With most of the Affordable Care Act’s major provisions now in effect, the nation’s health insurance marketplace has undergone a significant transformation. Obamacare impacts individuals, families and small business owners alike. Most Americans are required to have minimum essential coverage unless they qualify for an exemption; however, the law is designed to make health insurance more accessible and affordable with income-based financial assistance and one-stop shopping via state-based and federally facilitated exchanges. Meanwhile, the private marketplace remains a place to shop for quality, affordable health insurance plans that meet ACA requirements.
The following guide offers a glimpse at the various types of ACA-compliant health insurance in Utah, including individual and family health plans, small group health plans, coverage for high-risk applicants, mini-COBRA continuation coverage, Medicaid, and CHIP.
Health and healthcare in Utah
Utah ranked 5th in United Health Foundation’s 2014 America’s Health Rankings.1 Its strengths include low prevalences of smoking and binge drinking; low prevalences of physical inactivity, obesity and diabetes; and a low rate of preventable hospitalizations. Utah’s health challenges include a high rate of drug deaths, a high incidence of pertussis infections, and limited availability of primary care physicians. Utah has the lowest smoking rate in the nation.
Utah individual and family health insurance
When Obamacare open enrollment began Oct. 1, 2013, the state of Utah defaulted to a federally facilitated exchange. Utah residents can buy qualified health plans through the federal Health Insurance Marketplace and may be eligible for income-based premium tax credits and cost-sharing subsidies when they do. Individuals who go without health insurance may face a tax penalty known as the shared responsibility payment.
The private marketplace also offers coverage that meets Affordable Care Act requirements. Individuals and families in Utah may use websites such as HealthCare.com to find health insurance plans away from the federally facilitated exchange. Check out HealthCare.com’s tax subsidy calculator to see if you qualify for a tax credit. If you do, visit Utah’s Health Insurance Marketplace to apply for health insurance coverage.
The U.S. Department of Health and Human Services reported that 84,601 individuals in Utah selected a marketplace plan through the exchange from Oct. 1, 2013, through April 19, 2014.2 In 2015, the number of individuals in Utah enrolled in a marketplace plan increased to 140,612 during the open enrollment period.3
|Utah’s health insurance exchange:||healthcare.gov|
|Utah department of insurance:||insurance.utah.gov|
Utah small group health insurance plans
Small business owners with 50 or fewer employees may purchase group health insurance plans through Utah’s federally facilitated Small Business Health Options Program marketplace, as well as in the private marketplace. Small businesses that use SHOP and have 25 or fewer employees may qualify for a Small Business Healthcare Tax Credit.
Self-employed individuals with no employees must apply for an individual health insurance plan on or away from the federally facilitated exchange.
Utah state COBRA variations for small groups
The Consolidated Omnibus Reconciliation Act (COBRA) allows those employed by businesses with 20 or more employees to continue their group health insurance plan for a limited time should they lose coverage due to qualifying events such as termination of employment due to reasons other than gross misconduct, a reduction in work hours, divorce or legal separation, and loss of dependency status. To learn more about the federal COBRA program, visit dol.gov/ebsa/cobra.html.
In some states, those who work for a small business and lose health insurance coverage due to a qualifying event may be eligible for health insurance continuation through mini-COBRA or a similar state continuation program. In a few states, these programs may also be extended to those who work for larger companies and exhaust their federal COBRA continuation coverage limit. Mini-COBRA generally works like the federal COBRA continuation coverage, but its terms may vary.
Utah’s small group COBRA continuation variations are as follows4:
|Eligible group sizes||All group sizes|
|Maximum continuation period – standard||12 months|
|Maximum premium Increase||102 percent|
|State legislation reference||Utah mini-COBRA; 31A-22-722|
|More information||800-439-3805 — Utah Insurance Department|
|Additional notes||Must elect to extend group coverage within 60 days of its termination due to qualified events|
Utah high-risk pools
It used to be that health insurance companies could deny applicants or charge them more based on health history and preexisting conditions. When the Affordable Care Act was passed in 2010, many states created federally funded preexisting condition insurance programs or accepted federal funding to assist with similar high-risk pool programs they already operated.5
The Affordable Care Act prohibits this practice for health insurance plans considered minimum essential coverage with effective dates beginning Jan. 1, 2014, and later. As such, the PCIPs and state high-risk pools created to provide health insurance for those once considered uninsurable are being phased out.
Medicaid is a state health insurance program for low-income individuals under age 65, pregnant women, children, disabled individuals, and seniors over age 65; it is partially funded by the federal government. In 2014, states were given the option to accept additional federal funding and expand their Medicaid program eligibility to those who make up to 133 percent of the federal poverty level (effectively 138 percent due to how it is calculated, according to HealthCare.gov).6
Utah opted not to expand Medicaid in 2014.7 Because Medicaid was not expanded in Utah, there is currently a coverage gap that includes those whose incomes are too high for Medicaid but too low to receive federal premium and cost-sharing assistance when shopping the state’s federally facilitated health insurance exchange.
The information below is specific to Utah’s Medicaid program:
|Governing agency||Centers for Medicare & Medicaid|
|Administrator||Utah Department of Health|
|Where to apply||healthcare.gov / medicaid.utah.gov/apply-medicaid|
|Phone number||Salt Lake City area: 801-538-6155 UT, WY, ID, CO, NM, AZ, NV: 800-662-9651All other states: 801-538-6155|
|Open-enrollment period||Year-round in all states|
The Children’s Health Insurance Program is a partnership between the states and federal government. CHIP provides health insurance to uninsured children who meet certain eligibility guidelines.
The information below is specific to Utah’s health insurance program for low-income children:
|Where to apply||health.utah.gov/chip/howtoapply.htm|
|Phone number||877-KIDS-NOW (877-543-7669)|
|Eligibility8||Uninsured, U.S. citizens or legal residents, under age 19 and meet household income limits|
1 United Health Foundation. 2014 America’s Health Rankings Annual Edition. “Annual State Health Rankings.” http://www.americashealthrankings.org
2 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2014/.
3 Kaiser Family Foundation http://kff.org/other/state-indicator/state-marketplace-statistics-2015/.
4 Utah Insurance Code. 31A-22-722. http://le.utah.gov/code/TITLE31A/htm/31A22_072200.htm.
5 National Conference of State Legislators. Coverage of Uninsurable Pre-Existing Conditions: State and Federal High-Risk Pools. Updated April 2014. http://www.ncsl.org/research/health/high-risk-pools-for-health-coverage.aspx.
6 Centers for Medicare & Medicaid Services. “Medicaid Expansion & What It Means for You.” HealthCare.gov. N.D. https://www.healthcare.gov/what-if-my-state-is-not-expanding-medicaid/.
7 Centers for Medicare & Medicaid Services. “Utah.” http://www.medicaid.gov/medicaid-chip-program-information/by-state/utah.html.
8 Utah Department of Health. “Frequently Asked Questions.” http://health.utah.gov/chip/faq.htm#2.