Utah is home to the Great Salt Lake, a vast expanse of desert, and the tallest mountains in the country. With 14 Alpine ski resorts, the dry snow of the area produces some of the world’s greatest powder for the sport. The state has five major national parks, six national forests, and seven national monuments. In addition to the abundance of nature, Utah is also known for housing the largest Mormon community in the world in its capital, Salt Lake City.
Individual health insurance in Utah is limited to three main carriers, including Altius Health Plans (a Coventry subsidiary), Humana, and SelectHealth. These companies offer various plan types to residents of Utah, with HMO, PPO, and HSA options. For further details about these plans, read plan summaries below or get a personalized quote to compare rates in your town. Enter your zip code below and get started, or call one of our agents to help guide you through your best options at 888 803 5917.
In Utah, the overall health is one of the best in the nation. Perhaps it is due to the natural surroundings, strict religious policy, or low population density, but the state has maintained a good level of health compared to the rest of the country for the past ten years. Compared to its own records, Utah has fallen short in certain areas, though still remaining #6 on UnitedHealth Foundation’s rankings. Utah has the lowest number of smokers in the US, consuming only 9 percent of the population. Though obesity has increased over the past ten years, Utah has the second smallest population of obese adults in the country.
There is also a low occurrence of binge drinking in Utah, as well as diabetes. Utah also has the least amount of cancer-related deaths in the nation. Health care is a bit more concerning, as public health funding is mediocre and there are a considerable amount of individuals without health insurance. Immunization coverage is extremely low, and the availability of primary care doctors is sparse. While every state has its strengths and challenges, Utah is pretty strong when it comes to health, though the state could use an increase in using health insurance and pursuing treatment when necessary.
Health Insurance Plans
- Peak Preference plans are HMOs that come in deductibles ranging from $500 to $5,000. These plans offer 80 percent coverage after you meet the deductible. Though these plans are connected to an HMO network, they also allow for out-of-network coverage for a different deductible. Preventive care is covered in full as soon as your plan begins, and several services are offered for a copay. Office visits with a primary care physician are a $30 copay, and specialists are $60. Urgent care and physiotherapy are also immediate benefits. Prescriptions are available after a pharmacy deductible, and maternity care is covered after your annual deductible.
- Peak Plus Platinum, Gold, and Silver plans cover 70 to 80 percent of your medical care in-network after deductible. These are POS plans, giving members the freedom to use in-network or out-of-network care. Care covered after deductible includes maternity services, surgery, inpatient stays, physical therapy, and lab work. Before meeting the deductible, primary care office visits and prescriptions are covered with no additional deductible. Peak Plus plans cover non-network care at 40% after deductible. Preventive services are no cost and available immediately within the Altius network.
- Peak Plus High Deductible plans are qualified for use with a health savings account for a higher level of cost management with tax rewards. After you meet the deductible, which is either $3,000 or $5,000 for individuals, all in-network care is covered at 100 percent. These plans provide the lowest monthly premiums in exchange for a higher deductible and responsibility with cost sharing in order to meet your limit. HSA funds can be used to pay for care or saved for the future, and are portable if you decide to change plans.
- Copay plans are available in Copay 70, Copay 80 and Enhanced Copay 80 options in Utah. Depending on how much coverage you want and how much you want to pay, there is a convenient plan with predictable rates on doctor’s office visits, prescription drugs and urgent care to fit your budget, but be prepared for a high deductible and higher premiums. Enhanced Copay plans have deductibles of $1,000 and $5,000 for individuals, Copay 80 plans have $3,500 and $5,000, and Copay 70 has a range from $1,500 to $7,500. All plans cover preventive care in full, and after deductible you can receive inpatient and outpatient hospital care and testing for a percentage of coinsurance.
- 100% After Deductible plans provide coverage on every service from physician’s office visits to surgery and hospitalization for 100% coverage after you reach the deductible amount. Louisiana residents can choose from Value (with deductibles of $5,000, $7,000 or $10,000 for individuals), HSA 100 (ranging from $1,500 to $5,950 annually), or Enhanced HSA 100 plans (with individual deductibles from $1,200 to $5,950). Enhanced HSA 100 and Value plans cover prescription drugs, while HSA 100 does not. HSA plans come with the opportunity of starting a health savings account for tax-advantaged funds to use on medical expenses.
- Select Value plans are HMO plans available in several options, including Base, HealthSave – an HSA-compatible choice, and one that includes an office deductible waiver. Deductibles range from $1,000 to $7,500 for individuals, and all types cover prescriptions and office visits for a copay after deductible. Value HealthSave plans cover all qualified services in full or at 80 percent with copays after meeting the deductible. Value Base plans also offer 80 percent coverage for hospital services, including maternity care, which is not covered by HSA plans. Select Value with Office Deductible Waiver plans allow members to see a doctor for non-preventive care before meeting the deductible, for a $25 copay.
- Select Med plans are also HMOs, with the same choices as the Value plans: Base, HealthSave, and an office deductible waiver option. Base plans offer a number of services after the deductible is met for a copay or 20 percent coinsurance. Though premiums are higher, Select Med with Office Deductible Waiver plans provide instant access to primary care and specialist office visits for a copayment. With HealthSave plans, services are covered at 80 percent with copays, or 100 percent after deductible, and give the opportunity to open a health savings account. Deductible options for individuals range from $1,000 to $7,500.
Public Health Options
The state of Utah offers a number of alternatives for individuals who are unable to afford health insurance and need medical coverage. Families and children as well as pregnant women and disabled residents of Utah can apply for Medicaid if they meet the criteria. Those who have been turned down for health insurance due to a medical condition or illness may be able to apply for a PCIP, the current high-risk pool. Other services offered to individuals without the means to pay for health care are immunizations, care for specific diseases and conditions, and preventive services. For a detailed list of programs offered in your state, visit the Utah Department of Health.
- Medicaid: health insurance coverage for low-income residents of Utah who are children, parents, pregnant, aged, blind, disabled, or meet other requirements.
- CHIP: the Children’s Health Insurance Program in Utah offering plans for uninsured children under 19 in Utah.
- Health Clinics of Utah: find a clinic near you to provide various health care services.
- Immunizations: vaccines for preventable illnesses given throughout the state for free or no cost to residents of all ages.
Health Insurance Laws
Utah health insurance companies are required to abide by many of the same laws as the rest of the country, including guaranteed renewability, where an insurer cannot cancel your benefits and must offer to renew your plan for another term if you choose. Other laws regarding individual health insurance in Utah revolve around health and the underwriting process. Pre-existing conditions are considered any medical condition an individual has received treatment for in the six months before applying for health insurance. Utah health insurers have the right to decline an applicant for coverage based on their health, or sell them a plan for a higher price.
Monthly premiums will increase for individuals who have a pre-existing condition and they may also find their plan is accompanied by an exclusion period. This period will exempt the insurer from covering costs of treatment for the pre-existing condition for however long they decide as long as it does not exceed 12 months. Utah also permits the use of elimination riders, which give insurance companies the ability to never pay to treat the condition as long as your plan is effective.
As mentioned previously, a federal and state-run program for high-risk individuals was created by the Affordable Care Act. The Pre-Existing Condition Insurance Plan in Utah provides residents with a temporary alternative to private health insurance if they have been uninsured for six months and have a qualifying health problem. PCIPs are available until 2014, when the ACA makes it possible for all individuals with pre-existing conditions to be accepted for private plans. At this point, some of the most crucial points of the health care law will go into effect. Exclusion periods and elimination riders, as well as increased premiums will not be permitted.
The ACA will also put in place another option for health insurance, as individual health care will be mandatory as of January 2014. A state health insurance exchange will be set up in Utah, acting as a competitor to the private market with essential benefits and comparable rates to existing carriers. Plans offered through the exchange will be subsidized and give access to care with the intention of inspiring other insurers to drop their prices and increase their benefits if they do not already match up to the requirements of an exchange. Many changes are going to alter the individual market in the near future, so it is important to know all the details of your plan.