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 usual and more widely available in 2021, 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.
Open enrollment for health insurance in Utah runs from November 1 through December 15. Outside of the open enrollment period, people can normally only enroll in an individual/family health plan (on-exchange or off-exchange) if they experience a qualifying event.
But to address the COVID pandemic and the additional premium subsidies created by the American Rescue Plan, a one-time enrollment window is open in 2021. It continues through August 15, 2021, and people do not need a qualifying event in order to enroll or make a plan change during this window.
Just like the annual open enrollment period, the COVID-related enrollment window gives individuals and families a chance to enroll in a health plan or make a plan change, regardless of prior coverage history or pre-existing conditions. People who already have ACA-compliant individual market coverage may find that their best option is to switch to a different plan in order to best take advantage of the larger premium subsidies available under the American Rescue Plan. This includes people with off-exchange coverage who might be newly eligible for subsidies, since they will need to transition to the exchange in order to receive those subsidies.
After August 15, 2021, a qualifying event will be necessary for anyone wishing to enroll or make a plan change for 2021. Open enrollment for 2022 coverage will start November 1, 2021, with plan selections effective January 1, 2022.
For 2021, Regence BlueCross BlueShield of Utah joined the exchange, after previously only offering plans outside the exchange. For 2020, Cigna joined Utah’s marketplace, and BridgeSpan rejoined, after exiting at the end of 2015. Molina rejoined the exchange in 2019 after exiting at the end of 2017.
So Utah’s health insurance marketplace went from having just two insurers in 2018 to having six insurers for 2021: Molina Healthcare of Utah, SelectHealth, Inc., University of Utah Health Insurance Plans, BridgeSpan, Cigna, and Regence BlueCross BlueShield of Utah (some have limited coverage areas, so plan options vary from one part of the state to another).
Four of Utah’s insurers decreased their average premiums for 2021, while the other two implemented modest rate increases.
During the open enrollment period in Utah for 2021 health plans, the state hit another record high enrollment, with 207,911 people signing up for coverage through Utah’s exchange. Utah avoided the year-over-year enrollment decreases that occurred from 2017 through 2020 in most of the states that use HealthCare.gov.
During the first several weeks of the COVID-related enrollment window in 2021, nearly 11,000 people enrolled in plans through Utah’s exchange. That was more than double the normal enrollment pace during that time of year, when a qualifying event would normally be necessary in order to enroll.
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 2021, all but three of the original ACA CO-OPs had closed. Those three remaining CO-OPs offer coverage in five states as of 2021.
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 as people lose their jobs and employer-sponsored health insurance.
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.
Gov. Gary Herbert has been 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, 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 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.
As of late 2020, total enrollment in Utah’s Medicaid/CHIP was 30% higher than it had been in 2013. Nationwide, the increase stood at 35%.
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.
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.
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.