Health insurance in Utah
- Utah utilizes the federally run exchange – HealthCare.gov – to enroll individuals.
- Open enrollment for 2020 health plans has ended, although residents with qualifying events can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
- Short-term health plans can be sold in Utah with initial plan terms up to 363 days.
- With BridgeSpan’s return, four insurers offer plans for 2020 in Utah’s exchange.
- More than 200,000 Utah residents enrolled in 2020 coverage through the exchange, which is a record high for the state.
- 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. Partial expansion took effect in April 2019 and full expansion took effect in January 2020. A work requirement was imposed but it was suspended amid the COVID-19 pandemic.
- More than 400,000 Utah residents are enrolled in Medicare. About 40 percent of that population had Medicare Advantage plans in 2020.
Utah’s health insurance marketplace
Utah uses the federally run exchange (HealthCare.gov) for individuals.
Open enrollment for 2020 health plans has ended, although Utah residents with qualifying events (including loss of employer-sponsored coverage) can still enroll or make changes to their coverage for 2020. The next open enrollment period, for plans effective in 2021, will begin November 1, 2020.
For 2020, BridgeSpan rejoined Utah’s 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 in 2018 to having four insurers in 2020: Molina Healthcare of Utah, SelectHealth, Inc., University of Utah Health Insurance Plans, and BridgeSpan (some have limited coverage areas, so plan options vary from one part of the state to another).
Regence BlueCross BlueShield of Utah continues to sell only off-exchange plans.
During the open enrollment period for 2020 health plans, a record-high 200,261 people selecting plans through Utah’s exchange. So Utah has avoided the year-over-year enrollment decreases that have occurred since 2016 in most of the states that use HealthCare.gov.
Read more about the Utah health insurance marketplace.
Does Utah have a health insurance 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 had closed, although those four have continued to operate ever since.
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 applied to people who earn up to the poverty level, rather than 138 percent 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 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 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.
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 — although it increased to 9.4 percent by 2018. Medicaid expansion has likely reduced the uninsured rate in 2020, and is particularly important in the midst of the COVID-19 pandemic as people lose their jobs and employer-sponsored health insurance.
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.
Gov. Gary Herbert has been generally opposed to the ACA, but had 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, so it was not surprising that the ballot initiative to expand Medicaid passed in 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
Read more about Medicare in Utah, including details about the state’s rules for Medigap plans.
State-based health reform legislation
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. 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.
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.