbert has been pushing a privatized version of Medicaid expansion that would provide subsidized private plans to people with incomes up to 138% of poverty level (those between 100% and 138% would pay a small portion of the premiums).

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, it’s unlikely that expanded Medicaid coverage will be available until at least 2015.  Unfortunately, that leaves roughly 57,000 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

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)

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.