Affordable health insurance in Utah is available for individuals, families and small and large businesses. The most recent federal legislation has created Exchanges and Marketplaces that allow you to directly purchase quality medical coverage from the most reputable carriers. Our website will allow you to shop for the lowest prices, compare the best plans, and easily purchase coverage. The Utah Health Exchange is federally managed and we help you find the best fit for you or your family.
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.
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. Some of the cheapest catastrophic plans are Altius POS, Bridge Span Catastrophic, Humana Connect Basic, and Select Med Millennial.
How cheap are premiums on these high deductible plans? For example, The monthly rate for a 25 year-old in Salt Lake or Davis County is approximately $102. The rate for a 15 year-old would reduce to approximately $62.
"Essential Health Benefits" will be 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 will have very few or no gaps. About 250,000 Utah residents will be eligible for these new plans.
About 100 different policies will be offered through the Marketplace by six carriers. They are Arches Mutual, Humana, Altius Health Plans, BridgeSpan, SelectHealth and Molina. Some of the bigger carriers mentioned below (UnitedHealthcare, for example) will not be participating in the individual Exchange. Although reasons vary, in 2015, additional companies may return to offer coverage to consumers.
You will also be able to buy policies independently from the Exchange. Since these options don't pay a federal subsidy, your individual income should be at least $45,000 and your family income at least $95,000 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."
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 will be offering Marketplace plans for 2014.
Humana is one of the biggest carriers in the US. They offer many types of plans including short-term, comprehensive, HSA and catastrophic high-deductible coverage. Their Value and Copay plans have been very popular and they feature of the largest provider networks in the state. Since they are a national company, out-of-the-area treatment is often treated as "in-network."
Regence Blue Cross Blue Shield has it all. Medical plans, Medicare Supplements, Medicare Advantage, Part D and more. Typically, the BC and/or BCBS rates in most states are very competitive for both seniors and non-seniors. Utah is not an exception. The Evolve and Core Value policy portfolio has allowed customers to keep prices fairly low, but still get solid benefits including 100% preventive.
UnitedHealthcare is larger than Humana. They often offer plans through their "Golden Rule" brand name and have an extensive portfolio consisting of HSAs, short-term, comprehensive and budget plans. Their provider list is very large and they also offer both group and individual policies. They have stated that they will not be participating in most State Marketplace Exchanges for 2013.
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 & Associates gives them a high ranking in member satisfaction (four consecutive years) and we expect this tradition to continue.
Altius is also known as Coventry and offers policies to both pre-Medicare and post-Medicare individuals and families. Coventry, is now part of Aetna, one of the largest companies in the US. Like UnitedHealthcare, they will be very selective about which states that will offer coverage in 2014. They offer many affordable options that feature lower deductibles between $500 and $1,250.
Is A Government Subsidy Available?
Yes. Actually, it is available in all states. Your modified adjusted gross income (MAGI) will determine your eligibility. If you are single and make under $45,000, you should be eligible. A family of three that earns less than $78,000 should also qualify (About $94,000 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.
It's paid in a 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.
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 set 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.
Can I Keep My Existing Plan?
If your existing policy is not being terminated (you will be notified in writing), many companies are allowing you to keep your current plan through 2015 and perhaps 2016. These "grandfathered" policies were issued prior to April of 2010 and often contain higher out-of-pocket expenses for hospital-related claims. Also, maternity and prenatal benefits are typically missing or limited.
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"?
This is the separate Exchange (also called "SHOP") for small business owners 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.
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 will oversee certifications, compliance and much of the Medicaid program. The three participating carriers are expected to be UnitedHealthcare, Regence Blue Cross Blue Shield and SelectHealth.
Avenue H, however, 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 run for 2014. This could change in 2015, depending on the projected expenses and how much taxpayers in the state will have to pay.
UPDATE: December 3, 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 rollout 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.