Utah is a wonderful state to live in – but not so much if you don’t have good health insurance for yourself and your family. But how do you know what insurance to buy? Purchasing health insurance can be a confusing process, especially considering how many options you have. But if you’ve got questions, we’ve got answers. Our health insurance experts have compiled a ton of useful information on the best options now available for Utah residents. So if you’re eager to learn more, just keep reading.
Major Medical Insurance in Utah
Back when the Patient Protection and Affordable Care Act was passed in 2010, it established a series of rules which created the Health Insurance Marketplace. These rules also changed the way insurance companies can sell their products, and what sort of insurance products they could sell through the Marketplace. If you’re looking for health insurance in Utah because you can’t or don’t want to purchase qualifying coverage through your employer, then you might want to take a look at what the Marketplace has to offer.
The health insurance products sold via the Marketplace are known as major medical coverage. You can enroll in major medical coverage through the ACA at HealthCare.gov every year during Open Enrollment, which starts November 1st. It usually lasts until mid-December, but these dates tend to change depending on demand. The application process is fairly quick and straightforward, and you can almost always get a same-day response. There are also Special Enrollment Periods that you might be eligible for if, for example, you recently moved to a new zip code or celebrated the birth of a new child.
What’s so great about major medical coverage through the ACA? Guaranteed issue insurance, for starters. Once you are approved to shop around the Health Insurance Marketplace, you cannot be rejected for coverage if you try to purchase insurance through the Marketplace, even if you have preexisting conditions. The same is true for your monthly premiums: you can’t be charged higher monthly premiums based on your health status. You can only be charged a higher rate based on the following circumstances:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Major medical policies also offer the 10 guaranteed Essential Health Benefits, which are another important part of the ACA legislation. These benefits are important for giving you and your family access to the medical care which can keep you optimally healthy and lower your total medical costs over time. It’s hard for most insurance consumers to find all of these benefits available from the same insurance policy outside of the ACA. The benefits include:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
Without financial help, it might be difficult for the average Utah resident to afford the monthly premiums for this type of insurance. That’s why federal subsidies exist to help you out. As long as you’re making at least 138% of the federal poverty limit, you can qualify for a premium tax credit that gets paid directly to your insurance provider, leaving you with a substantially smaller monthly premium payment. In order to find out if you make enough money to qualify, you can start by examining the chart below:
|Household Size||Annual Income (138% of FPL)|
For those who make less than 138% of the federal poverty limit, there’s a bit of a transition period going on right now. Utah is a late adopter of the Medicaid expansion that came with the original ACA legislation, but was rejected by a minority of states at first. Some states have finally come around and accepted the free federal funds set aside to helping needy households get expanded access to Medicaid, and Utah is one of them. During the 2019 Open Enrollment period, anyone whose income fell between 100% and 138% of the federal poverty limit will be eligible for federal subsidies for their 2020 coverage year. In subsequent years, however, making below 138% of the federal poverty limit will relegate you to applying to Medicaid only. For more information on what sort of qualifications you need to meet for Medicaid in Utah, visit Medicaid.Utah.gov.
Short Term Health Insurance in Utah
If you can’t get Medicaid or a federal subsidy in Utah, you might want to take a look at a short-term health insurance plan. With the way short-term health insurance Works in Utah, you can get a policy to cover you and/or your family for up to 363 consecutive days, but you cannot immediately renew that same policy with the same company. This can be particularly helpful if you just need health insurance to get you through until either a job change or the next Open Enrollment period. These plans tend to cost upwards of 33% less than an unsubsidized ACA major medical health insurance policy. Although they may not come with all of the essential health benefits, they will come with some fairly decent medical benefits and you might be able to negotiate for more coverage if you’re lucky. And they work the same way most major medical coverage works with a monthly premium, co-pays, deductibles, coinsurance, and the like.
But there are some other things to consider when it comes to short-term health insurance. For starters, they require medical underwriting, which means you won’t have any protections against discrimination or rejection for coverage if you have a pre-existing condition. You might also have a fairly High deductible that you have to start paying out-of-pocket on day one before you finally get any of your claims reimbursed. Monthly premiums will also be higher unless you are perfectly healthy when you sign up, and there will likely be caps on your annual and lifetime insurance benefits – which means you could be covered for a while after you meet your deductible, require a lot of medical care, and go back to paying out-of-pocket again if your medical care gets too expensive. But at the end of the day, even though you have no legal requirement to purchase insurance coverage, it can still be substantially less expensive than suffering an unexpected medical emergency and going into debt.
Christian Health Plans/Health Share Plans in Utah
In case you haven’t heard the news yet: the individual mandate is no longer the law of the land in Utah ir on the federal level in most other states. This means that most people might not bother with it – but that could be a mistake. If short-term health insurance is too expensive, you might find a better deal with something called a Christian health plan (otherwise known as a health share plan). Since these plans are offered by religious organizations, people who purchase them used to receive an exemption to the individual mandate and weren’t charged a tax penalty for not buying major medical coverage. But just because this exemption is now defunct doesn’t mean that these plans don’t have something to offer.
Christian health plans actually have more in common with short-term health insurance than they do major medical, despite the former exemption to the individual mandate. Here’s all of the things they have in common:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include all of the guaranteed Essential Health Benefits
- The monthly share amount can cost up to 33% less than an unsubsidized major medical monthly premium
But don’t forget about the differences between a health share plan and short-term health insurance before you decide to sign up for one or the other. For starters, you’ll have to agree to certain participation guidelines if you want to receive benefits from a health share plan. That could be as simple as declaring a specific religion/faith, attending a specific church on a regular basis, or changing the way you use alcohol and tobacco products to make a positive change in your health. You should also get used to some new terminology: your monthly share amount replaces the monthly premium you would pay to a regular insurance company, and your unshared amounts or personal responsibility amounts will replace things like co-pays, deductibles, and coinsurance (although they will essentially serve the same purpose). Lastly, understand that their religious nature means that the government can’t regulate them or arbitrate claim disputes, so if you ever feel like your benefits have been denied you unjustly, your best hope is to try negotiate with your health share plan provider for a better outcome. You can’t take them to court over unpaid benefits. But if you happen to be particularly religious and find an organization that shares your beliefs, you can likely get a lot of benefit out of one of these plans.
Fixed Indemnity Plans in Utah
There are two major ways in which fixed indemnity plans work differently from major medical and most other types of health insurance. For one, these plans don’t pay out a fixed percentage of your medical costs the way regular insurance would; instead, they pay out a fixed amount per claim. Whether that claim is for a $250 doctor bill or a $5,000 ER bill makes no difference with an indemnity plan (whereas it would with major medical coverage). Most indemnity plans also work on a fee-for-service basis, so you aren’t restricted to networks like HMOs or PPOs. Fixed indemnity plans will pay out claims on a per day, per week, per month, per instance, or per-event basis. You may also have options to add things like hospital benefits, doctor visit benefits, or dental to a fixed indemnity plan.
Like many of the nonmajor medical options we discussed so far, you will have to deal with things like medical underwriting and caps on your annual and lifetime benefits with a fixed indemnity plan. Because fixed indemnity plans pay out such a small percentage of your total medical costs compared to major medical, it’s recommended that you only purchase these plans as a supplement to more comprehensive coverage rather than as a replacement for it. But the premium payments are still relatively low, especially if you are healthy and don’t expect to use your coverage much. These reasons and more are why people turn to fixed indemnity plans if they’re having trouble paying for the medical care they need.
Discount Cards in Utah
You may have heard of something called a medical discount card program being offered in place of major medical coverage. As a consumer, though, you should understand that medical discount cards are not insurance and are rarely an adequate replacement for major medical coverage. What most of them do is charge you a membership fee and send you a card in the mail that you can present in order to get discounts on certain medical products and services at participating providers and retailers. Some programs, like the Utah Drug Card, offer discounts on pharmaceutical drugs free of charge to whoever wants to participate. Under ideal conditions, the membership for your medical discount card program (if there is one) will cost you less money than what you would have paid getting medical care without the discounts the program provided. If that’s the case, a medical discount card might be a good deal on top of other insurance coverage – but not as a replacement.
The problem with medical discount card programs, however, is that they are not regulated at all – and easily prone to scams. Some providers lie and say that medical discount cards are equivalent to insurance, which isn’t true. Some exaggerate the discounts available in order to get you to fork over a membership fee. The providers and retailers promised to you by the medical discount card provider could leave that “network” at any time for any reason, and you will no longer receive a discount. It’s important to do your homework if you’re thinking about investing in a medical discount card program to make sure that their services are reliable and that the discounts they advertise are genuine before you sign any paperwork. You can learn more about discount card programs in Utah and how to avoid scam by visiting the Utah Insurance Department.