This guide provides an overview of the Utah Health Insurance Exchange including the history of the Exchange, how the Exchange will operate, and Exchange information for Utah residents and small businesses.
Utah Health Insurance Exchange - Introduction
Beginning in 2014, as part of the Affordable Care Act (ACA), health insurance coverage for individuals and small businesses will become available through new state health insurance exchanges (also called health insurance marketplaces).
Most importantly, the key tax credits (e.g. the small business healthcare tax credits) and tax subsidies (e.g. individual health insurance tax subsidies) will only be available for coverage purchased through a state health insurance exchanges.
All states have three options for setting up a state health insurance exchange for 2014:
Build a State-Based Exchange
Enter into a State-Federal Partnership Exchange
Default to a Federally-Facilitated Exchange
Utah will enter into a unique state-federal partnership: Utah will run the small business "SHOP" exchange, and the federal government will run the individual health insurance exchange. The Utah Health Insurance Exchange will open October 1, 2013, with coverage beginning January 1, 2014.
Utah Health Insurance Exchange - History
Utah has one of the more unique histories in developing their Health Insurance Exchange. Prior to federal health care reform, former Governor Jon Huntsman signed HB 133 in 2008 and HB 188 in 2009 which created the Utah Health Exchange. Additional legislation (HB 294 and HB 128) was signed into law in 2010 and 2011, respectively, by current Governor Gary Herbert amending provisions related to health care reform in 2010. These later pieces of legislation reauthorized the Health System Reform Task Force to evaluate options for bringing the state’s already existing exchange into compliance with the Affordable Care Act.
These laws, along with HB 144 introduced in February 2012, allowed small businesses to participate in a type defined contribution or "employee choice" model where small businesses and employees could compare, select, and enroll in commercial health insurance online. In 2012 the Utah Exchange was re-branded Avenue H.
The biggest question over the last few months has been, would the federal government certify Avenue H as Utah's small business "SHOP" exchange while also allowing Utah to default to the federally-run individual health insurance exchange?
On May 10, 2013, Utah announced they reached an agreement with the US Department of Health and Human Services (HHS) for Utah to run Avenue H, the small business "SHOP" health exchange, without a competing federal solution or interjection from the federal government, and that the federal government would run the individual health insurance exchange.
In a press release by Avenue H, Governor Herbert said "The only way this was going to work was if we were granted flexibility. Fortunately for all, HHS proved to be flexible, concurring with everything we proposed to be able to operate an exchange that meets the needs of Utah residents," said the Governor. "The new model clearly outlines what Utah will do and what HHS will do. We are sticking with our exchange and moving forward."
With Utah's Health Insurance Exchange, Utah will maintain oversight over qualified health plans, including certification, recertification, decertification and compliance. Utah will also continue to administer the Medicaid program through existing Medicaid structure.
The federal government will be responsible for operating the individual health insurance exchange, conducting pre-certification for Medicaid and CHIP eligibility, and managing tax credits through the individual exchange.
Utah Health Insurance Exchange for Individuals
The Utah Health Insurance Exchange will be operated through a federally-run Health Insurance Exchange (also called the "Health Insurance Marketplace"). According to healthcare.gov, starting in October 2013 Utah residents will be able to access information about insurance plans available through the Exchange.
According to an estimate by healthcare.gov, 359,579 or 15% of Utah’s non-elderly residents are uninsured, of whom 332,969 (93%) may qualify for either tax credits to purchase coverage in the Marketplace or for Medicaid if Utah participates in the Medicaid expansion. Through the Exchange, Utah residents can shop for and compare insurance plans, access insurance premium tax credits, and be screened for eligibility in public assistance programs such as Medicaid and CHIP.
Utah Health Insurance Exchange for Small Businesses
Avenue H is Utah's existing small group health insurance exchange for small businesses with 2-50 employees. Avenue H will serve as Utah's official "SHOP" Exchange. Avenue H will include an "employee choice" model, where a business owner can contribute a set dollar amount and employees can shop for a health insurance plan from one of three carriers: Regence BlueCross BlueShield, SelectHealth, or UnitedHealthcare. According to their website, Avenue H currently offers 140 plans among the three carriers and aims to add more carriers by the end of 2013.
Utah Health Insurance Exchange - Role of Insurance Professionals & Navigators
The Utah Health Insurance Exchange for individuals will follow federal guidelines for insurance professionals selling policies through the Exchange, and for Navigators assisting consumers.
For individual plans, insurance professionals will be able to register with the federally-run Utah Health Insurance Exchange and receive any commissions directly from the carriers (using their Exchange ID number and NPN). For more information see: Role of Agents in Health Insurance Marketplaces.
For small group plans, insurance professionals will register with Avenue H. Training and registration information is available on their website.
The Utah Health Insurance Exchange Navigator program will assist consumers in making choices about their health care options and accessing their new health care coverage, including access to premium tax credits for some consumers. The federal government will run the Utah Navigator program.