Utah Health Insurance Consumer Guide

Most people in Utah can buy health insurance through the exchange. Marketplace health coverage is available if you meet the following criteria:⁴

• You must be a resident of Utah.
• You must be lawfully present in the U.S.
• You can’t be incarcerated.
• You must not be enrolled in Medicare.

Whether or not you qualify for financial assistance with your premium, deductible, or out-of-pocket costs depends on your income and how it compares with the cost of the second-lowest-cost Silver plan in your area. 

Additionally, to qualify for financial assistance, you must: 

• Not have access to affordable health coverage through an employer. If you think your employer-sponsored health plan is too expensive, use our Employer Health Plan Affordability Calculator to check if you qualify for premium subsidies in the Marketplace. 
• Not be eligible for Medicaid or CHIP in Utah, or for premium-free Medicare Part A.⁵ 
• If married, file a joint tax return.⁶
• Not be able to be claimed by someone else as a tax dependent.⁶

In Utah, the open enrollment window to sign up for ACA Marketplace individual and family health plans runs from November 1 to January 15.⁷

For coverage to start on January 1, enroll by December 15. Enrolling between December 16 and January 15 will push your coverage start date to February 1.

Outside of open enrollment, you can only sign up for coverage (through the exchange or directly through an insurance company) if you have a special enrollment period (SEP). In most cases, this means you need to have a qualifying life event, but there are some SEPs that don’t require specific qualifying events, such as:

• Your income is more than 138% of the poverty level but no more than 150% of the poverty level, and you’re eligible for premium tax credits. In this scenario, you can enroll anytime (note that if your income isn’t more than 138% of the poverty level you’ll likely qualify for Utah Medicaid, which accepts enrollments year-round).
• American Indians and Alaska Natives can enroll whenever necessary.
• For people who lose Medicaid or CHIP coverage between March 31, 2023, and November 30, 2024, there’s an extended SEP available for enrollment.⁸

You have a few ways to enroll in a Marketplace health plan in Utah:

• Online: Go to HealthCare.gov. This is the federal Marketplace website that also lets you shop around for plans.
  
• By Phone: Call 1-800-318-2596 (TTY: 1-855-889-4325) to talk to a representative over the phone. The call center is available 24 hours a day, seven days a week, except holidays.
  
• In-person: Get help from a licensed insurance agent, navigator, or certified application counselor in your area. Look for assistance at localhelp.HealthCare.gov. Call 2-1-1 or visit takecareutah.org.⁹

No matter which of the above methods you use, you’ll still purchase your health plan through HealthCare.gov since Utah uses the federally-facilitated Marketplace. The website will walk you through the application process and determine your eligibility for financial assistance.

People in Utah who enroll in a Marketplace plan (accessed at HealthCare.gov) can be eligible for two different types of financial assistance, depending on their household income:

• Premium tax credits (premium subsidies): If you sign up on HealthCare.gov, you may qualify for financial assistance called Advance Premium Tax Credits (APTC) to lower your monthly premiums. Ninety-six percent of Utah Marketplace enrollees were receiving premium subsidies in early 2024, which reduced average net premiums to about $63/month.¹⁰ (These numbers are based on effectuated enrollment; the chart below shows some different metrics and uses data from all applications submitted during open enrollment.)
• Cost-sharing reductions (CSR): If your household income is no more than 250% of the federal poverty level, you can also receive cost-sharing reductions (CSR) assistance, as long as you select a Silver-level plan. CSRs reduce your deductible and out-of-pocket expenses, which means you can get the care you need at an affordable cost. 

Source: CMS.gov ¹¹

Medicaid: Check if you’re eligible for Medicaid by going online to HealthCare.gov or through medicaid.utah.gov.¹²

Short-term health insurance: Short-term health insurance is a lower-cost option in Utah, where five insurers offer short-term plans. Short-term health insurance is generally only a reasonable option if you’re not eligible for any financial assistance through the exchange, or if you’re trying to enroll outside of open enrollment and don’t have a SEP.

Utah’s exchange has eight insurers providing health plans in 2024, including two newcomers (Aetna Health and Imperial Health Plan of the Southwest).¹³

Coverage areas vary from one insurer to another, with just one or two insurers offering plans in several counties, and five or more insurers offering plans in the northern part of the state.¹⁴

For 2025, seven insurers will offer Marketplace coverage in Utah. But Cigna is exiting the Utah individual market, so enrollees with 2024 coverage from Cigna will need to select a new plan during the open enrollment period that begins in November 2024.³

According to Utah’s Health Insurance Transparency webpage, the following average rate changes have been proposed for 2025 by Utah’s individual market insurers:¹⁵ 

Source: Utah Health Insurance Transparency¹⁶

The Utah Health Insurance Transparency website indicates how many policyholders each carrier has,¹⁶ although the number of members isn’t specified for some enrollees (a policy can cover multiple family members). But the weighted average proposed rate increase based on the number of policyholders is about 10.2% (calculated before any subsidies are applied; subsidies change to keep pace with the cost of the second-lowest-cost Silver plan in each area).

The rates are under review by state regulators and will be finalized before open enrollment begins in November 2024.

For perspective, here’s how average full-price premiums have changed in Utah’s individual/family market in previous years:

• 2015: Average increase of 5%¹⁷
• 2016: Average increase of 25%¹⁸
• 2017: Average increase of 31.7%¹⁹
• 2018: Average increase of 39.5%²⁰
• 2019: Average increase of 0.5%²¹
• 2020: Average decrease of 2.3%%²²
• 2021: Average rate changes ranged from -7% to +3%²³
• 2022: Average increase of 1%²⁴
• 2023: Average increase of 6%²⁵
• 2024: Average increase of 11.4%²⁶

During the open enrollment period for 2024 coverage, 366,939 people enrolled in private plans through Utah’s health insurance Marketplace.²⁷

This was a substantial record high, far exceeding the previous record high when 295,196 people enrolled for 2023.²⁸ 

The chart below shows enrollment over time in Utah’s exchange. The sharp increase in enrollment in recent years has been driven in large part by the subsidy enhancements under the American Rescue Plan and Inflation Reduction Act, which made Marketplace plans more affordable. The enrollment increase for 2024 is also partially driven by Medicaid disenrollments, which resumed in 2023. Some people who are no longer eligible for Medicaid have obtained coverage in the Marketplace instead.

Source: 2014,²⁹ 2015,³⁰ 2016,³¹ 2017,³² 2018,³³ 2019,³⁴ 2020,³⁵ 2021,³⁶ 2022,³⁷ 2023,²⁸ 2024³⁸

HealthCare.gov
The official federal website where you can sign up for health insurance plans through the ACA Marketplace. 

Utah Insurance Department
Oversees and licenses health insurance companies, brokers, and agents, offering information and help for various health insurance concerns. 

Utah Health Insurance Transparency; Latest Rate Changes
Shows rate and plan filings that insurers have submitted for review by state regulators.

Utah Senior Services
Supports Medicare beneficiaries by providing assistance, information, and valuable resources.

Take Care Utah
An initiative aimed at helping Utah residents understand and access health insurance options, including the ACA Marketplace and Medicaid.