All states are currently in the process of revising their health care regulations to come into full compliance with the provisions of the 2010 Patient Protection and Affordable Care Act, which has already made significant changes to how insurance is handled for given groups. Children, for instance, may no longer be denied coverage on the basis of a pre-existing condition.
Current Insurance Regulations
In Utah, all health insurance plans have guaranteed renewability, and cannot be denied renewal or be canceled on the basis of health status. Currently, pre-existing condition exclusions can be imposed for as long as 12 months, with a six-month look-back period.
Health Care Exchanges
The state of Utah had an existing health care exchange, created in 2008, which it updated in 2010 to meet the requirements outlined in the Affordable Care Act. In March 2011, the governor signed a law banning any policy sold through the exchange from providing abortion coverage except in cases of rape, incest, fetal abnormality, or severe danger to the pregnant woman. The exchange operates on the clearing house model.
Pre-Existing Condition Insurance
The Pre-Existing Condition Insurance Plan in the state is run by the Utah Comprehensive Health Insurance Pool. The coverage includes primary and secondary care, hospitalization, and prescription drug benefits. Premiums fall in the range of $127 to $744 a month, with deductibles of $500 to $5000 and out-of-pocket limits of $2000 to $5000.
Medicaid eligibility is determined according to income level as a percentage of the Federal Poverty Level. Children under five years of age in Utah qualify for Medicare at 133% FPL, with the 6-19 age group accessing benefits at 100%.
Pregnant women are Medicaid eligible at 133% FPL, parents at 44%, adults at 150%, and non-elderly disabled Social Security recipients at 100%.
Approximately 10 percent of Utah’s population accesses Medicare benefits, with more than 266,000 drawing on prescription drug coverage.
Medicare recipients can also access Utah’s Premium Partnership for Health Insurance to further lower their medical costs, while the Senior Health Insurance Information Program (SHIP) provides counseling and educational services.