Frequently asked questions about health insurance
coverage options in Utah
Utah uses the federally run exchange/marketplace, which means individuals and families enroll in health plans using HealthCare.gov (or an authorized enhanced direct enrollment entity).
The marketplace is used by individuals and families who need to purchase their own health insurance. This includes early retirees who aren’t yet eligible for Medicare, the self-employed, and people employed by a small business that doesn’t offer health benefits (small employers are not required to offer coverage under the ACA; that requirement only applies to a business with at least 50 employees).
Enrolling in a plan offered through the exchange is the only way Utah residents can obtain financial assistance with their individual market coverage. This includes premium subsidies, which reduce enrollees monthly health insurance premiums, and cost-sharing reductions, which reduce out-of-pocket costs when people need medical care.
Premium subsidies are larger than they used to be, and more widely available, thanks to the American Rescue Plan. But again, the exchange/marketplace is the only way to receive them, regardless of whether you take them upfront (sent directly to your insurance company each month) or claim them on your tax return.
The open enrollment period for individual/family health coverage runs from November 1 through January 15 in Utah. You can learn more about open enrollment in our comprehensive guide.
Outside of open enrollment, a qualifying event is generally necessary to enroll or make changes to your coverage. But people who are eligible for Medicaid can enroll at any time. And enrollment in private plans through the exchange is available year-round to Native Americans and to subsidy-eligible enrollees whose household income doesn’t exceed 150% of the poverty level.
In Utah, consumers may be able to buy affordable individual and family health insurance by enrolling through the ACA marketplace (HealthCare.gov). More than 90% of consumers who enrolled in 2022 coverage through HealthCare.gov received premium subsidies.
Utahns may also find affordable coverage through Medicaid if they’re eligible. See Medicaid eligibility guidelines in Utah.
Short-term health insurance is also a lower-cost coverage option in Utah, where five insurers offer short-term plans.
There are six insurers offering health plans for 2023 through Utah’s exchange. That’s down from seven in 2022, as Bright Health is no longer offering coverage after the end of 2022, after offering coverage in Utah for just one year. Coverage areas vary from one insurer to another, but plans are available from the following insurers for 2023:
- BridgeSpan
- Cigna
- Molina
- Regence
- SelectHealth (plans available statewide)
- University of Utah Health Plans (plans available statewide)
For 2023, the overall average rate change in Utah’s individual insurance market amounted to an increase of roughly 6%. But that’s before income-based subsidies are applied, and subsidy amounts change to keep pace with the cost of the benchmark (second-lowest-cost silver) plan in each area.
During the open enrollment period in Utah for 2022 coverage, 256,932 people enrolled in plans through the exchange. That was a record high, on the heels of previous record highs in 2020 and 2021.
The ACA contained a provision that provided funding for the creation of Consumer Oriented and Operated Plans (CO-OPs), and more than $2 billion was awarded for CO-OP creation in 22 states. Utah’s Arches Mutual Insurance Company received $89.6 million.
As of early 2015, there were 22 CO-OPs operating in 23 states. By the end of October 2015, however, Utah’s CO-OP delivered the news that it would cease operations at the end of the year. As of 2022, all but three of the original ACA CO-OPs had closed. Those three remaining CO-OPs offer coverage in five states.
Read more about the Affordable Care Act’s CO-OPs.
Utah has not 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 uninsured in 2013, and that dropped to 8.8% by 2016 — although it increased to 9.4% by 2018 and to 9.7% by 2019.
But full Medicaid expansion took effect in Utah at the beginning of 2020, and has likely resulted in a considerable reduction in the uninsured rate. Medicaid expansion has been particularly important in addressing the COVID-19 pandemic, and Medicaid eligibility redeterminations have been paused nationwide since early 2020 in response to the pandemic. This has helped millions of Americans maintain continuous coverage throughout the COVID public health emergency.
Utah initially took a unique approach to running the health insurance marketplace. In a compromise with HHS, the state ran its own “Avenue H” small business (SHOP) exchange, which pre-dated the ACA, while HHS ran the individual exchange.
But Utah eventually decided that it would be more cost-efficient to switch to the federally run SHOP exchange and that transition was made as of 2018. (The federal SHOP exchange has also transitioned to a direct enrollment process; the exchange platform no longer facilitates enrollment in small group plans. Instead, businesses use a broker or work directly with the insurance company.)
Former Gov. 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’s residents favored the governor’s approach over no Medicaid expansion at all, so it was not surprising that the ballot initiative to expand Medicaid coverage passed in 2018.
Medicaid expansion became available as an option for states in 2014, although Utah was among the states that initially refused to accept federal funding to expand Medicaid coverage to more low-income adults.
But in the 2018 mid-term elections, Utah residents voted for passage Proposition 3 with 54 percent of voters supporting Medicaid coverage expansion. The ballot initiative directed the state to fully expand Medicaid plans, as called for in the ACA (ie, to people with income up to 138% of the poverty level)
The text of the ballot initiative called for Medicaid expansion to take effect as of April 1, 2019—and that did happen, albeit only partially. Lawmakers in Utah balked at the idea of Medicaid expansion and quickly enacted legislation in 2019 that would limit it. Although expansion did take effect in April 2019, it only applied to people with household income up to the poverty level, rather than 138% of the poverty level.
This meant there was no longer a coverage gap in Utah. But CMS rejected Utah’s request to receive full federal funding (ie, a 90/10 federal/state split as of 2020) for the costs associated with the state’s partial Medicaid expansion, so Utah was only receiving their normal federal match rate for the partial expansion group in 2019. Ultimately, Utah did fully expand Medicaid coverage as of January 2020, although a work requirement also applied at that point. The work requirement was soon suspended, however, as a result of the COVID-19 pandemic, and approval for it was subsequently revoked by the Biden administration.
As of mid-2022, total enrollment in Utah’s Medicaid/CHIP was 57% higher than it had been in 2013. Nationwide, the increase also stood at 57% at that point, although there was wide variation from one state to another.
Read more about Medicaid expansion in Utah.
Utah state regulation of short-term health insurance plans is stricter than the current federal rules regulating short-term health insurance policies. The maximum duration for a short-term health insurance plan in Utah is 363 days and the policies cannot be renewed.
Read more about short-term health insurance coverage in Utah.
Utah Medicare enrollment reached 436,694 as of mid-2022. About 47% were enrolled in private Medicare Advantage plans, and the other 53% were enrolled in Original Medicare.
Read more about Medicare in Utah, including details about the state’s rules for Medigap plans.
Learn about Medicare’s annual open enrollment period (October 15 – December 7), during which Medicare beneficiaries can compare plan options and make changes to their Medicare Part D prescription coverage or Medicare Advantage coverage.
- Utah Insurance Department — Licenses and regulates health insurance companies, brokers, and agents. Can provide information and assistance to consumers with a wide range of health insurance questions and complaints.
- Utah Senior Services — Part of the state Department of Human Services, provides assistance, information, and resources for people with Medicare in Utah.
SB96 was enacted in Utah in 2019, after voters approved a ballot initiative in 2018 calling for full Medicaid expansion. The legislation reiterated the state’s proposal to expand Medicaid coverage only to those earning up to the poverty level, keeping people above that level on subsidized private plans in the exchange instead.
Ultimately, however, full Medicaid expansion took effect in Utah in 2020. The work requirement that initially applied was suspended in April 2020 due to the COVID-19 pandemic, and approval was later revoked by the Biden administration.
Before 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 could result in higher premiums or pre-existing condition exclusions.
The Utah Comprehensive Health Insurance Pool (HIPUtah) was created to give 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 issue, high-risk pools are largely obsolete. HIPUtah coverage ended on December 31, 2013, and members were able to transition to guaranteed issue coverage through the exchange instead.
