Availability of short-term health insurance in Utah

Yes. As of 2023, there were at least five insurers offering short-term health insurance in Utah.

The average monthly premium for a short-term health insurance plan sold in Utah was $162.48 in 2022, 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.

Several health insurance companies offer short-term medical insurance in Utah:

• Allstate Health Solutions (National Health Insurance Company)
• UnitedHealthcare/Golden Rule
• Select Health
• Standard Life and Accident Insurance Company
• United State Fire Insurance Company

SelectHealth also offers ACA-compliant major medical plans in Utah. In most states, there is no overlap between the insurance companies that offer short-term policies and those that offer ACA-compliant policies.

Short-term health insurance in Utah can be purchased by residents who qualify under the underwriting guidelines of insurers. In general, this means being under 65 years old and in fairly good health.

Folks in Utah should consider that short-term health medical insurance plans typically include exclusions for all pre-existing conditions (typically a blanket exclusion for any pre-existing condition, rather than specific exclusion riders for each condition) so these types of plans are not adequate for someone who needs medical care for ongoing or pre-existing conditions.

It’s also important to understand that although short-term plans are often more affordable than regular major medical coverage (unless the person is eligible for a premium subsidy, in which case the major medical coverage might be less expensive), they have shortcomings that can result in much higher out-of-pocket medical costs if a serious health condition arises, even if it’s not related to a pre-existing condition.

Short-term healthcare plans do not have to cover the essential health benefits, and often exclude coverage for at least some of them (maternity care, prescription drugs, and mental health care are the most commonly excluded). In addition, short-term plans generally impose benefit caps on the total amount they’ll pay for your care.

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 exchange 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.

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).
• If you’re losing coverage under another plan mid-month and enrolling in a new ACA-compliant plan using a special enrollment period, the new coverage typically cannot start sooner than the first of the following month. So you would have a gap in coverage from the day your plan ends until the start of the next month. A short-term health plan might be the only available option to fill that window, although if COBRA or state continuation coverage is available to you, you could use that option as your fall-back instead. (HHS has proposed a rule change that would address the gap in coverage that exists when a person loses coverage mid-month and replaces it with an ACA-compliant 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 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.