Availability of short-term health insurance in Utah

Yes. As of 2024, there were at least three insurers offering short-term health insurance in Utah.

The average monthly premium for a short-term health insurance plan sold in Utah was $129.99 in 2023, according to data from IHC Specialty Benefits.

The maximum initial term limit for short-term health insurance in Utah is under 12 months. If the policy is renewable, total duration can be up to 36 months. This aligns the state’s rules with the Trump administration’s rules for short-term plans, which took effect in late 2018.

In 2024, the Biden administration finalized new rules for short-term health plans, so short-term plans issued or sold on or after September 1, 2024 will be limited to total durations of no more than four months, including renewals.

Short-term health insurance in Utah can be purchased by residents who qualify under the underwriting guidelines of insurers.

Most short-term health insurance policies can be purchased by people who are younger than 65 and who do not have any of the short list of medical conditions that will result in a declined application.¹ But the specific requirements vary from one insurance company to another.

Short-term health insurance plans typically exclude coverage for pre-existing conditions, and they often use post-claims underwriting (meaning that they will go back through a person’s medical records after a claim is filed, to make sure it isn’t related to a pre-existing medical condition).²

Short-term health plans also generally exclude coverage for some of the ACA’s essential health benefits — most commonly, maternity care, prescription drugs, and mental health care.¹ They also tend to impose dollar limits on the coverage they provide. So it’s important to understand all of the plan information before purchasing a short-term policy, to make sure that you’re not caught off-guard by the limitations of the plan.

If you’re in Utah and need health insurance, you’ll first want to find out whether you can enroll in an ACA-compliant major medical plan. These plans, which cover pre-existing conditions and provide comprehensive coverage, are available during an annual open enrollment window (November 1 through January 15 in Utah) and during special enrollment periods linked to certain qualifying life events. If you have the option to purchase an ACA-compliant plan, it will offer better coverage than a short-term health insurance policy.

ACA-compliant individual major medical plans (obtained through the HealthCare.gov exchange/Marketplace platform or directly from an insurance company) are purchased on a month-to-month basis, so you can enroll in a plan even if you only need coverage for a few months before another policy takes effect.

And if your total annual household income makes you eligible for a premium subsidy, you can receive the subsidy for the months you have coverage, even if it’s only a few months. Note that subsidies are only available if you get your health insurance through the exchange/Marketplace. They are not available if you buy your plan directly from an insurer.

Although short-term health plans do not provide the level of protection that an ACA-compliant plan will provide, they’re better than having no coverage at all. And there are some scenarios in which they might be your only option or your only realistic option:

• If you missed open enrollment for ACA-compliant coverage and do not have a qualifying event to trigger a special enrollment period.
• If you’re newly employed and you’ve got a waiting period before your employer’s health plan takes effect (if you also have a qualifying event, you may be able to enroll in an ACA-compliant plan to cover you until your employer’s plan starts; alternatively, you may be able to use COBRA if you’re transitioning from a former employer’s plan).
• If you’ll soon be enrolled in Medicare, but don’t have another coverage option before that point. Note that although Medicare covers pre-existing conditions, optional Medigap plans can require enrollees to wait up to six months for pre-existing condition coverage, if they didn’t have coverage for their pre-existing conditions prior to enrolling in Medicare.
• If you’re not eligible for Medicaid or a premium subsidy in the exchange, the monthly premium costs for an ACA-compliant plan might be unaffordable.

Utah’s coverage requirements for short-term plans

In January 2021, the Utah Insurance Department proposed new minimum standards for short-term health insurance plans.

Those rule changes were finalized (see Utah Insurance Administration Rule R590-286), and include several minimum coverage requirements on short-term plans, including a benefit cap of at least $1,000,000, and coinsurance/copayments that cannot exceed 50 percent of the covered charges. Most of the available short-term health plans in Utah already had benefit caps of at least $1 million, but there were some plans with benefit caps of $500,000, and those are no longer allowed.

Various inpatient services also have to be covered under Utah’s minimum standard requirements, including anesthesia, prescription drugs, imaging and lab services, etc. And various outpatient services also have to be covered, including dialysis, office visits, physical/speech/occupational therapy, and diagnostic and lab services—but notably, not prescription drugs, unless it’s related to a surgical procedure.

And mental/behavioral health services do not have to be covered, nor does maternity care. These three benefit categories (outpatient prescriptions, mental health care, and maternity care) are often excluded on short-term health plans, and Utah’s rules for short-term plans allow them to continue to be excluded.

Utah’s duration rules for short-term plans

Utah Insurance Code 31A-1-301(172) defines a short-term health insurance plan as having an initial term of less than 12 months, and a total duration of no more than 36 months, including renewals or extensions. This lines up with the federal limits that apply to short-term health plans, under a rule change that was made by the Trump administration in late 2018.

It’s noteworthy, however, that Utah’s code has changed on this matter. As of late 2018, when the new federal rules were taking effect, Utah insurance code 31A-30-103(19) — which now refers to small employer carriers and no longer defines short-term health insurance — stated that a short-term plan was a nonrenewable policy with a duration of “less than 364 days.” As long as a plan met those standards, it was not subject to the “health benefit plan” rules in Utah.

The current statute also confirms that short-term plans are not considered health benefit plans (and are thus not subject to the rules that apply to such plans), but the definition has been expanded to allow Utah’s short-term health plans to be renewable and last up to three years if the insurer chooses to offer renewability.

As noted above, new federal rules will apply to short-term policies sold or issued starting in September 2024. Initial terms will be capped at three months and total duration will be capped at four months, unless a state imposes stricter limits.