Affordable Utah Marketplace Exchange Health Insurance Rates And Plans

Find affordable health insurance in Utah that is available for individuals, families, and small and large businesses. Instantly compare comprehensive and catastrophic policies that fit within your budget. Exchanges and Marketplaces allow you to directly purchase quality medical coverage from the most reputable carriers. Our website makes it easy to shop for the lowest 2018 prices, compare the best plans, and easily purchase enroll for coverage in less than 25 minutes. Any changes resulting from President Trump's changes to Obamacare, will be immediately published on our website.

Applicants that have reached age 65 and are Medicare-eligible, can apply for Medigap coverage. Many plans are offered that can reduce out-of-pocket costs, such as copays, coinsurance, and deductibles. Advantage and Supplement policies are "guarantee-issue" during the separate Open Enrollment period of October 15th-December 7th. Also, when you first become eligible for Medicare, a 7-month window is provided to compare and choose Medigap benefits. Part D prescription drug plans are also offered. NOTE: The Under age-65 Marketplace OE period occurs between November 1 and December 15th (additional details below). It is possible for one spouse to be covered under an individual Marketplace plan, while the other spouse has reached age 65 and has supplementary benefits.


The Utah Health Exchange is federally managed, and we help you find the best fit for you or your family. You can customize benefits to match your individual situation. Whether you are in perfect physical and mental condition, or have multiple per-existing conditions that require chronic treatment, we review the policies that are the most cost-effective. regardless if you live in Salt Lake City, Provo, Orem, Sandy, Ogden, or any other part of the state, you are eligible to enroll (assuming you meet application qualifications).


What Are The Types Of Available Plans?


When the "Affordable Care Act" was enacted, four types of "Metal" policy options were created for consumers. They are "Platinum," "Gold," "Silver," and "Bronze." The Platinum contracts are the most expensive, since they pay approximately 90% of your medical expenses. The Bronze contract costs the least of the Metal options, since up to 40% of projected medical costs have to be paid by you. Of course, the overall health of your household ultimately determines how much out-of-pocket cost you pay. Bronze and Silver-tier plans are the most popular.


An additional type of policy that is offered is a "Catastrophic" contract. Available to persons under age 30, or anyone that can't afford other Metal plans, rates are very inexpensive, since deductibles and out-of-pocket expenses are higher. The cheapest available catastrophic plans are Select Value Millennial 7150, and Select Med Millennial 7150. Federal subsidies do not apply, so often, rates on these plans may actually be higher than Bronze-tier options.


Bronze-Tier Options Vs. Catastrophic Options


However, if you are over the age of 30, to qualify for these low-cost plans, there must be no other available options that cost less than 8% of your income. It is also important to understand that catastrophic contracts are not eligible for the federal subsidy. Thus, in many situations, a Bronze or Silver plan may only cost less because of the instant tax-credit. And special "cost-sharing" features on Silver plans often reduce the deductible by thousands of dollars. Just as importantly, there is no limit on the number of covered primary-care physician (pcp) or specialist office visits you can use (subject to an applicable copay) on Bronze-tier plans.


Sample Rates For Young Persons


How cheap are premiums on these plans? Below, we have provided several examples for a 25 year-old ($23,000 income) that resides in Salt Lake County. Because of the federal subsidy, many low-cost options are offered. Prices shown are monthly.


$61 -- Molina Marketplace Bronze -- $35 and $80 office visit copays with $35 copay for blood work and and $80 copay for x-rays. Deductible is $6,650 with 40% and 50% coinsurance. Generic and preferred brand drugs are subject to $33 and $65 copays.

$66 -- Molina Marketplace Options Bronze -- $45 pcp office visit copay while specialist visit subject to 50% coinsurance. Deductible is $6,650 with $7,150 maximum out-of-pocket expenses and 35%-50% coinsurance. Generic drugs subject to $35 copay, while all other drugs must meet coinsurance.

$77 -- SelectHealth Select Value Preference Benchmark Bronze 5700 -- $50 and $65 office visit copays with $65 copay for Urgent Care visits. Deductible is $5,700. Tier 1 drugs subject to $20 copay, while other tiers are subject to coinsurance.

$91 -- SelectHealth Select Value Preference Bronze 6350 -- $50 and $65 office visit copays with $65 copay for Urgent Care visits. Deductible is $6,350. Tier 1 drugs subject to $20 copay, while other tiers are subject to coinsurance.

$116 -- Molina Marketplace Silver -- $10 and $30 office visit copays with $10 copay for blood work and $30 copay for x-rays. Deductible is $500 with 20% and 30% coinsurance. Generic and preferred brand drugs are subject to $5 and $30 copays.

$184 -- University of Utah Health Plans Healthy Premier Silver Copay -- $10 and $30 office visit copays with $75 Urgent Care copay. 25% coinsurance for blood work and x-rays. Deductible is $400 with 20% and 25% coinsurance. Preferred generic drugs are subject to a $10 copay.


Required Benefits


"Essential Health Benefits" are included on all policies. They consist of a wide variety of items including complete preventive care for adults and children, catastrophic hospital, office visit, prescription, maternity, mental health and many other coverages. Unlike policies prior to 2014, these plans have very few or no gaps. Although alternative plans are available without these benefits (short-term contracts), federal subsidies are not offered, pre-existing conditions are not guaranteed to be covered, and since temporary contracts are underwritten policies, applications can be denied.


If any plans do not contain these 10 mandated benefits, including temporary contracts previously mentioned, they can not be approved for enrollment through any Exchange in the US. Also, a 2.5% household income tax penalty will be assessed if a non-compliant policy is purchased instead of an approved plan. A 3-month grace period is provided that helps offset some of the penalty. Thus, a household with $60,000 of income could face a special tax of about $1,500 if they remain uninsured for an entire year.


However, short-term policies are a very viable solution to situations that leave you very little time to obtain coverage. For example, if your existing benefits (non-compliant) were set to expire in 48 hours (and you were not eligible for COBRA or a "Special Enrollment), obtaining approved coverage quickly would become your immediate priority. Although a 2.5% income tax penalty could be imposed, the offsetting lower premiums, and major medical coverage provided from a short-term plan may be your best choice for that specific predicament.


About 70 different policies are offered through the Marketplace by three carriers. They are SelectHealth, University of Utah Health Plans, and Molina. Some of the bigger carriers, such as UnitedHealthcare, Regence Blue Cross Blue Shield, and Humana are not participating in the subsidized Marketplace, although they offer "off-Exchange" options. Humana is the most recent carrier to cease writing "on-Exchange" business. SelectHealth is the only company offering plans in most counties in the state.


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You can also buy policies independently from the Exchange. Since these options don't pay a federal subsidy, your individual income should be at least $35,000 (Age 35) and your family income at least $98,000 (Family of four -- Adults age 35) before you consider these plans. It is likely that the number of available physicians, specialists and other facilities will be much larger on policies bought "away from the Marketplace." NOTE: The size and age of your family will impact the income guidelines just mentioned. Thus, the "breakpoint" income may be $98,000 for one family, and $115,000 for another.


Which Utah Health Insurance Companies Offer The Lowest Rates?


There may not be a good answer for that question since there are so many variables. Of course our website allows you to easily compare the best options when you provide your zip code. However, listed below are the carriers that are likely to offer affordable options in your area. Not all of these companies offer Marketplace plans in all areas of the state for 2017. Companies that recently stooped offering private individual medical coverage include:
Regence Blue Cross
Arches Mutual
Altius (Aetna/Coventry)


SelectHealth specializes in HMO-type of coverage along with high-deductible plans (HDHP) that work with HSA accounts. With their HMO coverage, a "primary-care physician" is selected that coordinates your treatment. For more than 25 years, SelectHealth has been providing integrated coverage, and they were voted Utah's "Top Plan" last year. J.D. Power Amp; Associates gives them a high ranking in member satisfaction (four consecutive years) and we expect this tradition to continue.


Molina offers off-Marketplace plans. They're a Fortune 500 company that specializes in plans through Medicare, Medicaid, and other programs paid by the government. Prices for many of their plans are very competitive. Medicare Advantage plans are offered in many areas, and the low premiums are attractive options for Seniors. Direct delivery medical clinics are owned and managed in many states, although none are available yet in Utah.
University Of Utah Health Plans began operating in 1998 and now insures almost 150,000 persons. In addition to single and family coverage, they also cover self-funded employer groups, along with Medicare and Medicaid recipients. As a local carrier, they are very community-oriented, and also offer many attractive student medical plans.


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Catastrophic Tier


SelectHealth Select Value Millennial 7150 -- $35 copay for pcp office visits. Substance abuse disorder (outpatient) and behavioral/mental health (outpatient) also receive the same copay. Deductible is $7,150 with 0% coinsurance.

SelectHealth Select Med Millennial 7150 -- $35 copay for pcp office visits. Substance abuse disorder (outpatient) and behavioral/mental health (outpatient) also receive the same copay. Deductible is $7,150 with 0% coinsurance. Larger network than previous plan.


Bronze Tier


Molina Marketplace Bronze Plan -- $35 and $80 office visit copays (pcp and specialist) with $75 copay for Urgent Care visits. $6,650 deductible with 40% and 50% coinsurance. Generic and preferred brand drugs subject to $33 and $65 copays with 50% coinsurance on non-preferred brand and specialty drugs.

Molina Marketplace Options Bronze Plan -- $45 pcp office visit copay with 50% coinsurance on specialist office visits. $6,650 deductible with 50% coinsurance. $35 generic drug copay with coinsurance of 35%, 40%, and 45% applying to other drugs.

SelectHealth Select Value Preference Benchmark Bronze 5700 -- $50 and $65 office visit copays with $65 copay for Urgent Care visits. $5,700 deductible with maximum out-of-pocket expenses of $7,150 and 30% coinsurance. Drug standard tier and maintenance tier copay is $20.

SelectHealth Select Value HealthSave Bronze 5750 HSA -- HSA-eligible plan with $5,750 deductible and $6,550 maximum out-of-pocket expenses and 30% coinsurance. $35 and $50 office visit copays after deductible has been met.

University of Utah Health Plans Healthy Premier Bronze HSA -- HSA-eligible plan with $6,550 deductible and maximum out-of-pocket expenses. Coinsurance is 0%.


Silver Tier


Molina Marketplace Silver -- Attractive $2,000 deductible with fairly low $20 and $55 office visit copays. $6,850 maximum out-of-pocket costs keeps premium low.

Humana Silver 3800 -- $3,800 deductible with $6,300 maximum out-of-pocket expenses. Office visit copays of $20 and $40.

SelectHealth Select Value Preference Benchmark Silver 1250 -- Low $1,250 deductible although most benefits must meet deductible before coverage begins. Exception is generic prescriptions which have a $10 copay.

SelectHealth Select Value HealthSave Silver 2000 -- HSA-eligible plan with $2,000 deductible. Also available with a $3,500 deductible.

SelectHealth Select Med Preference Silver 3800 Copay -- $3,800 deductible with $25 and $50 office visit copays.


Gold Tier


Molina Marketplace Gold -- $500 deductible with low $15 and $35 office visit copays. $15 generic drug copay and $6,850 maximum out-of-pocket expenses.

Humana Gold 2250 -- $2,250 deductible with fairly low $3,500 out-of-pocket maximum. Low office visit copays of $20 and $40. Generic drug copay is $8.

SelectHealth Select Value Preference Gold 500 -- $500 deductible but you must meet that deductible before copays apply to office visits. $4,000 maximum out-of-pocket costs.

SelectHealth Select Value Preference Gold 1000 -- $1,000 deductible with $2,5000 maximum out-of-pocket expenses.

SelectHealth Select Value Preference Gold 250 -- Very low $250 deductible with $5,000 maximum out-of-pocket expenses.
Is A Government Subsidy Available?


Yes. Actually, it is available in all states. Your modified adjusted gross income (MAGI) will determine your eligibility. For example, if you are 35, single and make under $33,000, you should be eligible. A family of three (45,45, and 10) that earns less than $81,000 should also qualify (About $98,000 for a family of four). About 300,000 persons in the state may qualify for the subsidy and a higher number of persons are currently not covered on any type of medical plan.


NOTE: Your age can also impact the amount of your subsidy since premiums are higher for older persons (and thus, generate more financial aid). For example, in Davis County, a single 35 year-old making $25,000 per year is eligible for an approximate subsidy of $86 per month. However, a 45 year-old would receive about $110 while a 60 year-old could receive as much as $290, resulting in many inexpensive options.


Utah Health Marketplace Gives Tax Subsidy

Do You Qualify For A Federal Tax Subsidy?

It's paid in the form of a tax credit that is instantly deducted from the health insurance premium. Since the insurance company receives the credit directly, individuals and families don't have to wait to be reimbursed. However, if you underestimate your income, you may have to pay some of the subsidy money back.  And if you overestimate your income, you may receive a larger credit than anticipated. NOTE: This credit typically arrives with your refund the following tax year.


If you don't qualify for a subsidy, then you can also buy a policy that is not listed on the Exchange. The major carriers offer these sets of plans to persons that may want a larger network of providers or a higher-deductible option. Medical coverage for young adults can also be found. With children's benefits, often keeping your set of providers is the most important factor in deciding which policy to purchase.


Are Temporary ID Cards Available?


Yes, they are. With most carriers, you can log into your online account and print the most recent policy information. It is also possible that you may be required to initially sign up and/or create an account. Your policy number, social security number and other identifying information also may be needed. Once the account is created, additional online services can be accessed, including billing and claims. Lost cards can be easily replaced and all family members (over the age of 15) should have their own ID cards.

Often, billing is one of the last portions of the enrollment process to be completed. If you have not received a bill seven days prior to your effective date, you should contact the carrier directly. Generally, you can make a payment online that will be processed within 24-48 hours, and ensure your initial premium is received. Electronic withdraw is very popular and helps avoid the potential of forgetting to pay your premium, which results in a lapse in coverage.


Can I Keep My Existing Plan?


If your existing policy is not being terminated (you will be notified in writing), many companies allow you to keep your current plan to 2017. These "grandfathered" policies were issued prior to March 23, 2010 and often contain higher out-of-pocket expenses for hospital-related claims. Also, maternity and prenatal benefits are typically missing or limited.

Of course, any policy issued in 2014 (or later) may be kept the following year unless that plan is discontinued by the carrier, or the carrier no longer offers coverage in your service area. Companies in many parts of the country will terminate a "block" of plans that may be extremely unprofitable, and replace them with a revised plan option. The Utah Department Of Insurance must approve new policy offerings.


Protections and benefits offered by ACA plans are often not found on older plans. However, rates are generally less-expensive for these policies because many unnecessary benefits are not included, and the plans are customized to meet specific needs. At any time, you may terminate a grandfathered plan and purchase new Marketplace coverage during Open Enrollment or a Special Enrollment Period (SEP).

Regence BlueCross BlueShield and SelectHealth have both stated they will allow policyholders to keep older plans. Other companies have not officially announced their intentions. However, if your policy is discontinued, an additional 60 days is provided to select and enroll for new coverage.


What Is "Avenue  H"?


Created in 2010, this is the separate Exchange (also called "SHOP")  for small business owners (1-50 employees) to shop for coverage on themselves and workers. More than 300 small businesses utilize this program to provide policies. Employers contribute a per-determined amount of funds for their worker's healthcare and those workers can then  contribute additional money to "upgrade" their coverage. More than 70 Avenue H plan options are available and this "Defined Benefit" approach has so far been very popular. 33 dental and 3 HSA options are also offered.


Governor Herbert was very instrumental in convincing the federal government to allow the state of Utah to run Avenue H. This means that the state oversees certifications, compliance, and much of the Medicaid program. The three participating carriers are UnitedHealthcare, HSA healthplan, and SelectHealth. Dental plans are offered by Alpha Dental, Delta Dental, DentalSelect, and Emi. HSA providers are HealthEquity, Optum Bank, and National Benefit Services. HSA healthplan offers policies in the Northwestern portion of the state, while UnitedHealthcare offers coverage in Utah, Salt Lake, Davis, and weber Counties.


Avenue H is not designed to offer policies for the private sector that does not have group medical insurance. Utah has opted to allow its State Exchange (previously mentioned) to be federally-operated. This could change in future years, depending on the projected expenses and how much taxpayers in the state will have to pay, although we expect a continuation of the federal control. Currently, all of the tax advantages provided by Group coverage remain. The cost of a policy is paid with deductible pre-tax funds, and all of the HSA tax advantages are still available.


Utah Senior Medicare Health Insurance Options


Medigap plans are very popular in the Beehive State. Supplement, Advantage, and Part D Prescription Drug coverage is available from a wide variety of companies. Although rates, of course, periodically change, prices have remained fairly stable over the last five years. Listed below are the approved carriers that are authorized to issue Medicare Supplement coverage. Not all available plans (A-N and High Deductible F and J) are offered by each company.


American Republic
Assured Life
Central States
Colonial Penn
Columbian Mutual
Educators Mutual
Family Life
Gerber Life
Globe Life
Government Personnel Mutual Life
Liberty National
Loyal American
Regence Blue Cross Blue Shield Of Utah
Reserve National
Standard Life
State Farm
Sterling Life
United American
United Of Omaha
WMI Mutual


Illustrated below are estimated monthly rates for Medicare Supplement plans for all Utah counties. Prices are for a non-smoking 65 year-old male. Female rates are lower.


Plan A
$65 -- AARP-UnitedHealthcare
$79 -- Transamerica
$82 -- Mutual Of Omaha
$84 -- Philadelphia American
$90 -- United American
$94 -- Companion Life
$94 -- Central States
$97 -- American Continental
$97 -- CSI Life
$99 -- Manhattan Life
$102 -- Equitable
$108 -- Medico
$114 -- American Retirement Life
$118 -- Individual Assurance
$119 -- Humana
$130 -- Oxford Life
$140 -- Gerber


Plan B
$106 -- AARP-UnitedHealthcare
$110 -- Central States
$120 -- American Continental
$126 -- United American
$133 -- Humana


Plan C
$130 -- AARP-UnitedHealthcare
$138 -- Manhattan Life
$159 -- Central States
$174 -- Humana
$181 -- United American


Plan D
$159 -- United American


Plan F
$130 -- AARP-UnitedHealthcare
$142 -- Transamerica
$146 -- Companion Life
$146 -- Manhattan Life
$152 -- Mutual Of Omaha
$152 -- Philadelphia American
$164 -- Medico
$164 -- Central States
$169 -- CSI Life
$172 -- Equitable
$172 -- United American
$178 -- Humana
$187 -- Oxford Life
$233 -- Gerber


Plan F (High Deductible)
$30 -- United American
$41 -- Philadelphia American
$44 -- Mutual Of Omaha
$50 -- Humana
$66 -- American Continental Life


Plan G
$102 -- American Retirement Life
$110 -- Transamerica
$110 -- AARP-UnitedHealthcare
$112 -- Philadelphia American Life
$112 -- Manhattan Life
$115 -- American Continental Life
$117 -- Mutual Of Omaha
$120 -- CSI Life
$122 -- Oxford Life
$125 -- Equitable
$125 -- Companion Life
$132 -- Central States
$143 -- Medico
$184 -- United American
$194 -- Gerber


Plan N
$86 -- AARP-UnitedHealthcare
$88 -- Transamerica
$92 -- Manhattan Life
$99 -- Mutual Of Omaha
$99 -- American Retirement Life
$101 -- Humana
$103 -- Central States
$104 -- American Continental
$104 -- CSI Life
$104 -- Equitable
$105 -- Medico
$128 -- Oxford Life
$143 -- United American


Medicare Advantage (Part C) contracts are also very popular. Offered by private insurers, these policies often include dental, vision, and hearing benefits, along with several wellness perks. Many plans also include prescription drug coverage. We have listed below several Advantage options that include prescription drug benefits:


AARP MedicareComplete 1 -- Underwritten by UnitedHealthcare, this plan is available in Box Elder, Cache, Davis, Morgan, Salt Lake, Summit, Tooele, Utah, Wasatch, and Weber Counties. Deductible is $150 with $4,900 maximum out-of-pocket expenses. Inpatient hospital copay is $295 for first five days while office visit copays are $5 and $40. Tier 1 and Tier 2 drugs have $0 copay for 90-day mail-order. Tier 3 copay is $125. NOTE: An additional plan (2) is available with a lower premium but higher deductible ($5,900).


Aetna Medicare Choice Plan -- Available in the following Counties: Box Elder, Cache, Davis, Salt Lake, Summit, Tooele, Utah, Wasatch, and Weber. $0 deductible with $4,700 maximum out-of-pocket expenses. $289 in-hospital copay for the first six days. Office visit copays are $5 and $40, while lab service and x-ray copays are $0 and $20. ER copay is $75 and $20 copay for chiropractic visits. Tier 1 90-day mail 0rder copay is $15. Tier 2 and Tier 3 are $36 and $141 respectively. A "Select" plans is also available for a higher premium.

Regence MedAdvantage + Rx Classic -- Available in Davis, Salt Lake, Utah, and Weber Counties. $360 deductible with $6,700 maximum out-of-pocket expenses. In-hospital copay of $350 for four days, and office visit copays of $20 and $40. Diagnostic radiology services have a 20% copay while lab and x-ray services have a $5-$20 copay. ER and Urgent Care copays are $75 and $40. Tier 1 cost-sharing 90-day copay is $20, while Tier 2 and Tier 3 copays are $36 and $117.50. NOTE: And Rx Enhanced plan is also offered at a higher rate with a $0 deductible and $5,000 maximum out-of-pocket expenses.

HumanaChoice -- Available in Daggett, Davis, Salt Lake, Unitah, and Weber Counties. $320 deductible with $6,700 maximum out-of-pocket expenses. The in-hospital copay is $325 for five days and office visit copays are $15 and $45. Lab services and diagnostic tests typically have copays between $0 and $100. The ER copay is $75 while the Urgent Care copy and coinsurance will vary, depending on the service. Tier 1 and Tier 2 90-day mail order copays are $0, while Tier 3 and Tier 4 copays are $131 and $287 respectively.
Altius Advantra -- Available in Daggett, Davis, Box Elder, Wasatch, Salt Lake, Utah, Weber, Cache, Morgan, Tooele, Summit, and Rich Counties. $400 deductible with $6,700 maximum out-of-pocket expenses. Tier 1 and Tier 2 90-day mail order copays are $4 and $15, while Tier 3 and Tier 4 copays are $141 and $300 respectively.

UnitedHealthcare MedicareComplete Choice -- Available in Washington County. $375 deductible with maximum out-of-pocket expenses of $5,900. Office visit copays are $10 and $45 (out-of-network is $20 and $65). The ER copay is $75 (network and out-of-network). Inpatient hospital out-of-pocket costs are $395 for the first four days, $0 for days 5-90, and $0 for all remaining days. Outpatient hospital out-of-pocket expenses are 20% per visit. Skilled nursing facility (SNF) copays are $0 for the first 20 days, $160 for days 21-57, and $0 for days 58-100. The mental health care copays are $395 for the first four days, and $0 for days 5-90. The ambulance copay is $200 (network and out-of-network). Tier 1 cost-sharing 90-day copay is $0, while Tier 2 and Tier 3 copays are $0 and $131.

Medicare Part D (Prescription Drug) Plans

Regence BCBS OF Utah Medicare Script Basic (PDP) -- Monthly premium of $97.50 with $310 deductible (not applicable to Tier 6 drugs). Retail and mail-order 30-day supply copays for Tiers 1, 2, and 3 are $5, $15, and $47. Retail and mail-order 30-day supply copays for Tiers 4, 5, and 6 are 30%, 26%, and 0. Retail and mail-order 90-day supply copays for Tiers 1, 2, and 3 are $10, $30, and $117.50. Retail and mail-order 90-day supply copays for Tiers 4 and 6 are 30% and $0. The "coverage gap" is reached when $3,750 has been paid (you and insurer). You then pay 44% of cost for generic drugs, and 35% of cost for brand name drugs. The coverage gap ends at $5,000.


Regence BCBS OF Utah Medicare Script Enhanced (PDP) -- Monthly premium of $148.50 with a $0 deductible. Retail and mail-order 30-day supply copays for Tiers 1, 2, and 3 are $2, $4, and $36. Retail and mail-order 30-day supply copays for Tiers 4, 5, and 6 are 40%, 33%, and 0. Retail and mail-order 90-day supply copays for Tiers 1, 2, and 3 are $4, $8, and $90. Retail and mail-order 90-day supply copays for Tiers 4 and 6 are 40% and $0. Once your drug out-of-pocket cost has reached $5,000, you pay the greater of 5% of prescription costs, or copays of $3.35 (generic drugs) and $8.35 (all remaining drugs).


Updates From The Past:


December 2013 -- Online enrollment for 2014 coverage is taking less time with far fewer delays and glitches. Although scattered issues are being reported, we are seeing a process that is much smoother compared to the initial roll-out in October.
However, applicants that are eligible for Medicaid should automatically be transferred to the State Agency that handles the program. Currently, that is not occurring and the Department of Workforce Services is unable to determine eligibility. Temporarily, any Utah resident who believes they should qualify for Medicaid, should directly contact the Department.


August 2014 -- Medicaid expansion in Utah may become a reality shortly. Governor Herbert and the federal government (HHS) are attempting to jointly approve a plan that would satisfy all parties. If approved, the new legislation would provide low-cost coverage to thousands of residents that currently are not Medicaid-eligible because of their household income. "Healthy Utah" could become law by the end of 2014.


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Medicaid Expansion May Be Coming To Utah


December 2014 -- Governor Gary Herbert's Medicaid expansion idea ("Healthy Utah") that would provide private coverage to many of the state's uninsured was not approved by the Utah health panel. However, the reform task force recommended two separate ideas that would be less costly to most residents. The Governor's plan would have cost taxpayers almost $80 million within the next seven years, and perhaps taken away needed funds for public education.


The upcoming legislative session will provide another opportunity for the Governor to try to sway some opinions so the bill can be passed. He believes that his proposal will cover more persons and it makes sense to utilize government funds that have been offered. The debate is expected to continue while almost 150,000 people wait to take advantage of a program that can't be passed.


July 2015 -- Utah companies have filed their 2016 rate requests with the Department of Insurance. Although the entire amount of these increases will unlikely be approved, prices will be going up. Shown below are several just-filed requests (within the last 30 days):


58% -- Arches Individual POS
36% -- Time (Assurant) Individual
23% -- SelectHealth Individual
22% -- Regence BlueCross BlueShield Direct Gold
22% -- BridgeSpan Exchange Gold
20% -- SelectHealth Minimum Individual
19% -- Aetna Peak Preference AltiusOne
18% -- HumanaOne Individual


September 2015 -- 12.5% of Utah residents were without healthcare coverage in 2014, which was down slightly from 14.0% in 2013. Although the state has not expanded Medicaid eligibility, federal subsidies continue to reduce premiums for household that qualify.


Also, The Brigham Young University student health plan currently available for the 2015-2016 academic year has been determined to be non-compliant with ACA requirements. Thus, policyholders will be subject to a federal tax penalty for being uninsured. College medical plans were grandfathered until September 1, 2015. However, many University plans have not made the appropriate changes to become compliant.


October 2015 -- Utah Access Plus, the proposed Medicaid expansion program for the state, may not get enough votes to pass, due to the amount of new taxes needed to run the program. For the last three years, the concept has been discussed and debated, and most residents seem to approve its implementation.


About $50 million in taxes would have to be payed by drug companies, hospitals, physicians, and other facilities in order to receive federal government funding of about $450 million. Those funds would help low-income families (less than 138% of Federal Poverty Level) qualify for subsidized health insurance benefits.


November 2015 -- CO-OP Arches Health Plan has ceased operations and will not offer 2016 Marketplace plans in Utah. The DOI has placed the carrier in receivership, and current policyholders have until December 15th to select another company. There will be no lapse in coverage since their benefits should continue through December 31st. Bridgespan and Altius also announced that they will only offer off-Exchange policies for 2016.


October 2016 -- Humana is not offering Marketplace plans for 2017. However, Group and several ancillary options will be available. The three major participating companies will be Molina, SelectHealth, and University of Utah Health Plans. Once again, about four out of five applicants will be eligible for financial subsidies.

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