Utah Health Insurance

Residents in the Beehive State can find Marketplace plans from more insurers with lower premiums in 2020.

Utah Health Insurance Overview

Nearly 382,000 Utahns lacked health insurance in 2013 when the Affordable Care Act (ACA or Obamacare) was implemented. The number of uninsured residents dropped to about 279,000 as of 2018.¹

Enrollment in government programs (Medicaid and Medicare) didn’t change much during this time. About 19 percent of the population enrolled in these programs in 2013 compared to 20% since 2018.²

For 2020, slightly more people bought coverage through the Health Insurance Marketplace than the year before. 

You can learn more about Utah health insurance below.

Buying Utah Health Insurance for Individuals, Families, and Self-Employed Entrepreneurs

Most Utahns get individual and family health insurance through an employer.³ Those without access to employer coverage can buy an ACA plan through the Marketplace. Self-employed residents with no employees can also use the Marketplace.

ACA plans are required to cover pre-existing conditions, and you can’t be denied a policy due to health. They provide essential health benefits, such as prescription drug coverage, hospitalization, and free preventive care. If children enroll, plans must also provide them with vision and dental benefits.

Private insurers sell plans via the federal Marketplace or exchange at Healthcare.gov. Some insurers sell off the exchange. You can buy any policy available in your area, which includes bronze, silver, gold, and platinum. Each plan pays for a certain percentage of covered care from 60% (bronze) to 90% (platinum).

Utah Health Insurance Marketplace Enrollment

Open enrollment for 2021 coverage starts on November 1, 2020 and ends on December 15, 2020. Plans take effect on January 1, 2021.

More than 200,000 Utahns bought Marketplace coverage at the end of open enrollment on December 18, 2019.⁴ About 195,000 residents signed up during the previous enrollment season.⁵

If you missed signing upthis date, you’d have to wait until the next enrollment period. But if you have a qualifying life event, such as moving to a new area or getting married, you can sign up at any time.

You can sign up for coverage through Medicaid or the Children’s Health Insurance Program (CHIP) any time of the year.

Who Offers Health Insurance in Utah?

You can buy Utah health insurance for 2021 from five health insurance companies .⁵

1. Cigna (aka Cambia Health Solutions)
2. Molina Healthcare of Utah
3. Regence BlueCross BlueShield of Utah
4. SelectHealth
5. University of Utah Health Insurance Plans

Utah Health Insurance Premiums 

Premiums are the monthly costs for health insurance. The premium rate for Marketplace coverage in Utah is lower in 2020 than in 2019.

Here’s a look at the average Marketplace premiums in Utah from 2019 to 2020.

Can I Get Help With Health Insurance Costs in Utah?

The federal government offers financial help with Marketplace coverage. You could get premium tax credits, or subsidies, to reduce your monthly payment, cost-sharing reductions (CRS) to lower your out-of-pocket expenses, or both.

You must make between 100% to 400% of the federal poverty level(FPL), which is $17,609 and $51,040 for a single person in 2020, to qualify for premium subsidies. The income limit for CSRs is up to 250% of the FPL ($31,900 for an individual in 2020). CSRs only apply to silver plans.⁶

In 2019, 93% of Utah enrollees received subsidies, and another 53% got cost-sharing reductions.⁷ The average premium subsidy was $416 a month.

Medicaid Enrollment in Utah: Coverage for Low-Income Residents

Utah has one of the lowest percentages of Medicaid enrollees. Approximately 8.8% of the population have Medicaid as of October 2019. That’s about 264,000 enrollees out of 3 million residents.⁸ This number includes 1 in 14 adults under 65 and 1 in 5 children.⁹

Utah currently has partial Medicaid expansion for childless adults earning up to 100% of the FPL ($12,760 per year for an individual in 2020). The federal government approved full Medicaid expansion for Utah in December 2019. Once implemented, childless adults earning up to 138% of the FPL ($17,609 a year for an individual in 2020) will qualify.

Other low-income residents who qualify for Medicaid in Utah include:

• Children 0 to 18 (up to 19 if in school)
• Parents and caretakers of minor children
• Current and former foster care youths
• Families who don’t qualify for parent or caretaker coverage
• Pregnant women
• Non-citizens 
• Refugees
• Individuals eligible for long-term care
• Aged, blind, and disabled adults
• Individuals under 65 with breast or cervical cancer

Residents must meet income requirements to enroll. For instance, parents of minor children, seniors, and people with disabilities must also earn up to 100% of the FPL.¹⁰ This is up to $17,240 for a family of two in 2020.¹¹

Utah’s Children’s Health Insurance Program (CHIP) 

Uninsured children under 19 who meet income and citizenship requirements can get benefits through Utah’s CHIP program. A family of two earning up to $33,820 (of 2019) can qualify.

The program covers vision, dental, hearing, major medical care, prescription drugs, and wellness exams. Most families pay a premium up to $75 every three months to cover all enrolled children. There are also copayments and deductibles.

Children who qualify as American Indian or Alaska Native don’t have premiums or copayments. Families without income for the benefit year aren’t required to pay copayments or deductibles. 

Who Qualifies for Medicare in Utah?

Medicare is a federal health insurance program. Utahns 65 and older and younger adults with disabilities can qualify. Nearly 390,000 Medicare beneficiaries enrolled in 2018, the latest possible information.

Among enrollees, just over 3 in 5 have Original Medicare. That coverage includes hospital (Part A) and medical insurance (Part B) managed directly by the federal government. The remaining enrollees get Part A and B through Medicare Advantage plans sold by private insurance companies. Policies typically include Medicare Part D prescription drug coverage.

Original Medicare doesn’t cover most medications, so some beneficiaries enroll in separate Part D plans from private companies. Almost 134,000 Utah residents enrolled in individual Part D drug coverage in 2018.

If you choose Original Medicare, you can also add a private Medicare Supplement plan (called Medigap). These plans cover some to all your out-of-pocket costs when you get care. For example, you have a 20% coinsurance when you use your Part B benefits. Most Medigap plans in Utah pay 100% of this cost. 

Does Utah Sell Short-Term Health Insurance?

Yes. You can get short-term health coverage in Utah for up to 363 days with no renewals.¹⁰ States that go by federal laws offer coverage for up to 364 days with renewals up to 36 months.

You might consider getting a plan if you’re in a temporary coverage gap, such as when:

• You’re waiting for new health coverage to begin
• You’re in between jobs 
• You missed the annual Obamacare enrollment, and you don’t qualify for a Special Enrollment Period (SEP)
• You lost coverage through a spouse’s or parent’s health plan

Short-term plans offer basic benefits, like doctor visits and emergency care. But they don’t count as guaranteed health insurance under the Affordable Care Act (ACA).

Plans aren’t required to cover preexisting conditions or essential health benefits, such as maternity care and mental health services. Less coverage usually means a cheaper monthly payment. But you may be responsible for a higher percentage of your costs when you get care.

If you choose to buy a policy, make sure you understand the coverage limitations. It’s also helpful to compare the costs and benefits with a comprehensive ACA plan. This can help you decide which better meets your needs.