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Utah residents may enroll in group health plans, apply for Medicare or Medicaid, buy a plan through the Health Insurance Marketplace, or purchase an individual or family plan from a health insurance company.
Read on to learn more about Utah health insurance.
To sign up for Utah health insurance via the Health Insurance Marketplace, go to HealthCare.gov and set up an account. You’ll need to enter your name and contact information, along with some basic information about your household income. HealthCare.gov uses this information to determine if you qualify for an Advanced Premium Tax Credit, which may reduce the amount of money you pay for your health insurance each month.
The application also contains questions about your expenses, your sources of income, and your current health coverage. For example, you need to indicate:
Once you complete the application, you’ll be able to view available health plans and find out more about each one. The plans are displayed in a grid that includes the monthly premium, annual deductible, annual out-of-pocket maximum, and copayments for primary care visits and prescription drugs.
If you need more information to make a decision, detailed plan documents are available. These documents explain what each plan covers and how much you can expect to pay for durable medical equipment, outpatient mental health counseling, and other services. For example, the detailed plan document may state that you must pay 30% coinsurance if you use home oxygen.
Several companies sell individual health insurance in Utah, including:
When you shop for coverage, you need to keep two essential factors in mind: affordability and your medical needs. Most people are concerned about how much their insurance costs, but it doesn’t always make the most sense to choose the plan with the cheapest monthly premium.
As an individual, you need to choose health insurance based on your income and health status. You may also want to look for a plan that covers visits with your preferred health care providers. If your income is limited, you may qualify for Medicaid coverage or an Advanced Premium Tax Credit designed to reduce the cost of health insurance. Otherwise, you’ll need to choose a plan that you can afford.
Many people buy coverage based solely on the amount of the monthly premium. Still, you should also consider the deductible, the copays for office visits and medications, and the annual out-of-pocket maximum. In some cases, it’s cheaper to pay a slightly higher premium if it means you’ll have a lower deductible or lower coinsurance requirements.
The type of plan you choose is also an important consideration.
Affordability and access to quality care are also important considerations for families. Instead of shopping based on your personal health needs, you’ll search for a plan that covers the care needed by every member of your family. This is especially difficult if you have a spouse or dependent with a chronic health condition. You also need to think about what type of care each person needs based on their age and personal risk factors.
The cost of a Utah health insurance plan depends on several factors, including the type of plan you purchase, the number of people who need coverage, and the plan’s out-of-pocket costs. When you shop via the Health Insurance Marketplace, you’ll notice that each plan has a metal designation. HealthCare.gov uses metal tiers to quickly identify plan levels, whether a low monthly premium and a high deductible or a high monthly premium with broad coverage.
|Average premiums in Utah||2019||2020||2021||2022|
|Most affordable Bronze plan||$290||$289||$285||$289|
|Most affordable Silver plan||$513||$479||$467||$438|
|Most affordable Gold plan||$626||$609||$483||$486|
If you have a low income, you may qualify for comprehensive health coverage through Medicaid, a partnership between Utah’s state government and the federal government. Utah also has the Children’s Health Insurance Program (CHIP), ensuring children whose families have low income have access to a wide range of medical services.
Utah Medicaid covers residents who have limited financial resources. To be eligible, an applicant must fall into one of the following categories:
For most types of Medicaid, the annual income limit ranges from $17,131 for a single individual to $59,398 for a household of eight. Once you qualify for Medicaid, you must qualify each month to keep your coverage. If you have Medicaid for pregnant women, your coverage will start the date you apply and end 60 months after your child is born.
Depending on which Medicaid category applies to your situation, there may be additional eligibility requirements. For example, Utah Medicaid for individuals with cervical or breast cancer is only available to people under the age of 65 who don’t qualify for other Medicaid programs, have no other health insurance coverage that would pay for cancer treatment, and have been screened by the Utah Cancer Control Program and found to need treatment for breast or cervical cancer or a precancerous condition.
To apply for Medicaid coverage, fill out the application form on the Department of Workforce Services myCase website. Before starting the application, make sure you have all the information you need to answer questions about your financial resources, such as pay stubs, bank statements, and tax returns. You must answer every question on the application. Otherwise, Utah Medicaid won’t process it, and you’ll continue to be without coverage.
Utah’s CHIP program offers health coverage for uninsured children and teens. The income limits for CHIP are higher than those for Medicaid, so your child may qualify for CHIP coverage even if you earn too much to enroll in the Medicaid program. The Utah CHIP income limit is 200% of the Federal Poverty Limit for household size.
If your child qualifies for CHIP, you may have to pay a monthly premium; however, there are limits on how much you have to spend in a calendar year. The total amount of copays and premiums is limited to 5% of your annual income; therefore, if your annual income is $40,000, the most you would pay in a single year is $2,000. To apply for CHIP, fill out the application form on myCase.
Utah has several Medicare options available to older adults and people with disabilities.
If you choose Original Medicare, you can also purchase supplemental plans to extend your coverage. Medicare Part D covers prescription medications, while Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket Medicare costs. If you have questions about Medicare, contact your local Area Agency on Aging or the New Mexico Aging & Long-Term Services Department.
To enroll in Original Medicare or Medicare Advantage, you must meet certain eligibility requirements. First, you must be a U.S. citizen or permanent resident. You must also be at least 65 years old or have a disability that causes you to receive SSDI benefits for at least 24 months. You may also qualify for Medicare at a younger age if you have end-stage renal disease or ALS.
If you start receiving your Social Security or Railroad Retirement Board benefits at least four months before you turn 65, you’ll be automatically enrolled in Medicare. Otherwise, you must fill out an application online or contact your local Social Security office. You can enroll in Medicare during the following periods:
If you have any questions about Medicare in Utah, contact Aging and Adult Services, a Utah Department of Human Services division.
Utah follows the federal guidelines for short-term health insurance plans. If you sign up for short-term health coverage, the initial term can’t exceed 12 months. You can renew or extend the coverage, but only up to 36 months. Once you reach the 36-month limit, you can’t renew or extend the same plan any further. These plans are subject to underwriting and typically do not cover pre-existing conditions.
Utah doesn’t require its residents to have health insurance. Technically, you’re required to have coverage under the Affordable Care Act; however, the tax penalty for going without coverage has been eliminated.
If you want to check your eligibility for an Advanced Premium Tax Credit to reduce your out-of-pocket costs, you must use HealthCare.gov to enroll in a health plan. Otherwise, you’re not required to use the Health Insurance Marketplace to compare plans or sign up for coverage.
Utah allows health care sharing ministries to operate. These ministries pool member contributions and use the money to cover expenses arising from hospitalizations, chronic illnesses, and other medical needs.
If you sign up for one of these ministries, you won’t get the same benefits from a traditional health plan. For example, you may be denied based on a preexisting condition, or the HCSM may refuse to pay one of your claims if it’s determined that your illness or injury arose from an activity that’s not in line with the organization’s guiding beliefs.
You should still have health insurance if you have an HSA or FSA. Although these accounts are helpful, you’re limited in how much you can save per year in an FSA or HSA. Bills can wipe out your account balance quickly if you’re injured or develop a serious illness.
Health insurance pays your medical expenses if you need to see a doctor, go to a hospital, or receive care from a therapist or counselor. If you have a serious injury or illness, it doesn’t replace your wages if you’re unable to work. It’s good to have short-term disability coverage on top of your health insurance, as one ensures your medical expenses are paid, and the other ensures you have funds available to pay your bills.
Like short-term disability, long-term disability coverage replaces some of your lost income if you can’t work because you have a serious illness or injury. Suppose your condition lasts for six months or more. In that case, you may find it difficult to pay your mortgage or cover the cost of groceries if you don’t have any income coming in. You should consider getting long-term disability coverage even if you already have health insurance.
CHIP covers many of the medical services children and teens need to stay healthy. For example, the program covers well-child visits, hearing exams, dental care, emergency room treatment, doctor visits, and immunizations.