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 2020 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). The five carriers offering Marketplace plans are Cigna, BridgeSpan, Molina, SelectHealth, and University Of Utah.

 

Cigna and BridgeSpan are new participating carriers for 2020. BridgeSpan previously marketed on-Exchanged plans five years ago, and will offer coverage in Davis and Weber counties. Bronze-tier plans are now available from Molina, which feature lower premiums, but higher out-of-pocket costs.

 

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 SelectHealth Value Catastrophic 8150 and Select Health Med Catastrophic 8150. 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 ($28,000 income) that resides in Salt Lake County. Because of the federal subsidy, many low-cost options are offered. Prices shown are monthly. Several plans have a $0 premium since federal subsidy exceeds cost of policy.

 

$12 -- SelectHealth Value Benchmark Bronze 8150 -- $8,150 deductible with maximum out-of-pocket expenses of $8,150 and 0% coinsurance.

$20 -- SelectHealth Value Benchmark Bronze 6800 -- $6,800 deductible with maximum out-of-pocket expenses of $8,000 and 40% coinsurance. Office visit copays are $40 and $65. Urgent Care copay is $65 and ER copay is $600. Tier 1 and Tier 2 drug copays are $20 and $30.

$31 -- SelectHealth Value Expanded Bronze 7800 -- $7,800 deductible with maximum out-of-pocket expenses of $8,150 and 40% coinsurance. Office visit copays are $40 and $65. Urgent Care copay is $65 and ER copay is $600. Tier 1 and Tier 2 drug copays are $20 and $30.

$31 -- SelectHealth Value HealthSave Expanded Bronze 6850 -- $6,850 deductible with maximum out-of-pocket expenses of $6,850 and 0% coinsurance. HSA-eligible.

 

Sample Family Monthly Rates

 

Family Of Five (50 year-old husband and wife with three children) residing in Provo. $105,000 Household income.
 

$22 -- SelectHealth Select Value Benchmark Bronze 8150

$65 -- SelectHealth Select Value Benchmark Bronze 6800

$112 -- Molina Core Care Bronze 2

$123 -- SelectHealth Value Expanded Bronze 7800

$123 -- SelectHealth Value HealthSave Expanded Bronze 6850 HSA

$178 -- Molina Core Care Bronze 1

$185 -- SelectHealth Med Benchmark Bronze 8150

$223 -- University Of Utah Health Plans Healthy Preferred Bronze HSA

$232 -- University Of Utah Health Plans Healthy Preferred Bronze w/3 Copay Before Deductible

$234 -- SelectHealth Med Benchmark Bronze 6800

 

Family Of Four (40 year-old husband and wife with two children) residing in Salt Lake City. $85,000 Household income.
 

$115 -- SelectHealth Select Value Benchmark Bronze 8150

$143 -- SelectHealth Select Value Benchmark Bronze 6800

$181 -- SelectHealth Value Expanded Bronze 7800

$181 -- SelectHealth Value HealthSave Expanded Bronze 6850 HSA

$196 -- Molina Core Care Bronze 2

$222 -- SelectHealth Med Benchmark Bronze 8150

$241 -- Molina Core Care Bronze 1

$254 -- University Of Utah Health Plans Healthy Preferred Bronze HSA

$255 -- SelectHealth Med Benchmark Bronze 6800

$260 -- University Of Utah Health Plans Healthy Preferred Bronze w/3 Copay Before Deductible

 

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 is no longer assessed if a non-compliant policy is purchased instead of an approved plan. A 3-month grace period was previously provided that helped offset some of the penalty. Thus, a household with $60,000 of income will not face a special tax of about $1,500 if they remain uninsured for an entire year.

 

Temporary 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. Since a 2.5% income tax penalty can not be imposed, the lower premiums and major medical coverage provided from a short-term plan may be your best choice for that specific predicament. Office visits, urgent-care and prescription drug copays are often available.

 

About 70 different policies are offered through the Marketplace by two carriers. They are SelectHealth and University of Utah Health Plans. 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.

 

Best Utah Health Exchange Rates Online

Get Affordable Utah Health Insurance Exchange Coverage

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 four carriers that offer single and family coverage throughout the state. Note: Companies that recently stopped offering private individual medical coverage include: Humana, Regence Blue Cross, UnitedHealthcare, Arches Mutual, Molina, BridgeSpan, and 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.

 

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.

 

Molina is a Fortune 500 company that has conducted business in Utah for more than 30 years, and covers more than 5 million persons in the US.

 

Cigna has more than 170 million customers and patients, and is one of the nation's largest insurers. They offer group, dental, and many other ancillary products in Utah.

 

How To Find Lowest UT Healthcare Options

Low-Cost Utah Health Insurance Plans Are Available

Most Affordable Health Insurance Plans In Utah

 

Catastrophic Tier

 

SelectHealth Select Value Catastrophic 8150 -- $35 copay for pcp office visits. Substance abuse disorder (outpatient) and behavioral/mental health (outpatient) also receive the same copay. Deductible is $8,150 with 0% coinsurance.

SelectHealth Select Med Catastrophic 8150 -- $35 copay for pcp office visits. Substance abuse disorder (outpatient) and behavioral/mental health (outpatient) also receive the same copay. Deductible is $8,150 with 0% coinsurance.

 

Bronze Tier

 

SelectHealth Select Value Benchmark Bronze 8150 -- $8,150 deductible with maximum out-of-pocket expenses of $8,150 and 0% coinsurance.

SelectHealth Select Value Benchmark Bronze 6800 -- $6,800 deductible with maximum out-of-pocket expenses of $8,000 and 40% coinsurance. $50 and $65 office visit copays after deductible has been met. $20 and $30 Tier 1 and Tier 2 drug copays.

SelectHealth Select Value HealthSave Bronze 6850 HSA -- HSA-eligible plan with $6,850 deductible and $6,850 maximum out-of-pocket expenses and 0% coinsurance. 100% coverage after deductible has been met.

SelectHealth Select Value Expanded Bronze 7800 -- $40 and $65 office visit copays. $7,850 deductible with maximum out-of-pocket expenses of $8,150 and 40% coinsurance. $20 and $30 Tier 1 and Tier 2 drug copays.

SelectHealth Select Med Benchmark Bronze 8150 -- $8,150 deductible with maximum out-of-pocket expenses of $8,150 and 0% coinsurance.

SelectHealth Select Med Benchmark Bronze 6800 -- $6,800 deductible with maximum out-of-pocket expenses of $8,000 and 40% coinsurance. $40 and $65 office visit copays after deductible has been met. $20 and $30 Tier 1 and Tier 2 drug copays.

University of Utah Health Plans Healthy Preferred w/3 Copay Before Deductible -- $45 copay for first three pcp office visits. Urgent Care copay is $45. $6,550 deductible with maximum out-of-pocket expenses of $8,150 and 40% coinsurance. A $35 copay applies to preferred generic drugs.

University of Utah Health Plans Healthy Preferred Bronze HSA -- HSA-eligible plan with $6,900 deductible and maximum out-of-pocket expenses of $6,900 and 0% coinsurance.

Molina Core Care Bronze 2 -- $8,000 deductible and maximum out-of-pocket expenses of $8,150 and 40% coinsurance.

Molina Core Care Bronze 1 -- $6,800 deductible and maximum out-of-pocket expenses of $8,150 and 40% coinsurance. $35 and $85 office visit copays. $35 Urent Care copay. $32 preferred generic drug copay.

Cigna Connect 8150 -- $8,150 deductible and maximum out-of-pocket expenses of $8,150 and 0% coinsurance.

BridgeSpan Bronze Care On Demand 8000 EPO -- $8,000 deductible with maximum out-of-pocket expenses of $8,150 and 20% coinsurance.

 

Silver Tier

 

Molina Constant Care Silver 2 250 -- $30 and $75 office visit copays with $30 copay for Urgent Care. $6,500 deductible with maximum out-of-pocket expenses of $8,150 and 40% coinsurance. Tier 1 and Tier 2 drug copays are $25 and $65.

Molina Constant Care Silver 1 250 -- $25 and $75 office visit copays with $25 copay for Urgent Care. $6,000 deductible with maximum out-of-pocket expenses of $8,150 and 40% coinsurance. Tier 1 and Tier 2 drug copays are $15 and $60.

SelectHealth Value Silver 2300 -- $35 and $60 office visit copays with $60 copay for Urgent Care and $600 copay for ER visits (All subject to deductible). $2,300 deductible with maximum out-of-pocket expenses of $8,150 and 50% coinsurance. Tier 1 and Tier 2 drug copays are $15 and $25.

SelectHealth Value HealthSave Silver 3250 -- HSA-eligible plan with $25 and $40 office visit copays with $40 copay for Urgent Care and $600 copay for ER visits. $3,250 deductible with maximum out-of-pocket expenses of $6,850 and 30% coinsurance. Tier 1 and Tier 2 drug copays are $15 and $25.

SelectHealth Value Benchmark Silver 6200 -- $25 and $60 office visit copays with $60 copay for Urgent Care and $600 copay for ER visits (not subject to deductible). $6,200 deductible with maximum out-of-pocket expenses of $8,000 and 50% coinsurance. Tier 1 and Tier 2 drug copays are $15 and $25.

Cigna Connect 1900 -- $45 pcp office visit copay with $55 copay for Urgent Care. $1,900 deductible with maximum out-of-pocket expenses of $8,150 and 50% coinsurance. Preferred generic and generic drug copays are $15 and $30.

Cigna Connect 2250 -- $30 and $75 office visit copays with $50 copay for Urgent Care. $2,250 deductible with maximum out-of-pocket expenses of $8,150 and 30% coinsurance. Preferred generic and generic drug copays are $8 and $25.

University Of Utah Health Plans Healthy Preferred Silver Copay -- $30 and $75 office visit copays with $30 copay for Urgent Care. $3,500 deductible with maximum out-of-pocket expenses of $8,000 and 40% coinsurance. Preferred generic drug copay is $15.

BridgeSpan Silver HDHP 3500 EPO -- HSA-eligible plan with $3,500 deductible and maximum out-of-pocket expenses of $6,900 and 20% coinsurance.

 

Gold Tier

 

University of Utah Health Plans Healthy Preferred Gold Copay -- $25 and $40 office visit copays with $65 Urgent Care copay. $1,500 deductible with maximum out-of-pocket expenses of $7,000 and 15% coinsurance. A $15 copay applies to preferred generic drugs.

SelectHealth Select Value Gold 1500 no deductible for office visits -- $25 and $40 office visit copays with $40 copay for Urgent Care and $350 copay for ER visits (not subject to deductible). $1,500 deductible with maximum out-of-pocket expenses of $6,000 and 20% coinsurance. Drug standard generic tier and maintenance tier copay is $15.

SelectHealth Select Med Gold 1500 no deductible for office visits -- $25 and $40 office visit copays with $40 copay for Urgent Care and $350 copay for ER visits (not subject to deductible). $1,500 deductible with maximum out-of-pocket expenses of $6,000 and 20% coinsurance. Drug standard generic tier and maintenance tier copay is $15.

Molina Confident Care Gold 1 -- $10 and $50 office visit copays with $10 copay for Urgent Care. $2,925 deductible with maximum out-of-pocket expenses of $6,000 and 20% coinsurance. $10 copay for lower cost generic and brand name drugs. $50 copay for preferred generic and brand name drugs.

Cigna Connect 1700 -- $20 and $60 office visit copays with $50 copay for Urgent Care. $1,700 deductible with maximum out-of-pocket expenses of $7,500 and 20% coinsurance. $5 and $10 ($15 and $30 mail order) copays for preferred generic and generic drugs.

 

Are Federal Subsidies Offered?

 

Yes. Actually, they are available in all states. Your modified adjusted gross income (MAGI) will determine your eligibility. For example, if you are 35, single and make under $48,000, 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 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 $346 per month. However, a 45 year-old would receive about $471 while a 60 year-old could receive as much as $906, 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 allowed you to keep your current plan. These "grandfathered" policies were issued prior to March 23, 2010 and often contained higher out-of-pocket expenses for hospital-related claims. Also, maternity and prenatal benefits were typically missing or limited. Mental health benefits were also limited, so if theses coverages are important to have, applying and enrolling for Marketplace plans would be advantageous.

 
Of course, newer policies 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).

 

What Was "Avenue  H"?

 

Created nine years ago, this was the separate Exchange (also called "SHOP")  for small business owners (1-50 employees) to shop for coverage on themselves and workers. New group quotes are no longer accepted, and existing groups received support until a few years ago. The SHOP Exchange replaced Avenue H, and offers enrollment throughout the entire year.

More than 500 small businesses utilized this program to provide policies. Employers contributed a pre-determined amount of funds for their worker's healthcare and those workers could then  contribute additional money to "upgrade" their coverage. More than 70 Avenue H plan options were available and the "Defined Benefit" approach was very popular. 33 dental and 3 HSA options were 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 was not designed to offer policies for the private sector that did 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
Equitable
Family Life
Gerber Life
Globe Life
Government Personnel Mutual Life
Liberty National
Loyal American
Medico
Regence Blue Cross Blue Shield Of Utah
Reserve National
Standard Life
State Farm
Sterling Life
Transamerica
United American
United Of Omaha
UnitedHealthcare
USAA
WMI Mutual

 

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

 

Plan A
$65 -- AARP-UnitedHealthcare
$76 -- Humana
$88 -- Mutual Of Omaha
$92 -- Philadelphia American
$93 -- Transamerica
$95 -- Lumico Life
$97 -- Aetna
$98 -- CSI Life
$98 -- Cigna
$99 -- Union Security
$104 -- Regence BCBS
$104 -- Great Southern Life
$105 -- Thrivent
$110 -- Medico
$117 -- Western United Life
$148 -- Oxford Life
$161 -- Assured Life

 

Plan B
$101 -- AARP-UnitedHealthcare
$109 -- Aetna
$185 -- Assured Life

 

Plan C
$118 -- AARP-UnitedHealthcare
$147 -- Western United Life
$159 -- Regence BCBS
$227 -- Assured Life

 

Plan D
$105 -- Philadelphia American
$182 -- Assured Life

 

Plan F
$115 -- Capitol Life
$120 -- Great Southern Life
$123 -- Union Security
$124 -- AARP-UnitedHealthcare
$125 -- Lumico Life
$127 -- Humana
$132 -- Thrivent
$138 -- Great Southern Life
$143 -- Aetna
$143 -- Guarantee Trust Life
$153 -- Lumico Life
$157 -- Mutual Of Omaha
$158 -- Transamerica
$160 -- Regence BCBS
$167 -- Philadelphia American
$188 -- Oxford Life

 

Plan F (High Deductible)
$33 -- Great Southern Life
$35 -- Mutual Of Omaha
$38 -- Philadelphia American
$39 -- Humana
$54 -- Aetna

 

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 K
$42 -- AARP-UnitedHealthcare
$71 -- Humana
$91 -- United American

 

Plan L
$72 -- AARP-UnitedHealthcare
$102 -- Humana
$128 -- United American

 

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

 

Utah 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. Prices, benefits, and availability of plans shown, may differ, depending upon your county of residence. We have listed below several Advantage options that include prescription drug benefits:

 

AARP Medicare Advantage Plan 1 -- $200 deductible and maximum out-of-pocket expenses of $4,500. Inpatient hospital copay is $290 per day for the first five days. The outpatient hospital copay is $0-$275. Office visit copays are $0 and $30, and the ER and Urgent Care copays are $90 and $30-$40. The lab service copay is $0 and the outpatient x-ray copay is $14. Outpatient mental health individual and group copays are $25 and $20. Occupational, physical, and speech and hearing therapy copays are $20. Preventative dental, vision, and hearing visits are covered, subject to policy limits. The 30-day prescription drug cost-sharing copays are $3 (Tier 1), $10 (Tier 2), $45, (Tier 3), $95 (Tier 4), and 29% (Tier 5).

 

AARP Medicare Advantage Plan 2 -- $200 deductible and maximum out-of-pocket expenses of $5,000. Inpatient hospital copay is $345 per day for the first five days. The outpatient hospital copay is $0-$325. Office visit copays are $0 and $40, and the ER and Urgent Care copays are $90 and $30-$40. The lab service copay is $6 and the outpatient x-ray copay is $14. Outpatient mental health individual and group copays are $25 and $20. Occupational, physical, and speech and hearing therapy copays are $20. Preventative dental, vision, and hearing visits are covered, subject to policy limits. The 30-day prescription drug cost-sharing copays are $3 (Tier 1), $10 (Tier 2), $45, (Tier 3), $95 (Tier 4), and 29% (Tier 5).

 

Aetna Medicare Elite Plan -- $0 deductible and maximum out-of-pocket expenses of $4,900. Inpatient hospital copay is $390 per day for the first five days. The outpatient hospital copay is $40-$295. Office visit copays are $0 and $40, and the ER and Urgent Care copays are $90 and $40. The lab service copay is $0 and the outpatient x-ray copay is $0. Outpatient mental health individual and group copays are $40. Occupational, physical, and speech and hearing therapy copays are $40. Dental, vision, and hearing visits are covered, subject to policy limits. The 30-day prescription drug cost-sharing copays are $0 (Tier 1), $0 (Tier 2), $47, (Tier 3), $100 (Tier 4), and 33% (Tier 5).

 

Aetna Advantra -- $100 deductible and maximum out-of-pocket expenses of $5,500. Inpatient hospital copay is $375 per day for the first five days. The outpatient hospital copay is $225. Office visit copays are $0 and $45, and the ER and Urgent Care copays are $90 and $45. The lab service copay is $0 and the outpatient x-ray copay is $10. Outpatient mental health individual and group copays are $40. Occupational, physical, and speech and hearing therapy copays are $40. Dental, vision, and hearing visits are covered, subject to policy limits. The 30-day prescription drug cost-sharing copays are $0 (Tier 1), $10 (Tier 2), $47, (Tier 3), $100 (Tier 4), and 31% (Tier 5).

 

Aetna Medicare Choice Plan -- $100 deductible and maximum out-of-pocket expenses of $5,900. Inpatient hospital copay is $390 per day for the first five days. The outpatient hospital copay is $45-$350. Office visit copays are $0 and $45, and the ER and Urgent Care copays are $90 and $45. The lab service copay is $0 and the outpatient x-ray copay is $10. Outpatient mental health individual and group copays are $40. Occupational, physical, and speech and hearing therapy copays are $40. Dental, vision, and hearing visits are covered, subject to policy limits. The 30-day prescription drug cost-sharing copays are $0 (Tier 1), $10 (Tier 2), $47, (Tier 3), $100 (Tier 4), and 31% (Tier 5).

 

Humana Gold Plus -- $200 deductible and maximum out-of-pocket expenses of $5,900. Inpatient hospital copay is $400 per day for the first four days. The outpatient hospital copay is $5-$400. Office visit copays are $0 and $45, and the ER and Urgent Care copays are $90 and $0-$45. The lab service copay is $0 and the outpatient x-ray copay is $0-$15. Outpatient mental health individual and group copays are $40. Occupational, physical, and speech and hearing therapy copays are $40. Vision and hearing visits are covered, subject to policy limits. The 30-day prescription drug cost-sharing copays are $4 (Tier 1), $15 (Tier 2), $47, (Tier 3), $100 (Tier 4), and 29% (Tier 5).

 

HumanaChoice -- $200 deductible and maximum out-of-pocket expenses of $5,900. Inpatient hospital copay is $450 per day for the first four days. The outpatient hospital copay is $5-$450. Office visit copays are $0 and $50, and the ER and Urgent Care copays are $90 and $0-$50. The lab service copay is $0 and the outpatient x-ray copay is $0-$15. Outpatient mental health individual and group copays are $40. Occupational, physical, and speech and hearing therapy copays are $40. Vision, preventative dental, and hearing visits are covered, subject to policy limits. The 30-day prescription drug cost-sharing copays are $4 (Tier 1), $15 (Tier 2), $47, (Tier 3), $100 (Tier 4), and 29% (Tier 5).

 

Molina Medicare Choice Care -- $0 deductible and maximum out-of-pocket expenses of $5,400. Inpatient hospital copay is $295 per day for the first six days. The outpatient hospital copay is $225. Office visit copays are $0 and $40, and the ER and Urgent Care copays are $90 and $40. The lab service copay is $5 and the outpatient x-ray copay is $5. Outpatient mental health individual and group copays are $40. Occupational, physical, and speech and hearing therapy copays are $40. Vision, dental, and hearing visits are covered, subject to policy limits. The 30-day prescription drug cost-sharing copays are $2 (Tier 1), $8 (Tier 2), $45, (Tier 3), $100 (Tier 4), and 33% (Tier 5).

 
Medicare Part D (Prescription Drug) Plans

 
Humana Walmart Value Rx Plan -- Monthly premium of $13.20 with $435 deductible (not applicable to Tier 1 and 2 drugs). 30-day supply cost-sharing copays are $1 (Tier 1), $4 (Tier 2), $47 (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $3 (Tier 1), $12 (Tier 2), $141 (Tier 3), 35% (Tier 4), and n/a (Tier 5).

 
Humana Premier Rx Plan -- Monthly premium of $51.80 with $435 deductible. 30-day supply cost-sharing copays are $1 (Tier 1), $4 (Tier 2), $42 (Tier 3), 44% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $0 (Tier 2), $116 (Tier 3), 44% (Tier 4), and n/a (Tier 5).

 
Humana Basic Rx Plan -- Monthly premium of $36.20 with $435 deductible. 30-day supply cost-sharing copays are $0 (Tier 1), $1 (Tier 2), 25% (Tier 3), 39% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $0 (Tier 2), $116 (Tier 3), 44% (Tier 4), and n/a (Tier 5).

 

Express Scripts Medicare-Saver -- Monthly premium of $21.20 with $435 deductible (not applicable to Tier 1 and 2 drugs). 30-day supply cost-sharing copays are $1 (Tier 1), $4 (Tier 2), $30 (Tier 3), 41% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $8 (Tier 2), $90 (Tier 3), n/a (Tier 4), and n/a (Tier 5).

 

Express Scripts Medicare-Value -- Monthly premium of $39.10 with $435 deductible. 30-day supply cost-sharing copays are $1 (Tier 1), $3 (Tier 2), $25 (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $6 (Tier 2), $75 (Tier 3), n/a (Tier 4), and n/a (Tier 5).

 

Express Scripts Medicare Choice -- Monthly premium of $74.60 with $250 deductible (not applicable to Tier 1 and 2 drugs). 30-day supply cost-sharing copays are $2 (Tier 1), $7 (Tier 2), $42 (Tier 3), 48% (Tier 4), and 28% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $4 (Tier 2), $126 (Tier 3), n/a (Tier 4), and n/a (Tier 5).

 

AARP MedicareRx Walgreens (UnitedHealthcare) -- Monthly premium of $33.50 with $435 deductible. 30-day supply cost-sharing copays are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 32% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $15 (Tier 2), $120 (Tier 3), 32% (Tier 4), and 25% (Tier 5).

 

AARP MedicareRx Saver Plus (UnitedHealthcare) -- Monthly premium of $35.20 with $435 deductible. 30-day supply cost-sharing copays are $1 (Tier 1), $6 (Tier 2), $27 (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $3 (Tier 1), $18 (Tier 2), $81 (Tier 3), 35% (Tier 4), and 25% (Tier 5).

 

AARP MedicareRx Preferred (UnitedHealthcare) -- Monthly premium of $82.90 with $0 deductible. 30-day supply cost-sharing copays are $5 (Tier 1), $10 (Tier 2), $45 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $0 (Tier 2), $120 (Tier 3), 40% (Tier 4), and 33% (Tier 5).

 

SilverScript Choice -- Monthly premium of $33.70 with $305 deductible. 30-day supply cost-sharing copays are $0 (Tier 1), $1 (Tier 2), $47 (Tier 3), 38% (Tier 4), and 27% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $3 (Tier 2), $141 (Tier 3), 38% (Tier 4), and n/a (Tier 5).

 

SilverScript Plus -- Monthly premium of $84.40 with $0 deductible. 30-day supply cost-sharing copays are $0 (Tier 1), $2 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $6 (Tier 2), $141 (Tier 3), 50% (Tier 4), and n/a (Tier 5).

 

WellCare Classic -- Monthly premium of $34.20 with $435 deductible. 30-day supply cost-sharing copays are $0 (Tier 1), $1 (Tier 2), $31 (Tier 3), 33% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $2.50 (Tier 2), $77.50 (Tier 3), 33% (Tier 4), and n/a (Tier 5).

 

WellCare Wellness Rx -- Monthly premium of $14.20 with $435 deductible. 30-day supply cost-sharing copays are $0 (Tier 1), $5 (Tier 2), $40 (Tier 3), 46% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $12.50 (Tier 2), $100 (Tier 3), 46% (Tier 4), and n/a (Tier 5).

 

Cigna-HealthSpring Rx Secure-Essential -- Monthly premium of $22.20 with $435 deductible. 30-day supply cost-sharing copays are $0 (Tier 1), $2 (Tier 2), 18% (Tier 3), 44% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $4 (Tier 2), 18% (Tier 3), 44% (Tier 4), and n/a (Tier 5).

 

Cigna-HealthSpring Rx Secure -- Monthly premium of $35.20 with $435 deductible. 30-day supply cost-sharing copays are $1 (Tier 1), $2 (Tier 2), $30 (Tier 3), 35% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $6 (Tier 2), $90 (Tier 3), 35% (Tier 4), and n/a (Tier 5).

 

Cigna-HealthSpring Rx Secure Extra -- Monthly premium of $56.30 with $100 deductible. 30-day supply cost-sharing copays are $4 (Tier 1), $10 (Tier 2), $42 (Tier 3), 49% (Tier 4), and 31% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $20 (Tier 2), $105 (Tier 3), 49% (Tier 4), and n/a (Tier 5).

 

EnvisionRxPlus -- Monthly premium of $36.00 with $435 deductible. 30-day supply cost-sharing copays are $1 (Tier 1), $3 (Tier 2), 15% (Tier 3), 26% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $0 (Tier 1), $4.50 (Tier 2), $15% (Tier 3), 26% (Tier 4), and n/a (Tier 5).

 

First Health Part D Value Plus -- Monthly premium of $56.20 with $0 deductible. 30-day supply cost-sharing copays are $10 (Tier 1), $20 (Tier 2), $47 (Tier 3), 50% (Tier 4), and 33% (Tier 5). 90-day supply cost-sharing mail-order copays are $6 (Tier 1), $15 (Tier 2), $141 (Tier 3), 45% (Tier 4), and n/a (Tier 5).

 

Magellan Rx Medicare Basic -- Monthly premium of $64.10 with $405 deductible. 30-day supply cost-sharing copays are $1 (Tier 1), $4 (Tier 2), 15% (Tier 3), 50% (Tier 4), and 25% (Tier 5). 90-day supply cost-sharing mail-order copays are $3 (Tier 1), $12 (Tier 2), 15% (Tier 3), 50% (Tier 4), and n/a (Tier 5).

 

Educators Rx Advantage -- Monthly premium of $184.50 with $0 deductible. 30-day supply cost-sharing copays are 10% (Tier 1), 20% (Tier 2), 40%% (Tier 3), 33% (Tier 4), and n/a (Tier 5). 90-day supply cost-sharing mail-order copays are 10% (Tier 1), 20% (Tier 2), 40% (Tier 3), 33% (Tier 4), and n/a (Tier 5).

 

Regence Medicare Script Enhanced -- Monthly premium of $110.00 with $0 deductible. 30-day supply cost-sharing copays are $3 (Tier 1), $10 (Tier 2), $47 (Tier 3), 40% (Tier 4), and 33% (Tier 5). 90-day supply cost-sharing mail-order copays are $6 (Tier 1), $20 (Tier 2), $117.50 (Tier 3), 40% (Tier 4), and n/a (Tier 5).

 

Regence Medicare Script Basic -- Monthly premium of $86.50 with $245 deductible. 30-day supply cost-sharing copays are $10 (Tier 1), $13 (Tier 2), $40 (Tier 3), 30% (Tier 4), and 28% (Tier 5). 90-day supply cost-sharing mail-order copays are $20 (Tier 1), $26 (Tier 2), $100 (Tier 3), 30% (Tier 4), and n/a (Tier 5).

 

Utah Short-Term Health Insurance

 

Rates illustrated below are monthly for Salt Lake City. Prices can vary throughout the state.

 

35-Year-Old Female
 
$63 -- National General $5,000 deductible with $1 million maximum policy benefits and 20% coinsurance
$83 -- National General $5,000 deductible with $1 million maximum policy benefits and 0% coinsurance
$104 -- National General $2,500 deductible with $1 million maximum policy benefits and 20% coinsurance
$116 -- Independence American $2,500 deductible with $1 million maximum policy benefits and 50% coinsurance
 

45-Year-Old Male
 
$96 -- National General $5,000 deductible with $1 million maximum policy benefits and 20% coinsurance
$128 -- National General $5,000 deductible with $1 million maximum policy benefits and 0% coinsurance
$167 -- National General $2,500 deductible with $1 million maximum policy benefits and 20% coinsurance
$199 -- Independence American $2,500 deductible with $1 million maximum policy benefits and 50% coinsurance
 

55-Year-Old Female
 
$158 -- National General $5,000 deductible with $1 million maximum policy benefits and 20% coinsurance
$209 -- National General $5,000 deductible with $1 million maximum policy benefits and 0% coinsurance
$266 -- National General $2,500 deductible with $1 million maximum policy benefits and 20% coinsurance
$351 -- National General $2,500 deductible with $1 million maximum policy benefits and 0% coinsurance
 

45-Year-Old Married Couple
 
$264 -- National General $5,000 deductible with $1 million maximum policy benefits and 20% coinsurance
$283 -- Independence American $5,000 deductible with $1 million maximum policy benefits and 50% coinsurance
$348 -- National General $2,500 deductible with $1 million maximum policy benefits and 20% coinsurance
$378 -- Independence American $2,500 deductible with $1 million maximum policy benefits and 50% coinsurance
 

55-Year-Old Married Couple
 
$337 -- National General $5,000 deductible with $1 million maximum policy benefits and 20% coinsurance
$445 -- National General $5,000 deductible with $1 million maximum policy benefits and 0% coinsurance
$567 -- National General $2,500 deductible with $1 million maximum policy benefits and 20% coinsurance
$750 -- National General $2,500 deductible with $1 million maximum policy benefits and 0% coinsurance
 

Updates From The Past:

 

Online enrollment for 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.

 

Medicaid expansion in Utah may become a reality in the future. 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 if expansion is approved. But since only partial expansion is proposed, federal funding is not available.

 

Find Best Medical Plans In Utah

Medicaid Expansion May Be Coming To Utah

 

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.

 

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

 

12.5% of Utah residents were without healthcare coverage last year, which was down slightly from 14.0% the previous year. 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.

 

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.

 

CO-OP Arches Health Plan has ceased operations and will not offer 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.

 

Humana is not offering Marketplace plans. 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.

 

The mandate requiring consumers to purchase qualified health insurance has been repealed, effective for 2019. Therefore, the tax penalty (2.5% of household income) will end.

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