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Utah Health Insurance

Utah Medical Insurance Overview

The general state of health in Utah is quite good when compared to the rest of the country as a whole.  Utah’s rankings are quite high in a number of areas and the access to healthcare coverage in this state is higher over the course of the past several years.  Enrollment in the state’s health benefits exchange was higher in 2015 by 166 percent over the previous year.

The state of Utah already had an existing benefits marketplace prior to the ACA and it is still in operation.  In 2012, Governor Herbert worked hard to try and modify the state’s exchange, Avenue H, to comply with the mandates under the ACA.

Under the ACA, many Americans would have greater access to health insurance coverage.  In effect, the legislation was implemented to offer benefits exchanges on the state level to encourage uninsured residents to apply for and obtain coverage through private providers and state-funded programs.  Overall, the state of Utah has seen some benefits from the exchange, but there are a lot of residents who signed up and failed to make their insurance payments.

Utah’s Health Care Issues
According to the ranking system provided by the United Health Foundation, the state of Utah is ranked in 7th place when compared to the rest of the states in the U.S.  When compiling the rankings system, there are a variety of factors that come into play.  Utah’s health is great, but the state still has room to grow for its residents to fully enjoy insurance coverage on a wider scale.

There are many healthy residents in the state of Utah and the benefits exchange was in place prior to the enactment of the Affordable Care Act.  The low level of residents who smoke, along with the low percentage of cancer related deaths and preventable hospitalizations impacted the overall health of the state’s residents in a positive way, among a variety of factors.  Negatively impacting the state’s health status was the low availability for primary care doctors, the deaths in the state as a result of drug abuse and the lack of vaccinations for various diseases among those of adolescent age.

Understanding Utah’s Uninsured Population
The Henry J. Kaiser Family Foundation compiles statistics on the health insurance data on a state-by-state basis.  The website shows that the uninsured population of the state of Utah was sitting at 12% as of 2014 and that figure has stayed the same since 2013.  According to the Department of Health, there is a high percentage of children who are eligible for coverage under the Medicaid program, but don’t have coverage as of yet.  This indicates that many residents with uninsured children are typically unaware that state-funded programs exist as opposed to having uninsured children as a result of financial hardship.

The statistics listed below paint a picture of the insurance status of the state of Utah:

  • 28% of residents earned less than 100% of the poverty level
  • 19% of residents earned between 100-199% of the poverty level
  • 11% of residents earned between 200-399% of the poverty level
  • 7% of residents earned over 400% of the poverty level and still opted out of purchasing insurance coverage

Group Health Plans
Group health insurance is a plan that is offered by employers to workers.  When providing insurance benefits, employers who offer this type of coverage usually pay a portion of the monthly premiums.  In the state of Utah, 59% of the residents who are working get coverage under this type of plan.

Working residents are more likely to obtain this sort of insurance coverage because the costs can be much cheaper than using other methods.  If applicable to you, contact a representative from your company’s human resources department in order to learn the plan options available to you.  Coverage through a group plan can differ based on your monthly contribution and the level of insurance coverage that you are seeking.  Group plans are more cost-effective when compared to other plan types, so if you can obtain coverage through your employer, explore all of the options available.

In addition, when obtaining coverage under a group plan, you cannot be turned down for a policy in the event that you are suffering from a pre-existing medical condition.  Other provisions also apply, but there are protections in place through HIPAA that regulate the activities of insurance companies.  In the state of Utah, the Insurance Department is responsible for the regulation of group health insurance policies.  Exploring the resources and data available on the Department’s website will give you a better idea of what to expect with regard to the health insurance market in this state.

Signing Up
Joining a company’s group health plan is usually allowed during the enrollment period.  New employees may wait to sign up for coverage, but in some cases, can enroll when the probationary period expires.  Many companies have a once per year enrollment period, so be sure to ask the HR department at your workplace if you need information on when and how to sign up for insurance coverage.

Group health insurance plans offer many benefits to employees with regard to the plan options available and monthly premium costs.  Before signing up for coverage through this or any other insurance plan, you will want to keep some important factors in mind.
Among them are the costs associated with coverage.  Many plans require your premiums to be deducted from your paychecks each pay cycle.  If the plan is affordable, this will be your best bet for coverage.  Budget your finances wisely to accommodate insurance payments every month.

Another factor is the options that the group coverage offers those it covers.  Is there only one option or are there a few choices?  Consider the plan options that will provide you with the most benefits for the smallest cost.  Some plans offer comprehensive coverage, but these aren’t usually inexpensive.  You will want a plan that is both affordable and beneficial to your medical needs.

Lastly, you should consider whether or not you have dependents to cover when selecting appropriate insurance coverage.  Before joining, ensure that your dependents will also get the coverage they need for medical expenses.

Pre-Existing Condition Exclusion Periods
Insurance companies that offer group health plans cannot decline to provide you with coverage if you have an existing medical condition prior to enrollment.  In the case of pre-existing medical conditions, the insurance company can require you to wait through a period of exclusion before you can access your insurance coverage.  In Utah, exclusion periods can last for no longer than 12 months.  In addition, upon enrollment, insurance companies can look back through your medical records for up to six months to make the determination of whether or not you have such a condition.

Affiliation or Waiting Periods
When you enroll into any group health insurance plan, especially an HMO, a waiting period usually goes into effect.  Waiting periods go into effect and can last for up to two months in most cases.  This amount of time is extended to three months if you have enrolled into the plan late.

If both an exclusionary and waiting period apply, they will run simultaneously and not get one tacked on to the end of the other.

Individual Health Plans
For people in the state who are self-employed or working for a company that doesn’t offer health insurance, there are individual plans to fill the gap.  These plans can be on the expensive end of policies offered and there are restrictions that apply, making it harder to obtain coverage.

In the state of Utah, eight percent of the population has coverage under an individual plan.  This number is quite low in comparison to other plan types, primarily because of the expense involved.  However, sometimes this is the only option for quality health insurance coverage.

Individual insurance policies can be more restrictive with regard to benefits offered under the plan.  Insurance providers offering this type of coverage can do an extensive amount of medical underwriting to determine your eligibility.  Restrictions are placed on people who have pre-existing medical conditions and the insurance provider can reject your application because of such a condition.

Estimates show that a young person who is healthy and has no pre-existing medical problems can receive coverage of the type for under $70 every month.  This case is not typical and should not be used in the place of the necessary research on your part.

Continuation Coverage
COBRA offers continuation insurance coverage to people who work for companies with more than 20 employees.  This coverage gives the applicant the same level of benefits enjoyed under the group plan, but when the employee loses coverage for any reason, COBRA extends it for a temporary period of time, which is commonly 18 months.  If you are able to get this type of insurance plan, the company previously offering the group plan will usually send out documentation on how to apply for coverage and the necessary premiums involved.

Continuation benefits are more expensive than group plans, just because the premiums consist of only the former employee’s contributions without the added monetary contribution of the employer.

Conversion plans are also available to those who wish to keep the provisions included in their group plan along with the insurance provider.  This exists to convert the group plan to one of an individual nature while maintaining the same coverage options. The difference is that the coverage may have a higher premium associated with the plan.

Utah Health Benefit Exchange
Prior to the enactment of the Affordable Care Act, the state of Utah already had its benefits exchange in place.  The Governor attempted to convert the exchange to meet the requirements set forth under the ACA, but in the end, opted to allow the exchange to be facilitated on a federal level.

Avenue H was created by the state of Utah in 2005, but it offers services the small businesses that operate there.  For other insurance needs, residents in Utah can get coverage information, compare plans and obtain insurance through

More information on the health benefits exchange and its history on the website for the Henry Kaiser Family Foundation.

Utah State Insurance Programs
Twenty-one percent of the state’s population has insurance through a program funded by the state.  Coverage under any of the available public programs offers a wide range of medical benefits to the population while factoring in income level, health condition, gender and pre-existing medical conditions.

Programs offered include the Utah Comprehensive Health Insurance Pool, the Federal HIPUtah program, Medicaid, the Medicaid Work Incentive Program, the Primary Care Network, the CHIP program, IHS, the Health Coverage Tax Credit, the VA program for medical benefits, the Partnership for Prescription Assistance, the NAMI Helpline, and Medicare.

Below is a list of the programs offered along with their descriptions:

Utah Comprehensive Health Insurance Pool (HIPUtah) 
This is a program that was created for persons suffering from pre-existing conditions.  Persons suffering from these types of conditions can have a great deal of trouble obtaining insurance benefits, but the HIPUtah program can provide a great deal of coverage options.

Participants can receive coverage for prescription medications, durable medical equipment, speech therapy, specialist’s visits and more.

Federal HIPUtah 
Federal HIPUtah is a program is similar in nature to HIPUtah yet is run on a federal level and does not require participants to have lived in the state of Utah for a year before being able to enroll.

The Medicaid program is aimed toward providing low income individuals and families with basic medical services.  This program is typically free to participants, but because it is based on income level, some contributions may be required.

Medicaid Work Incentive Program (MWI) 
This program is available to disabled people who meet the income guidelines for coverage of medical services.  Premiums for the Medicaid Work Incentive Program can be anywhere between free of charge and 15 percent of the participant’s income.

Primary Care Network (PCN) 
Through the Primary Care Network, adults without insurance can obtain coverage if they meet the income guidelines.  If you wish to qualify for the PCN, you must earn below 150% of the federal poverty level.  There is also a yearly enrollment fee that is solely based on income.

Children’s Health Insurance Program (CHIP) 
CHIP offers the uninsured children of low income households the ability to obtain health insurance benefits.  Covered services include mental health care, vaccinations, eye exams, prescription medications and more.

To qualify for CHIP, the child must be part of a household that earns under 200%  of the federal poverty level.

Women-Infants-Children (WIC) 
The USDA Food and Nutrition Service is accountable for the management of the WIC program.  The program offers nutritional assistance to pregnant women and new mothers but is based on certain income requirements.  You can obtain help through the WIC program if you earn 185% of the federal poverty level.

Utah Cancer Control Program (UCCP) 
This program offers screening services for such as pelvic exams, breast exams, pap tests, mammograms, colonoscopies and more.  To qualify, your income will be scrutinized, however there are no premiums charged for participation in UCCP.

Indian Health Services (IHS) 
For Native Americans, IHS offers a great deal of services.  To qualify, you must be of Native American descent or be pregnant by a qualifying male member who is.  Coverage options include inpatient care services, dental care, outpatient services and more to those who qualify.

Health Coverage Tax Credit 
This tax credit offers help to trade dislocated workers in Utah.  Coverage options include outpatient care, preventive care, prescription drugs and more.  In order to be eligible, you must be over the age of 55, receive a pension through the Pension Benefit Guaranty Corporation and not be a participant in any other program.  Certain additional restrictions may apply.

VA Medical Benefits Package 
For veterans of any branch of the armed forces, the VA Medical Benefits Package offers comprehensive benefits.  To qualify, the following conditions must be met:

  • You must have served for 24 consecutive months or have fulfilled your active duty requirement
  • You must have received an honorable discharge from the service

Medicare and the Medicare Prescription Drug Program 
The Medicare Program has four parts and was created to assist disabled individuals, individuals suffering from renal disease and seniors who are aged 65 and over with health benefits.  If you wish to apply for coverage under the Medicare program, you or your spouse must have worked for ten years in a Medicare covered job in order to be eligible for coverage.

Partnership for Prescription Assistance 
For people who need help paying for the high costs of prescription drugs, the Partnership for Prescription Assistance is a valuable resource.  It is a free nationwide program that connects consumers with 475 programs that offer assistance for prescription costs.

National Association of Mental Illness (NAMI) Helpline 
The National Association of Mental Illness Helpline is a valuable resource for providing the mentally ill with guidance and support.  The volunteer network also works to provide the same help to anyone who is affected by the mentally ill.

The Health Insurance Portability and Accountability Act (HIPAA) 
This legislation was created in 1996 to offer a wide variety of protections to consumers nationwide.  As a result, the healthcare industry has been regulated with regard to the protection of consumers’ private medical data.  In addition, health insurance providers are prohibited from denying group insurance coverage to those persons suffering from pre-existing medical conditions.

For more information on how HIPAA applies to residents of Utah, refer to the documentation provided by the Utah Department of Health.