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Insurance and Healthcare Consultant

Tammy Burns is an experienced health insurance advisor. She is ACA-certified for health insurance and other ancillary, life, and annuity product.

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.

What to know about insurance in Utah

  • Direct purchase insurance: As a Utah resident, you’re allowed to buy an individual or family health insurance plan directly from a health insurance company. If you’d rather buy directly from a health insurance company, look for insurers that sell “off-exchange” plans.
  • Open Enrollment: Utah’s annual open enrollment period lasts from November 1st to December 15th. You can sign up for health insurance coverage during open enrollment or switch from one plan to another.
  • Special Enrollment: Generally, you can’t sign up for health coverage outside the open enrollment period unless you have a qualifying event. For example, if you get laid off from your job and lose your group health coverage, you can enroll in a new plan.
  • Health Insurance Marketplace: Utah uses the federal Health Insurance Marketplace (HealthCare.gov) as its insurance exchange. If you need help paying your monthly premiums, use the Health Insurance Marketplace to determine if you qualify for an Advanced Premium Tax Credit.
  • Coverage types: Just over 60% of Utah’s insured population had group health coverage in 2019. Another 9.3% had non-group coverage, 1.2% had military coverage, and 19.3% were enrolled in Medicare or Medicaid. Just under 10% of Utah residents had no health coverage at all.

How do I enroll in Utah's health insurance marketplace?

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 whether you currently have employer-sponsored health coverage or access to a health reimbursement arrangement (HRA). Depending on your answers to these questions, you may be asked to provide additional information, such as how much student loan interest you pay each month or whether you have to pay alimony to a former spouse.

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:

  • BridgeSpan
  • Cigna
  • Molina Healthcare
  • Regence BlueCross BlueShield of Utah
  • SelectHealth

How do I enroll in Utah individual and family insurance?

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.

Insurance for individuals in Utah

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.

  • Health Maintenance Organization (HMO) plans typically cost less than other health coverage types and have some restrictions that can affect your ability to access care. For example, you may have to ask for a referral to see a specialist and your network is local.
  • Preferred Provider Organizations (PPOs) don’t require referrals and usually offer nationwide coverage but cost more than HMO plans. Most PPOs also have out-of-network benefits.
  • Point-of-Service (POS) plans combine the features of an HMO with the features of a PPO. You have to ask for a referral to see a specialist, but you can get care from out-of-network providers if you’re willing to pay a larger percentage of the cost.

Insurance for families in Utah

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.

How much does health insurance cost in Utah?

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  2018 2019 2020 2021
Most affordable bronze plan $303 $290 $289 $285
Most affordable silver plan $534 $513 $479 $467
Most affordable gold plan $621 $626 $609 $483

  • Plans on the bronze tier are usually the least expensive, but you should know that you’re trading a low monthly premium for higher out-of-pocket costs. Some bronze plans have annual deductibles as high as $8,150 for an individual. You may also have to pay a coinsurance of 40% on each covered service. In Utah, the most affordable bronze plan cost has decreased over the past four years, falling from $303 per month in 2018 to $285 in 2021.
  • Silver plans offer a balance of coverage and affordability. Although these plans usually have higher premiums than bronze plans, they also tend to have lower copays, deductibles, and out-of-pocket limits. It can be cheaper to buy a silver plan than a bronze plan, especially if you qualify for an Advanced Premium Tax Credit to make your health coverage more affordable. In Utah, the most affordable silver plan cost has decreased from $534 in 2018 to $467 in 2021.
  • Gold plans are one of the most expensive options but also have lower out-of-pocket costs. For example, a gold plan may have an individual deductible of $1,500 and low copays for primary care visits. If you have a chronic health condition, a gold plan may be the best value with comparatively lower copays and coinsurance for covered services. The cost of Utah’s most affordable gold plan has fallen sharply over the past four years, decreasing from $621 in 2018 to $483 in 2021.

What kind of low-income health insurance is available in Utah?

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.

Medicaid in Utah

Utah Medicaid covers residents who have limited financial resources. To be eligible, an applicant must fall into one of the following categories:

  • Disabled, aged, or blind
  • Pregnant women
  • Caregivers with children under age 19
  • Women with cervical or breast cancer
  • Children

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.

State of Utah CHIP

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. For example, the monthly income limit for a single parent and one child is $2,904. A family of seven would have an income limit of $6,687 per month, or more than $80,000 per year.

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.

What are Utah's Medicare options for seniors and people with disabilities?

Many Utah residents qualify for Medicare, an insurance program for older adults and younger people with disabling medical conditions.

  • Original Medicare is the standard, government-managed form of Medicare. If you sign up for Original Medicare, you’ll have access to inpatient care under Medicare Part A and outpatient care under Medicare Part B. You can also sign up for Medicare Supplement Insurance and Medicare Part D. Medicare Supplement Insurance (Medigap) covers deductibles, copays, and other out-of-pocket costs left over after Medicare pays its share of each claim. Medicare Part D is a supplementary plan just for prescription medications.
  • You also have the option of signing up for a Medicare Advantage Plan offered by private insurers. Medicare Advantage Plans are usually more comprehensive than Original Medicare, so your plan may include prescription drug coverage or coverage for extra services.
Eligibility and Enrollment
Eligibility 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.
Enrollment To enroll in Medicare, fill out the online application or contact your local Social Security office for more information. You can sign up for coverage during your initial enrollment period, which starts three months before you turn 65 and ends three months after your 65th birthday month. If you don’t enroll during the IEP, you can enroll during the general enrollment period. Unless you qualify for a special enrollment period, you won’t be able to sign up or change your coverage outside these periods.

Medicare Resources

If you have any questions about Medicare in Utah, contact Aging and Adult Services, a Utah Department of Human Services division.

Are there short-term health insurance plan options in Utah?

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’re 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 Insurance FAQs

Does Utah require health insurance?

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.

Do I have to use the Health Insurance Marketplace in Utah?

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.

What types of alternative health insurance plans (like cost-sharing plans) are available in Utah?

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.

Do I need health insurance if I have an HSA/FSA?

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.

Do I need short-term disability coverage in Utah if I have health insurance?

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.

Do I need long-term disability coverage in Utah if I have health insurance?

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.

What does Utah CHIP cover?

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.

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