Health insurance in Utah
- Utah utilizes the federally run exchange – HealthCare.gov – to enroll individuals.
- Open enrollment for 2020 coverage in Utah runs from November 1 to December 15, 2019.
- Enrollment is possible outside of open enrollment for Utah residents who have qualifying events.
- Short-term health plans can be sold in Utah with initial plan terms up to 363 days.
- With BridgeSpan’s return, four insurers will offer plans for 2020 in Utah’s exchange.
- More than 194,000 Utah residents enrolled in 2019 coverage through the exchange, up slightly from 2018 enrollment.
- Utah’s CO-OP is one of 19 ACA CO-OPs that have folded.
- In 2018, Utah voters passed Proposition 3, delivering Medicaid expansion to the state in April 2019 (but Utah lawmakers scaled back the expansion and are working to impose additional requirements).
- Only about 12 percent of Utah’s residents are enrolled in Medicare. About 36 percent of that population had Medicare Advantage plans in 2017.
Utah’s health insurance marketplace
Utah uses the federally run exchange (HealthCare.gov) for individuals.
Open enrollment for 2020 coverage in Utah runs from November 1 to December 15, 2019; all plans will take effect January 1, 2020. Outside of open enrollment, ACA-compliant plans are only available for purchase when residents have qualifying events.
But for 2020, BridgeSpan is rejoining the exchange, after exiting at the end of 2015. Molina rejoined the exchange in 2019 after exiting at the end of 2017. So Utah’s exchange has gone from having just two insurers tin 2018 to having four insurers in 2020 (some have limited coverage areas, so plan options vary from one part of the state to another).
Regence BlueCross BlueShield of Utah will continue to sell only off-exchange plans.
Utah enrollment in qualified health plans
The Kaiser Family Foundation estimated in late 2013 that the potential market for Utah’s federally facilitated exchange was 331,000 residents, and that 206,000 of them would qualify for premium subsidies to offset the cost of their plans. By mid-April 2014, when the first open enrollment period ended, 84,601 people had completed their enrollment in qualified health plans through the Utah exchange, and HHS reported that 86 percent of them received subsidies to lower their premiums.
Enrollment then climbed each year until 2017, when more than 197,000 people purchase coverage. Enrollment declined in 2018, but only by about 1.6 percent. And it increased slightly in 2019, with more than 194,500 people enrolled. So Utah has avoided the year-over-year enrollment decreases that have occurred since 2016 in most of the states that use HealthCare.gov.
Because Utah uses the federal exchange, the state follows the much shorter open enrollment period that the federal government implemented in 2018, and enrollment was hampered by the federal funding cuts for exchange marketing and enrollment assistance in the weeks leading up to the open enrollment period. But Take Care Utah, a navigator organization, was able to obtain local funding to offset the federal funding cuts (which had reduced the organization’s annual funding by 60 percent), and remained available to help people enroll for 2018. The Utah Health Policy Project is also available to consumers, providing public outreach and education and also working toward “advancing sustainable health care solutions for underserved Utahns through better access, education, and public policy.”
Read more about the Utah health insurance marketplace.
Arches Mutual Insurance Company – Utah’s CO-OP
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 2018, all but four of the original ACA CO-OPs have closed.
Read more about the Affordable Care Act’s CO-OPs.
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 2018 mid-term elections, Utah residents voted for passage Proposition 3 with 54 percent of voters supporting the expansion. The ballot initiative directed the state to fully expand Medicaid, as called for in the ACA (ie, to people with income up to 138 percent 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 applies to people who earn up to the poverty level, rather than 138 percent of the poverty level.
This is a step forward, as it means there is 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 state’s partial Medicaid expansion, which means Utah is only receiving their normal federal match rate for the partial expansion group. And the state is working towards other limitations, including a work requirement. If CMS does not agree to the state’s revised proposals by mid-2020, full Medicaid expansion will take effect in Utah at that point.
Read more about Medicaid expansion in Utah.
Short-term health insurance in Utah
Utah state regulation of short-term health insurance plans is stricter than the new federal rules regulating short-term 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 in Utah.
Has Obamacare helped Utah residents?
Utah has not exactly embraced Obamacare, but the state’s uninsured rate has still fallen significantly since the law was enacted. According to U.S. Census data, 14 percent of Utah residents were uninsured in 2013, and that dropped to 8.8 percent by 2016.
Had Utah expanded Medicaid under the Affordable Care Act earlier, it is likely more significant improvements would have materialized. The state obtained federal approval in 2017 to implement a very limited version of Medicaid expansion for people with no income who are homeless and/or in need of substance abuse treatment. But the bulk of the people who would be eligible for Medicaid under full expansion continue to be ineligible.
Proponents of Medicaid expansion were successful in getting an initiative on the ballot in 2018 to expand Medicaid by vote. Its passage in November means Medicaid expansion is slated for April 2019.
Utah and the Affordable Care Act
Utah initially took a unique approach to running the exchange. 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 the state 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.
Does Utah have a high-risk pool?
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.
Medicare in the state of Utah
As of mid-2019, there were 397,692 Medicare enrollees in Utah. That’s a little more than 12 percent of the state’s population versus an average of 18 percent of the total U.S. population enrolled in Medicare. About 85 percent of Utah’s Medicare beneficiaries qualify based on age alone, and 15 percent are on Medicare as the result of a disability.
In 2017, Medicare spent about $8,789 per Utah beneficiary—about 10 percent lower than the U.S. average.
Utah residents eligible for Medicare can select a private Medicare Advantage plan instead of Original Medicare if they want additional benefits. In Utah, 36 percent of 2017 Medicare enrollees chose a Medicare Advantage plan compared with 33 percent nationwide.
Of all 2017 Utah Medicare enrollees, 35 percent had a Medicare Part D prescription drug plan. Nationwide, enrollment in a stand-alone Rx plan among Medicare enrollees is 44 percent. As enrollment in Medicare Advantage plans trends generally upwards, enrollment in stand-alone Part D plans will tend to decrease, since the Part D plans are designed to work with Original Medicare, while most Medicare Advantage plans have their own built-in Part D coverage.
State-based health reform legislation
Gov. Gary Herbert has been generally opposed to the ACA, but has been looking for a way to expand Medicaid 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 expansion at all.
HB472 was enacted in Utah in March 2018, and calls for the state to expand Medicaid, but only to people earning up to the poverty level (instead of up to 138 percent of the poverty level, as called for in the ACA. The legislation directed the state to submit a waiver proposal to CMS to see enhanced federal funding for this approach. Although this version of partial Medicaid expansion did take effect in Utah in 2019, the state is receiving its regular Medicaid matching rate from the federal government, instead of the enhanced funding that applies when states fully expand Medicaid.
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 only to those earning up to the poverty level, keeping people above that level on subsidized private plans in the exchange instead.
Scroll to the bottom of this page for a summary of more state-level health reform bills in Utah.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.