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Utah health insurance

Three insurers are offering 2019 health plans through Utah's exchange. A Medicaid expansion ballot initiative has passed.

Health insurance in Utah

Utah’s health insurance marketplace

Utah uses the federally run exchange (HealthCare.gov) for individuals.

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.”

Open enrollment for 2019 coverage in Utah ended December 15, 2018, enrollment in ACA-compliant plans is still possible for Utah residents who have qualifying events.

Three insurers – Molina Healthcare of Utah, SelectHealth, Inc. and University of Utah Health Insurance Plans – are offering 2019 health insurance plans through the Utah exchange. BridgeSpan and Regence BlueCross BlueShield of Utah will sell 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.

During 2016 open enrollment, 175,637 people enrolled. 86 percent of Utah exchange enrollees qualified for premium subsidies that year. The average pre-subsidy premium was $271 per month, and the average after-subsidy premium was $84 per month; both are the lowest of all 38 states using HealthCare.gov.

Private plan enrollment for 2016 was more than double 2014 enrollment. By the end of March, effectuated enrollment stood at 164,415.

For 2018 coverage, 194,118 people purchased individual market plans through the Utah exchange during open enrollment. That was about 1.6 percent lower than the 197,187 people who had enrolled for 2017, but it was still considerably higher than 2016’s enrollment.

Nationwide, the trend in HealthCare.gov states has been reduced enrollment in both 2017 and 2018 (ie, with 2016 being the high-water mark). But in Utah, enrollment in 2017 was the high point so far, and 2018 enrollment is only slightly lower.

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

Utah is one of 19 states that – through 2018 – had not yet expanded Medicaid. If the state accepted expansion, at least 46,000 people in the coverage gap would gain access to benefits. And estimated 158,000 Utah residents would gain coverage if the state adopted the expansion.

But in 2018 mid-term elections, Utah residents voted for passage Proposition 3 with 54 percent of voters supporting the expansion. The ballot will result in full Medicaid expansion, as called for in the ACA.

Coverage will be available to Utah residents with income up to 138 percent of the poverty level. The text of the ballot initiative calls for Medicaid expansion to take effect as of April 1, 2019.

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 can not be  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

In 2015, Utah Medicare enrollment reached 345,340, which is 12 percent of the state’s population and lower than the U.S. average of 17 percent. 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.

Medicare spends about $8,016 per Utah beneficiary each year. In terms of overall spending on Medicare, as of 2009, Utah ranked 39th with $2.3 billion per year.

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 favor the governor’s approach over no expansion at all. On July 17, 2015, the state’s leadership announced it had reached an agreement on Medicaid expansion. However, in October, the bill failed to get enough House votes to advance to the Senate.

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 directs the state to submit a waiver proposal to CMS by January 1, 2019, although it’s doubtful that CMS, even under the Trump Administration, will approve the state’s plan.

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.